The military physician and contested medical humanitarianism: A dueling identity?

Abstract

A critical issue in the study of humanitarianism is who counts as a medical humanitarian. Military physicians are often characterized as caught between the potentially incompatible roles of physician and military professional. Medical NGOs, such as Médecins Sans Frontières (MSF), have also vociferously rejected military medical humanitarianism: questioning the mandate, skills, and appropriateness of military involvement in humanitarian medicine as well as the potential impact on ‘humanitarian space’. Yet many military doctors contest this. Consequently this study examines the ways in which primarily British military physicians identify and manage their identities as both medical humanitarians and soldiers. The research utilized a mixed method, grounded theory approach involving systematic document searches/expert identification of a core literature of 300 policy and peer reviewed documents, plus grey literature and 53 formal medical post operational reports from units serving in Iraq and Afghanistan between 2004 and 2012. Semi structured interviews involved purposive sampling (34 respondents) ranging from a former Surgeon General to more junior staff. Methods also included an analysis of the original data and literature from the 2003 Medical Services Delphi study (involving an additional 40 experts and an extensive literature review) on military medical identity/future roles as well as direct observation of military doctors in Iraq and Afghanistan (two, 2 month research trips). The research concluded that military physicians conceived of themselves as autonomous medical humanitarians with an individual morality rooted in civilian medical ethics that facilitated resistance to the potentially hegemonic military identity. Nevertheless military physicians were part of a medical organization with fundamentally different priorities from those of civilian humanitarian physicians. Furthermore, the perceived emergence of multiple civilian ‘humanitarianisms’ has legitimated a space for the military physician alongside other variants of humanitarianism. This study contributes to the growing body of work on the self-identity of health professionals as humanitarians in conflict settings and demonstrates how the military medical identity fits into a fragmented civilian humanitarianism.