This post originally appeared on the End of life studies blog, and was adapted from my new book International Responses to Mass Atrocities in Africa: Responsibility to Protect, Prosecute and Palliate (University of Pennsylvania Press, September 2015).
In the context of armed conflict, humanitarianism frequently functions as palliation. It is a powerful tool which must be used cautiously, with a close eye on political agendas.
Palliation as a concept is most often used in the context of end of life medical care. There is a recognition that medical care can longer cure a disease or life-threatening illness, and so medical care is, instead, reoriented towards making the patient as comfortable as possible for the time they have left. However, this idea can be applied, both positively and negative, in a number of other areas. One area where it might be applied critically is in the conceptualisation and practice of humanitarianism – the provision of food, water, shelter and medical care to those caught in the midst of war.
There are many approaches to humanitarianism which revolve around whether or not humanitarians see themselves as political, and whether or not they accepts constraints on what they can accomplish – i.e. attempting to protect human rights by reporting on the abuses they witness and hoping for greater international response. Yet, such witnessing (or temoignage as Médecins sans Frontièrs conceptualises its work) can create significant problems for humanitarian organisations, underming their claims to neutrality and impartiality upon which they depend to gain access to affected populations. Further, any claims to protection are tenuous, as humanitarians cannot usually directly protect people from armed groups, and any attempts to induce greater international protection – in particular in the form of an armed military intervention to protect people – are far from certain. Thus, in its most basic sense, humanitarianism is palliation.
According to the World Health Organization,
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
In the medical sense, palliative care ‘intends neither to hasten or prolong death.’ It ‘provides relief from pain and other distressing symptoms’ and ‘offers a support system to help patients live as actively as possible until death.’ The ‘illness,’ the symptoms of which humanitarians treat, is not the malnutrition and diseases from which those affected suffer. Rather, it is war and violent conflict itself. Thus, whereas palliative care ‘affirms life and regards dying as a normal process,’ humanitarianism as palliation affirms life but also regards war as a normal process. It takes the world and its illness – war – as it is and helps those affected by the illness – refugees, internally displaced persons, and others – to stay alive – hopefully until the war ends and localised illness is cured, or until the illness – war – ultimately kills them. It treats the symptoms rather than effecting a cure. While many millions of people have been saved by humanitarianism, it must seem for some caught in the midst of conflict that the refugee camp is akin to a hospice, with humanitarians keeping refugees alive and comfortable until the war – either directly through an attack by armed forces or indirectly through malnutrition and war-associated disease – kills them.
This description is in no way meant to devalue the work of humanitarians. Indeed, most people helped by humanitarians live to see the end of the war in which they are caught, and even those in hospices will appreciate the efforts undertaken to ease their pain and make them comfortable as the inevitable happens. Yet, taking war as inevitable imposes rather severe limits on the goals of humanitarians. At the same time, some humanitarians do not take the inevitable as such, and attempt to go beyond palliation.
Indeed, humanitarianism as palliation engages with many different interests and perspectives. The International Committee of the Red Cross may see palliation as the ultimate expression of humanity – you are keeping people alive for this one day, and hopefully the next, and the one after that, and so on. And many other international humanitarian organisations also see this as their humane goal, while others want to go beyond palliation and find a cure – that is, address the root causes which are leading to the disease of war which is killing so many people. This creates operational problems. It also brings them into conflict with others who may prefer palliation as state policy. That is, while states – especially rich, Western states with the resources to put toward stopping conflict – may want to see a particular conflict stop and prevent people from being killed – they do not necessarily want to invest the resources (troops) to do so. Palliation thus becomes the preferred course of action, and a substitute for more robust action. Thus, to bring the medical analogy to a close, instead of bringing in surgeons (troops) to excise the tumor of war and genocide, states bring in hospice workers (humanitarians) to keep people alive until the war ultimately kills them.
This recourse to what de Waal (1997) calls the humanitarian international, or what I have described as the Land Cruiser Brigade (Mills 2006), appears to give humanitarian organisations significant power in the midst of conflict. Yet, it also brings with it many problems as humanitarians become politicised, wedded to one side in a conflict, and perceived, according to Hardt and Negri (2000), as the ‘mendicant orders of Empire,’ ‘some of the most power pacific weapons of the new world order.’ The white Toyota Land Cruisers of the humanitarians become a representation of the international community’s response to conflict – more evocative than the armored tank – taking humanitarians into a realm of high politics which conflicts with their depoliticised humane palliation.
As a result of the changing nature of conflict, humanitarianism has become embedded within contemporary conflict. Although it may have different interpretations and meanings, it is recognised and accepted as a good thing, an expression of our ultimate humanity. It is, in fact, recognised as a duty or responsibility of the international community. This makes it a very powerful tool, not only for humanitarians themselves but for other actors who may want to use it for purposes other than what its supporters and practitioners may wish. And it is this possibility that should serve as a caution to to those who believe they can engage in palliation – in the humanitarian sense – in isolation from other political agendas.
de Waal, Alex (1997) Famine Crimes: Politics and the Disaster Relief Industry in Africa (Woodbridge: James Currey).
Hardt, Michael and Negri, Antonio, Empire (Cambridge: Harvard University Press).
Mills, Kurt (2006) “The Postmodern Tank of the Humanitarian International,” Peace Review 18:261-267.