Social Science & Medicine 120 (2014) 311e316
Contents lists available at ScienceDirect
Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Introduction
Medical humanitarianism: Research insights in a changing field of
practice
Byron J. Good a, b, Mary-Jo DelVecchio Good a, Sharon Abramowitz c, Arthur Kleinman a, b,
Catherine Panter-Brick d, *
a
Department of Global Health and Social Medicine, Harvard Medical School, USA
b
Department of Anthropology, Harvard University, USA
c
Department of Anthropology and Center for African Studies, University of Florida, USA
d
Department of Anthropology and Jackson Institute for Global Affairs, Yale University, USA
a r t i c l e i n f o
Article history:
Available online 18 September 2014
1. Introduction
In the past two decades, ‘medical humanitarianism’ has come to
constitute not only an increasingly powerful set of organizations
and interventions, but a significant topic of scholarly research.
Medical humanitarianism e the delivery of health-related services
in settings of crisis e has a prominent international presence in
contexts of violence, famine, natural disasters, as well as conditions
of extreme poverty, deprivation, and structural violence. The defi-
nition of what constitutes ‘humanitarianism’ and a ‘humanitarian
crisis’ has of course evolved historically in close parallel with
changed forms of humanitarian responses (Calhoun, 2010; Fassin
and Pandolfi, 2010a; Allen and Schomerus, 2012). Increasingly,
social scientists find themselves working alongside humanitarians,
in fieldwork conditions best characterized as states of emergency,
complex emergencies, or crises. They do so as researchers studying
conflict and post-conflict settings, responses to natural disasters, or
pathways of risk, resilience, and recovery, with a specific lens on
local beneficiaries, local service providers, or humanitarian global
organizations; they may be themselves actively involved in the
grass-roots delivery of humanitarian work. States of emergency
prove compelling to many social scientists, be they anthropologists,
sociologists, global health specialists, psychologists, historians, or
scholars of conflict and peace building, working alongside health-
care practitioners and policy-makers.
In February 2013, Social Science & Medicine issued a call for
papers focused on medical humanitarianism. The lead editors of
* Corresponding author.
E-mail address: catherine.panter-brick@yale.edu (C. Panter-Brick).
http://dx.doi.org/10.1016/j.socscimed.2014.09.027
0277-9536/© 2014 Elsevier Ltd. All rights reserved.
this Special Issue, Sharon Abramowitz and Catherine Panter-Brick,
expressed the goal of contributing original social science research
on medical humanitarianism, while establishing a dialogue with
the field of humanitarian practice. They suggested a number of is-
sues relevant to an emerging, interdisciplinary field. For example,
what insights are generated from a comparative perspective on
medical humanitarianism? How do medical humanitarians take
culture, social relations, and issues of equity and justice into
quotidian practice? What are the characteristics of relations and
transactions in medical humanitarian encounters? And how do
medical humanitarians negotiate conflicting demands related to
funding, policy, clinical medicine, public health interventions, or
data gathering for court proceedings, human rights testimonies, or
political witnessing?
The fourteen papers published in this Special Issue are a
response to that call. They represent diverse research efforts in this
interdisciplinary domain e contributions that provide important
insights into the social sciences of the field of medical humanitar-
ianism. These are papers of relevance to the concerns of practi-
tioners as well as academics. In this editorial introduction, we
group these papers in four domains of enquiry; we ask how these
contribute to a burgeoning field of medical humanitarian studies,
and make note of the diverse perspectives and opportunities for
sustained engagement. We conclude with reflections for future
development of this field.
2. A historical note on medical humanitarianism
The historiography of medical humanitarianism is dense and
highly contested, given that it historically provided ideological and
moral justifications for colonialism, capitalism, and other global
‘civilizing missions.’ Research has also linked medical expertise,
public health interventions, and medical humanitarian subjectivity
to political activism and social movements for the poor.
Stehrenberger and Goltermann's (2014) paper in this Special
Issue provides an important contribution to one strand of this
history, that of ‘disaster medicine’ and its evolution conceptually,
312 Introduction / Social Science & Medicine 120 (2014) 311e316
practically, and politically in Switzerland. The authors bring
attention to a pioneering essay by Heinrich Zangger, in a 1915
Swiss medical journal, outlining medical procedures to be
applied in cases of natural and technological disasters associated
with industrialization. While Zangger's work emerged during the
first Great War, this paper demonstrates the work required to
define the place of disaster medicine in major industrial disasters,
particularly mining accidents. It argues that much of what con-
stitutes medicine practiced in large scale disasters today grew out
of these developments. The authors provide a fascinating account
of the further evolution of disaster medicine during the Cold War,
when medical responses were designed for feared nuclear strikes,
and when public health became increasingly integrated into in-
ternational aid projects. This study adds great specificity to an
important strand in the genealogy of medical humanitarianism.
These historical notes gesture to a genealogical linking of
modern technologization and industrialization, Enlightenment-era
religious and moral commitments, and larger political and civi-
lizing missions. Other histories have shown how medical human-
itarianism has established politically neutral spaces for medical
responses to suffering in times of warfare, particularly with the
founding of the International Committee of the Red Cross, most
controversially in places such Palestine, Biafra, Ethiopia, Iraq,
Afghanistan, and Syria. Debates around priority-setting and com-
munications, regarding the provision of aid to displaced persons,
immigrants, and at-risk populations, frame many of the papers in
this issue.
3. Humanitarianism, humanitarian organizations, and modes
of governance
A second domain of analysis includes critical social science
scholarship on medical humanitarianism as it has evolved since the
1960s. This growing literature reviews medical humanitarian or-
ganizations for their structural forms and activities, their modes of
humanitarian decision-making, and their relations to local, often
competing, centers of power and governance. This literature has
generated important critical frameworks for studying how medical
humanitarian institutions function, how they are inserted into
contemporary paradigms of complex emergencies, and how they
create new forms of biocitizenship in insecure contexts. Much of
the research and writing in this domain is conducted by persons
who are or have been directly involved in humanitarian work.
Analyses often reflect on-going conflicts among decision-makers
and advocates for or against particular forms of intervention, but
from a more theorized perspective than that of many practitioners.
They speak to ‘humanitarianism's past and possible futures’
(Barnett and Weiss, 2008, 2011), placing such discussions in rela-
tion to moral philosophy, conflict theory, economic development
principles, international aid practices, and issues of neocolonialism
and dependency.
The number of recent collections focused on humanitarianism
reflects the emergence of an active domain of social science
research and theorizing e e.g., Saillant (2007), Wilson and Brown
(2008), Bornstein and Redfield (2010), Fassin and Pandolfi
(2010a), Feldman and Ticktin (2010), Allen and Schomerus (2012),
Abramowitz and Panter-Brick (2015), Hinton and Good (2015).
Some writings examine specific humanitarian organizations and
their evolution e such as M edecins Sans Frontieres, e.g., Redfield
(2005, 2013), Fox (2014) e as well as humanitarianism in specific
religious traditions (Benthall and Bellion-Jourdan, 2003), or
distinctive cultural traditions of philanthropy (Bornstein, 2012).
Some examine specific crises and medical or psychosocial in-
terventions e in post-conflict Liberia (Abramowitz, 2014) and Aceh
(Good et al., 2010), for example e and the ethical dilemmas faced by
those engaged in such interventions. And much of the writing on
medical humanitarianism is closely linked to studies of violence,
peacekeeping, and post-conflict programs of relief, intervention, or
resilience (e.g., Malkki, 1996; Nordstrom, 2004; Rylko-Bauer et al.,
2009; Panter-Brick, 2010; Viterna, 2013; Autesserre, 2014).
One thread of writing on medical humanitarianism is framed by
critical analyses of changes in humanitarian organizations and
forms of intervention that have emerged in the past several de-
cades. Specifically, social scientists have critiqued humanitarianism
for the manner in which its rapid growth in size, funding, profes-
sionalization, and influence has made possible what Pandolfi
(2008, 2010) calls ‘mobile global sovereignty.’ Observers have
noted that the clear boundaries between military and humanitarian
interventions have been seriously eroded, linking security and
humanitarian work in new ways. Fassin and Pandolfi (2010a,
2010b) have drawn on Nietzsche's trenchant critique of gover-
nance by ‘states of exception’ (elaborated by Agamben, 2012) as a
frame for critiquing practices and norms that emerge during re-
sponses to conflicts and disasters.
However, this line of critique is not without its limits. As com-
mentators have scrutinized classic moral justifications for hu-
manitarian intervention, and highlighted the discursive power of
the ‘moral’ aspects of humanitarian logics and motivations (Fassin,
2013b), new configurations of military, humanitarian, and financial
organizations have created ‘gray zones,’ or ‘laboratories of inter-
vention’ (Pandolfi, 2008) that are difficult to assess and evaluate.
The slippery equation of humanitarian assistance with humani-
tarian intervention, the assumption that humanitarian and military
interventions can be coupled and essentially indistinguishable, the
failure to analyze the relevance of strong and weak state structures
with respect to humanitarian governance, and the assumption that
social science can make ethical judgments without regard for the
contingencies of actual humanitarian practice, are all matters of
serious debate.
From a moral standpoint, policy-makers, practitioners, and ac-
ademic scholars are all in this together. There is no ethical higher
plane that critics can occupy, no position exempt from the
complexity of real demands and real decision-making. Scholars
enter this field with the same set of moral ambiguities, conflicts,
and responsibilities as humanitarian workers. At the same time,
doctors, nurses, and other workers deeply involved in the care-
giving for persons in need are not exempt from critical moral
reflection; there are no exemptions based on good motives. There is
no moral hierarchy in this field. All involved can engage in genuine
critical discussions.1 The view of a critical study of medical hu-
manitarianism, as outlined here, presumes that ameliorating social
suffering is the larger goal of both scholars and humanitarians.
These literatures provide a larger frame for the contributions of
another five papers in this Special Issue. Asad and Kay (2014)
examine specifically the forms of relationships developed
1
In a forthcoming book, entitled ‘A Passion for Society: Social Suffering, Social
Science and Social Care,’ Iain Wilkinson and Arthur Kleinman argue that the origins
of the social sciences, particularly in writings of Adam Smith and early nineteenth
century English liberal thinkers, lie in a vision of social inquiry as contributing to
reducing social suffering and improving human lives. That vision, they argue, runs
down to the present in Amartya Sen's notion of human capabilities or the writings
of Martha Nussbaum. The professionalization of the social sciences has carried
many away from this originating value orientation toward an increasingly morally
unsupportable idea of the ‘neutrality’ of social science and the study of society for
its own sake. The development of health related social sciences and the movement
toward engaged research and writing have increasingly brought social sciences
back to a deep linking of social inquiry and efforts to respond to human suffering.
Some of the critiques of humanitarian assistance can themselves be criticized for
their failure to value social reform, the reduction of suffering and the improvement
of human prospects.
 Introduction / Social Science & Medicine 120 (2014) 311e316
between two medical humanitarian organizations (Partners in
Health and Oxfam) and notions of ‘the state.’ Whereas some cri-
tiques of humanitarian work suggest that humanitarian organiza-
tions often operate as quasi-state organizations or under-theorize
the complexity of states, this paper begins with an assumption that
states are “complex, heterogeneous, and fragmented” entities. Asad
and Kay provide case data for the complex ways in which NGOs
negotiate with different levels of states and state agencies through
building alliances, exchanging resources, and adjusting frames in
order to achieve their goals. This paper points to the importance of
recognizing the diversity across states (e.g. weak versus strong
states, as elaborated by Good et al., 2015), the complexity within
states, and changes in NGO-state relations in different stages of
complex emergencies in theorizing the interactions between hu-
manitarian organizations and states.
Grayman (2014) examines the structure of internal commu-
nications within one major intergovernmental organization e the
International Organization for Migration (IOM) e engaged in
medical humanitarian projects in post-tsunami, post-conflict
Aceh. Working as an IOM staff member, Grayman had access to
nearly all levels of email exchanges. By juxtaposing the processing
of a difficult psychiatric case (of an Acehnese villager who suf-
fered head trauma during the conflict and was in prison for
committing petty robbery) through email exchanges with his own
field-based participant observation of the case, he is able to
deconstruct the processes that led IOM to make bureaucratic
decisions that failed to deal effectively with the complexity of the
case. Grayman's account is one of very few in the literature to
examine seriously and analytically the formal structure of internal
communications within large humanitarian organizations and the
effects such communications have on actual decisions within the
organizational hierarchy, involving complicated ethical and
practical engagement with individuals and communities. His
analysis adds richness to understandings of the interactions of
humanitarian organizations with local communities and govern-
ment agencies.
Berry (2014) provides an important description and analysis of
short-term medical missions in a poor community in Guatemala.
Compared with studies of large organizations such as Me decins
Sans Frontie res, there are relatively few analyses of such missions.
Berry describes the basic structure of short-term medical missions
and the interdependence between the many small NGOs in
Guatemala and the NGOs in the United States and Canada that
organize the missions and recruit participants. Many of the Gua-
temalan NGOs she describes were founded by North Americans
who came to Guatemala to provide humanitarian services, then
stayed on to found their own NGOs. They develop complex
financial and administrative interdependencies with those NGOs
that send the missions, making evaluation of the effectiveness of
the missions difficult. Berry demonstrates that this interdepen-
dence is particularly complex because the local NGOs require
support from outside volunteers, but that sustaining the work that
is accomplished during short-term missions e such as identifying
patients with long-term or chronic illnesses e requires long-term
investment on the part of the local agencies. Evaluation is
complicated not only by such relations but also by the humani-
tarian zeal of the ‘volunteers’ who participate in the programs,
coloring local evaluation of the programs with the ‘glow’ of the
participants. Berry describes both the potential benefits of such
programs, but also draws important attention to the unintended
harms they may produce.
Huschke's (2014) study of humanitarian care for uninsured
immigrants in Germany, and the Tiedje and Plevak (2014) study of
an originally Catholic NGO developed to provide care for unin-
sured immigrants in a small town in Minnesota in the United
313
States serve as important comparative cases, and link to critical
analyses of biocitizenship. Both demonstrate the limits to national
health plans (the German national health plan, and Obamacare)
faced by those who are without legal status. The Huschke study
focuses attention on physicians who are recruited to provide ser-
vices, their expectations of what constitutes ‘deserving’ or ‘needy’
patients for whom they are providing free care, and the pressures
on such patients to ‘perform deservingness.’ By contrast, Tiedje
and Plevak focus on the responses of the local community e which
is relatively hostile to the mixed Hispanic community of undoc-
umented workers, particularly in a context in which poor Ameri-
cans themselves have limited access to health insurance. Both
studies place their work within the theoretical frames developed
by Willen (2011, 2012) and Ticktin (2006, 2011), examining the
nature of citizenship implied by linking immigration status to
access to health services. These studies of ‘statelessness’ in weal-
thy and developed nations offer unusual insights on medical hu-
manitarian care.
Taken together these papers contribute to understanding the
forms of medical humanitarianism that have emerged in the past
several decades. They suggest the complexity of the relations
developed between NGOs, IGOs, local governments, and interna-
tional systems of healthcare delivery. They raise important ques-
tions about the subjectivity of both activists and volunteers
engaged in providing health services in these settings. The Huschke
study, in particular, draws attention to the ways subjective re-
sponses of volunteers influence the experiences of those receiving
care.
4. Effects and effectiveness
Social scientists not only write about humanitarian organiza-
tions and their work; they also directly participate in and
contribute to them. Some contribute to interventions as staff or by
conducting program evaluations; some develop measures and
innovative methods aimed specifically at improving such evalua-
tions. Social scientists study best practices or outcomes of partic-
ular interventions, conduct research aimed at understanding both
intended or unintended effects, and participate in research aimed
specifically at influencing humanitarian practice and policy, at
improving the quality of the delivery of services, or understanding
why things have gone awry. Several of the contributions to this
Special Issue are outstanding examples of these types of work. We
detail six papers here.
de Waal and colleagues (2014) point out the inadequacy of
existing forms of categorizing and measuring types of lethal
violence in local conflict settings, and provide a critical model for
linking deep understanding of local conditions to epidemiological
measurement. The poor quality of measurement in turn hampers
the ability of organizations to focus their programs or evaluate
effectiveness, even at the level of monitoring ceasefire violations.
Their paper calls for an epidemiology of lethal violence, akin to an
epidemiology of infectious diseases. Using data from incidence
reports from Darfur in 2008e2009, de Waal et al. both argue and
demonstrate that the diverse and often limited data sources used to
assess who is killing whom in settings of complex violence must
include local knowledge of local conflict situations, in order to
develop trustworthy data on mortality and valid categories of
violence.
In a related study, Footer and colleagues (2014) investigated
violence against health workers in a chronic conflict setting in
eastern Burma. They conducted qualitative interviews to determine
the range of types of violence and threats against health workers
and attacks on clinics, in order to understand types of vulnerability
experienced by health workers, particularly when they are of the
314 Introduction / Social Science & Medicine 120 (2014) 311e316
same ethnic group as those experiencing violence, and to assess the
impact of such violence on the provision of health services in areas
of violence. Their interviews revealed the importance of the role of
local communities in protecting the health workers and clinics, and
provided the basis for more nuanced incidence reports to measure
levels of violence against health workers.
Mendelsohn et al. (2014) examine adherence to antiretroviral
therapy among refugees, in a facility-based study comparing ex-
periences of HIV treatment in two asylum settings, Kenya and
Malaysia. In both settings, the qualitative accounts of refugees
clustered thematically around migration, insecurity, and resilience,
while serving to highlight the variable effects of settings upon
agency across humanitarian spaces. This work shows us that
research efforts are needed to evaluate how new practices might
help people on the ground, especially in contexts where extreme
social and structural challenges are compromising their efforts to
access and utilize health care. We are also reminded that the in-
dividuals and communities who experience crises, violence, and
suffering should remain at the forefront of our research efforts.
Two studies e that by Palmer et al. (2014) in South Sudan, and
that by Carruth (2014) in the Somali region of Ethiopia e demon-
strate the importance of ethnographic studies of what happens in
communities after emergency services provided by international
organizations have disappeared. Palmer et al. found evidence of
quite different responses to the withdrawal of active outreach ser-
vices for sleeping sickness among two ethnic groups in South Sudan,
and develop ethnographic data to make hypotheses about differ-
ential utilization of hospital testing. Carruth provides a classic
ethnographic study of how a pluralistic medical system develops
during multiple encounters with humanitarian services that were
provided at different times, each time to be withdrawn, in one So-
mali community. Both suggest that any studies of ‘outcomes’ of
interventions need to take the long view, to understand what
happens during the afterlife of medical humanitarian interventions.
Finally, Rutayisire and Richters (2014) provide a detailed account
of the long-term consequences of a community justice system in
post-genocide Rwanda, one intended to help establish peace and
stability through justice, reconciliation, and healing. The authors
give voice to what is least spoken about in Rwanda until today – the
suffering of family members, friends, and neighbors of the geno-
cidaires during the process of incarceration and community return.
They bring to our attention the fragile social world of local com-
munities and the demanding accountability of humanitarian action.
5. Subjectivity of medical humanitarians
Running throughout the emerging field of medical humanitar-
ian studies are analyses of the subjectivity of medical humanitar-
ians themselves e their motives, their inner experiences of joy, fear
or pain, their experiences of attempting to organize services or
provide care in settings of enormous scarcity or in settings of
violence, the development of strategies for dealing with ethical
conflicts in these local moral worlds of scarcity, and the conflicts
they experience between personal moral or political values and the
institutional norms within which they work. Two papers deal
directly with these issues.
Gordon (2014) provides a nuanced discussion of the experience
of British military physicians, who have served in Afghanistan.
These physicians reject the simple dichotomy between humani-
tarian and military practice. They point to their role in providing
care for civilians and local combatants, while acknowledging the
priority given to serving their own troops. Some describe the great
difficulties they face in being forced to refer civilians or local service
members they have treated and stabilized to deeply inadequate
medical services, while members of their own services are quickly
stabilized and referred to the highest quality of care. These are of
course not so different from the experiences of physicians working
in the NGO world. Gordon argues that the emergence of multiple
civilian ‘humanitarianisms’ has created spaces for military physi-
cians to develop self-identity as humanitarians while still recog-
nizing their institutional constraints.
There are similarities here with the findings of Ager and Iacovou
(2014), who analyzed web-based narratives of MSF humanitarian
workers. Focusing on what they describe as the ‘co-construction’ of
personal and organizational frames of these narratives, they pro-
vide insight not only into the motives of these workers but how
they make meaning of the limitations of what they are able to do.
Barriers are represented as surmountable, while the natio-
naleinternational relations of team members and the resilience of
local communities are all stressed as means for maintaining posi-
tive valuation of humanitarian work. Humanitarian workers ulti-
mately view their activities as ‘making a difference.’ A desire to
make a difference (as opposed to ‘doing good’) is one central
motivational structure that gives shape to personal narratives and
motivations in the fields of medicine and global health (Good and
Good, 2012).
These two papers, as well as the papers by Footer et al. (2014)
and Rutayisire and Richters (2014), tell us important things about
the experiences of humanitarian workers. The study of violence
against health workers in eastern Burma (Footer et al., discussed
above), and steps taken to circumvent violence while attempting to
provide services, is a reminder that these are not experiences of
foreign humanitarians alone but particularly acute experiences of
local health workers in settings of conflict. And some of the subtle
but powerful expressions of subjectivity come through in the voices
of the authors of articles who are local researchers involved in
humanitarian work in settings with histories of massive violence,
such as that of Rutayisire and Richters (2014). It remains critical to
listen to the voices e often haunted and haunting e of those who
work in the field, whether decision-makers or local health workers,
as well as to the voices of authors who themselves have been
deeply affected by those persons and communities about whom
they write.
6. Reflections
A genuine program of medical humanitarian studies will require
interdisciplinary collaboration and research. The kinds of collabo-
rations that create insightful links between research and practice
will provide welcome change in the field. Notably, recent funding
initiatives launched by ELRHA (Enhancing Learning & Research for
Humanitarian Assistance) call for the development of a “global
humanitarian community where humanitarian actors actively
collaborate with higher education institutes to develop highly
professional responders, share expertise and carry out research
that noticeably reduces risk and ensures that those suffering from
the impact of disasters receive more timely, relevant and sustain-
able assistance” (www.elrha.org). Neat dichotomies between
practitioners and scholars of humanitarian organizations are passe 
in this field.
We conclude with brief thoughts about areas that require
deeper research and reflection. To begin with, medical humani-
tarianism is first and foremost a field of practice, not a scholarly
field. It is a rapidly changing field, which actively engages in de-
bates regarding the ethics of intervention, program effectiveness,
and the relevance of social science research to the field. One of the
goals of the call for papers for this Special Issue was to bring this
field of practice and the critical discussions it has generated among
practitioners into closer conversation with critical studies of med-
ical humanitarianism. We use the term ‘critical studies’ in the sense
 Introduction / Social Science & Medicine 120 (2014) 311e316
in which Biehl and Petryna (2013:1e20) define ‘Critical Global
Health’: as a field in which practitioners, scholars, and practitioner/
scholars join together in the careful examination of medical hu-
manitarianism e its organizational structures, policies, practices,
ethics, and evaluation of impacts. For some, this will include active
collaborations among humanitarian organizations and universities.
For all, it will require a deep engagement and an assumption of
equal moral status among practitioners and scholars.
Second, the individuals and communities who experience
violence and social suffering should always remain at the center of
this field. The critical study of medical humanitarianism must give
special place to local voices and local moral worlds, to complex
understandings of suffering, victimhood, and resilience, and should
commit to staying with those voices over time. Such points have
long been argued by anthropologists who strive for a deep, moral
accountability to local communities (Das et al., 2000; Das, 2007;
Kleinman, 2008; Kleinman et al., 1997; Biehl and Petryna, 2013).
What Fassin (2013a) has called ‘critical ethnography’ and writing
that “displaces the lines of the obvious” (Fassin 2013a:123) are
necessary elements in a field that deeply engages the work of
medical humanitarians.
Third, complex understandings of the subjectivity, voices and
motives of humanitarian workers are as important as those of local
peoples. Much of the work of medical humanitarianism, whether
clinical or other, consists of acts of caregiving (Kleinman, 2009,
2012). Competence and professionalism are utterly crucial in hu-
manitarian operations, and those who work in them are often
among the first to decry failures of professionalism and organi-
zational malpractice. Medical humanitarians are driven to respond
to desperate need and suffering, to make a difference despite the
costs to self, and to provide the highest quality of care possible
without calculating costs or knowing the long-term consequences.
Moral complexity is central to this work e and should be as
central to critical studies of medical humanitarianism as it is to
practitioners.
Fourth, critical studies of organizational issues need to have a
more serious place in studies of medical humanitarianism than
they have to date. These will require analyses by social scientists
working closely with or within humanitarian organizations, as well
as those steeped in organizational theory or comparative studies of
bureaucracies. Recent calls for attention to re-imagine global
health-care delivery (Farmer et al., 2013; Panter-Brick et al., 2014)
are to be taken seriously and require scholarship focused on
bureaucratic organizations e global organizations, NGOs, or gov-
ernments e and on bureaucratic transformations. Improvements in
health care delivery require changes in bureaucracies e changes in
local health bureaucracies, as well as in the bureaucratic structures
of organizations such as the World Bank, WHO or IOM. Social sci-
entists find the inner workings of humanitarian bureaucracies and
their funding practices difficult to penetrate (Abramowitz et al.,
2015), but research on bureaucratic agencies needs to be actively
pursued. This complements analyses of humanitarian actors and
beneficiaries.
Lastly, the critiques of humanitarianism e by scholars, practi-
tioners, and policy-makers alike e must be taken seriously. While
much of this field is driven by an ethic of action and responding to
need, consequences matter deeply. The papers in this Special Issue
provide warnings about short-term evaluations of the effectiveness
of even the most humane interventions, particularly when evalu-
ations are carried out by those who conduct the interventions, and
about the importance of time and long-term understandings of the
aftermath of humanitarian programs. There is space for critical
reflections on the emerging structures of humanitarianism, their
global reach, and their relations with new forms of military in-
terventions undertaken in the name of humanitarianism. But there
315
is also important space for good quality, locally relevant evaluation
metrics of programs and their consequences for individuals, com-
munities, and local state organizations. Intervention can be a
critical site for ethnographic observation (Good, 2012), opening
access to much that can only be observed in the process of
responding to problems.
References
Abramowitz, S., 2014. Searching for Normal in the Wake of the Liberian War. Uni-
versity of Pennsylvania Press, Philadelphia, PA.
Abramowitz, S., Marten, M., Panter-Brick, C., 2015. Medical humanitarianism: an-
thropologists speak out on policy and practice. Med. Anthropol. Q. 29 (1) (in
press).
Abramowitz, S., Panter-Brick, C. (Eds.), 2015. Medical Humanitarianism: Ethnogra-
phies of Practice. University of Pennsylvania Press, Philadelphia, PA.
Agamben, G., 2012. States of Exception. University of Chicago Press, Chicago.
Ager, A., Iacovou, M., 2014. The co-construction of medical humanitarianism:
analysis of personal, organizationally condoned narratives from an agency
website. Soc. Sci. Med. 120, 430e438.
Allen, T., Schomerus, M., 2012. Complex Emergencies and Humanitarian Responses.
University of London, London.
Asad, A.L., Kay, T., 2014. Theorizing the relationship between NGOs and the state in
medical humanitarian development projects. Soc. Sci. Med. 120, 325e333.
Autesserre, S., 2014. Peaceland: Conflict Resolution and the Everyday Politics of
International Intervention. Cambridge University Press, Cambridge.
Barnett, M., Weiss, T. (Eds.), 2008. Humanitarianism in Question: Politics, Power,
Ethics. Cornell University Press, Ithaca, NY.
Barnett, M., Weiss, T.G., 2011. Humanitarianism Contested: Where Angels Fear to
Tread. Routledge Global Institutions.
Benthall, J., Bellion-Jourdan, J., 2003. The Charitable Crescent. Politics of Aid in the
Muslim World. IB Tauris, London.
Berry, N.S., 2014. Did we do good? NGOs, conflicts of Interest and the evaluation of
short-term medical missions in Solola , Guatemala. Soc. Sci. Med. 120, 344e351.
Biehl, J., Petryna, A., 2013. Critical Global Health. In: Biehl, J., Petryna, A. (Eds.), When
People Come First: Critical Studies in Global Health. Princeton UP, pp. 1e20.
Bornstein, E., 2012. Disquieting Gifts: Humanitarianism in New Delhi. Stanford
University Press, Stanford, CA.
Bornstein, E., Redfield, P., 2010. Forces of Compassion: Humanitarianism between
Ethics and Politics. School for Advanced Research, Santa Fe, NM.
Calhoun, C., 2010. The idea of emergency: humanitarian action and global (dis)or-
der. In: Fassin, D., Pandolfi, M. (Eds.), Contemporary States of Emergency: the
Politics of Military and Humanitarian Interventions. Zone Books, Cambridge,
MA, pp. 29e58.
Carruth, L., 2014. Camel milk, amoxicillin, and a prayer: medical pluralism and
medical humanitarian aid in the somali region of Ethiopia. Soc. Sci. Med. 120,
405e412.
Das, V., 2007. Life and Words: Violence and the Descent into the Ordinary. Uni-
versity of California Press, Berkeley.
Das, V., Kleinman, A., Ramphele, M., Reynolds, P. (Eds.), 2000. Violence and
Subjectivity. University of California Press, Berkeley.
de Waal, A., Hazlett, C., Davenport, C., Kennedy, J., 2014. The epidemiology of lethal
violence in Darfur: using micro-data to explore complex patterns of ongoing
armed conflict. Soc. Sci. Med. 120, 368e377.
Farmer, P., Kim, J.Y., Kleinman, A., Basilico, M. (Eds.), 2013. Reimagining Global
Health: An Introduction. University of California Press, Berkeley.
Fassin, D., 2013a. A case for critical ethnography: rethinking the early years of the
AIDS epidemic in South Africa. Soc. Sci. Med. 99, 119e126.
Fassin, D., 2013b. Humanitarian Reason: a Moral History of the Present. University
of California Press, Berkeley.
Fassin, D., Pandolfi, M., 2010a. Contemporary States of Emergency: the Politics of
Military and Humanitarian Interventions. Zone Books, Cambridge, MA.
Fassin, D., Pandolfi, M., 2010b. Introduction: military and humanitarian government
in the age of intervention. In: Fassin, D., Pandolfi, M. (Eds.), Contemporary States
of Emergency: the Politics of Military and Humanitarian Interventions. Zone
Books, Cambridge, MA, pp. 9e25.
Feldman, I., Ticktin, M. (Eds.), 2010. In the Name of Humanity: the Government of
Threat and Care. Duke University Press, Durham, NC.
Footer, K., Meyer, S., Sherman, S.G., Rubenstein, L., 2014. On the frontline of eastern
Burma's chronic conflict - listening to the voices of local health workers. Soc.
Sci. Med. 120, 378e386.
Fox, R., 2014. Doctors Without Borders: Humanitarian Quests, Impossible Dreams of
Me decins Sans Frontie res. John Hopkins University Press.
Good, B.J., 2012. Theorizing the ‘subject’ of medical and psychiatric anthropology.
JRAI 18, 515e535.
Good, B., Good, M., 2012. “To make a difference…”: narrative desire in global
medicine. Narrat. Inq. Bioeth. 2 (2), 121e124.
Good, M.D., Good, B.J., Grayman, J., 2010. Complex engagements: responding to
violence in postconflict Aceh. In: Fassin, D., Pandolfi, M. (Eds.), Contemporary
States of Emergency: the Politics of Military and Humanitarian Interventions.
Zone Books, Cambridge, MA, pp. 241e266.
316 Introduction / Social Science & Medicine 120 (2014) 311e316
Good, B., Grayman, J., Good, M.D., 2015. Humanitarianism and ‘mobile sovereignty’ in
strong state settings: reflections on medical humanitarianism in Aceh, Indonesia.
In: Abramowitz, S., Panter-Brick, C. (Eds.), Medical Humanitarianism: Ethnogra-
phies of Practice. University of Pennsylvania Press, Philadelphia, PA (in press).
Gordon, S., 2014. The military physician and contested medical humanitarianism: a
dueling identity? Soc. Sci. Med. 120, 421e429.
Grayman, J.H., 2014. Rapid response: Email, Immediacy, and medical humanitari-
anism in Aceh, Indonesia. Soc. Sci. Med. 120, 334e343.
Hinton, D., Good, B., 2015. Culture and PTSD. University of Pennsylvania Press,
Philadelphia, PA (in press).
Huschke, S., 2014. Performing deservingness. Humanitarian health care provision
for migrants in Germany. Soc. Sci. Med. 120, 352e359.
Kleinman, A., 2008. What Really Matters. Living a Moral Life amidst Uncertainty and
Danger. Oxford University Press, Oxford.
Kleinman, A., 2009. Caregiving: the odyssey of becoming more human. Lancet 373,
292e293.
Kleinman, A., 2012. Caregiving as moral experience. Lancet 380, 1550e1551.
Kleinman, A., Das, V., Lock, M.M., 1997. Social Suffering. University of California
Press, Berkeley.
Malkki, L.H., 1996. Speechless emissaries: refugees, humanitarianism, and dehis-
toricization. Cult. Anthropol. 11 (3), 377e404.
Mendelsohn, J.B., Rhodes, T., Spiegel, P., Schilperoord, M., Burton, J.W.,
Balasundaram, S., Wong, C., Ross, D.A., 2014. Bounded agency in humanitarian
settings: A qualitative study of adherence to antiretroviral therapy among ref-
ugees situated in Kenya and Malaysia. Soc. Sci. Med. 120, 387e395.
Nordstrom, C., 2004. Shadows of War: Violence, Power, and International Profit-
eering in the Twenty-first Century. University of California Press, Berkeley.
Palmer, J.J., Kelly, A.H., Surur, E.I., Checchi, F., Jones, C., 2014. Changing landscapes,
changing practice: negotiating access to sleeping sickness services in a post-
conflict society. Soc. Sci. Med. 120, 396e404.
Pandolfi, M., 2008. Laboratories of intervention: the humanitarian governance of
the post-communist Balkan territories. In: Good, M.D., Hyde, S.T., Pinto, S.,
Good, B.J. (Eds.), Postcolonial Disorders. University of California Press, Berkeley,
pp. 157e186.
Pandolfi, M., 2010. From paradox to paradigm: the permanent state of emergency in
the Balkans. In: Fassin, D., Pandolfi, M. (Eds.), Contemporary States of
Emergency: the Politics of Military and Humanitarian Interventions. Zone
Books, Cambridge, MA, pp. 153e172.
Panter-Brick, C., 2010. Conflict, violence, and health: setting a new interdisciplinary
agenda. Soc. Sci. Med. 70, 1e6.
Panter-Brick, C., Eggerman, M., Tomlinson, M., 2014. How might global health
master deadly sins and strive for greater virtues? Glob. Health Action 7, 23411.
http://dx.doi.org/10.3402/gha.v7.23411.
Redfield, P., 2005. Doctors, borders, and life in crisis. Cult. Anthropol. 20 (3),
328e361.
Redfield, P., 2013. Life in Crisis: the Ethical Journal of Doctors without Borders.
University of California Press, Berkely, CA.
Rutayisire, T., Richters, A., 2014. Everyday suffering outside prison walls: A legacy of
community justice in post-genocide Rwanda. Soc. Sci. Med. 120, 413e420.
Rylko-Bauer, B., Whiteford, L., Farmer, P. (Eds.), 2009. Global Health in Times of
Violence. SAR Press, Santa Fe, NM.
Saillant, F. (Ed.), 2007. Entre-lieu de l’humanitaire. Anthropologie et Societes, vol. 31
(2), pp. 7e321.
Stehrenberger, C.S., Goltermann, S., 2014. Disaster medicine: genealogy of a
concept. Soc. Sci. Med. 120, 317e324.
Ticktin, M., 2006. Where ethics and politics meet: the violence of humanitarianism
in France. Am. Ethnol. 33 (1), 33e49.
Ticktin, M., 2011. Casualties of Care. Immigration and the Politics of Humanitari-
anism in France. University of California Press, Berkeley.
Tiedje, K., Plevak, D.J., 2014. Medical humanitarianism in the United States: alter-
native healthcare, spirituality and political advocacy in the case of Our Lady
Guadalupe Free Clinic. Soc. Sci. Med. 120, 360e367.
Viterna, J., 2013. Women in War: The Micro-processes of Mobilization in El Salva-
dor. Oxford University Press, Oxford.
Willen, Sarah S., 2011. Do ‘illegal’ migrants have a ‘right to health’? engaging ethical
theory as social practice at a Tel Aviv open clinic. Med. Anthropol. Q. 25 (3),
303e330.
Willen, S.S., 2012. How is health-related ‘deservingness’ reckoned? Perspectives
from unauthorized im/migrants in Tel Aviv. Soc. Sci. Med. 74 (6), 812e821.
Wilson, R., Brown, R. (Eds.), 2008. Humanitarianism and Suffering: The Mobilization
of Empathy. Cambridge University Press, Cambridge.