Medical Humanitarianism Research Articles

Survey of Residents Who Have Participated in Humanitarian Medical Missions

To survey physicians who participated in humanitarian missions as residents to assess the value of this experience on residency training and future career choices. An anonymous 26-question survey was electronically mailed to 45 individuals identified as having participated in a cleft lip/palate mission during residency. The survey was created and distributed, and the data were collected using the online survey engine Survey Monkey. Thirty-nine individuals (86.7%) completed the survey. Of these, 27 were men (69.2%) and 12 were women (30.8%). Thirty-two (82.1%) were oral and maxillofacial surgeons, 4 (10.3) were plastic and reconstructive surgeons, 1 (2.6%) was an otolaryngologist, and 2 (5.1%) were pediatric dentists. Twenty-five respondents (64.1%) stated that, before their first mission, they had not operated on a primary cleft lip; 21 (53.8%) noted that they had not operated on a primary cleft palate before their first mission. Thirty-six (92.3%) noted that their mission experience improved their ability to repair facial clefts. Thirty-seven (94.9%) believed their mission experience improved their overall surgical skill. All respondents (n = 39, 100%) believed their mission experience improved their overall ability to evaluate patients with cleft. Thirty-six (92.3%) believed their experience in humanitarian missions made them more culturally sensitive/competent health care providers. Thirty-eight respondents (97.4%) believed these missions made them more socially aware of the differences in access/availability of health care globally. Thirty-eight (97.4%) believed that participation in a humanitarian mission was a high point of their residency. Thirty-seven (94.9%) planned to participate in humanitarian medical missions during their career after residency. All respondents believed that participation in a humanitarian mission during residency was a positive part of their training. In addition, these missions allowed the residents to develop as surgeons and improve their awareness of global health care and cultural competence. Given these important educational aspects, participation in a humanitarian mission should be considered a required part of residency training.

In Search of the 'New Informal Legitimacy' of Medecins Sans Frontieres

For medical humanitarian organizations, making their sources of legitimacy explicit is a useful exercise, in response to: misperceptions, concerns over the ‘humanitarian space’, controversies about specific humanitarian actions, challenges about resources allocation and moral suffering among humanitarian workers. This is also a difficult exercise, where normative criteria such as international law or humanitarian principles are often misrepresented as primary sources of legitimacy. This essay first argues for a morally principled definition of humanitarian medicine, based on the selfless intention of individual humanitarian actors. Taking Médecins Sans Frontières (MSF) as a case in point, a common source of moral legitimacy for medical humanitarian organizations is their cosmopolitan appeal to distributive justice and collective responsibility. More informally, their legitimacy is grounded in the rightfulness of specific actions and choices. This implies a constant commitment to publicity and accountability. Legitimacy is also generated by tangible support from the public to individual organizations, by commitments to professional integrity, and by academic alliances to support evidence-based practice and operational research.

Medical humanitarianism, human rights and political advocacy: The case of the Israeli Open Clinic

In the context of neo-liberal retrenchments humanitarian NGOs have become alternative healthcare providers that partially fill the vacuum left by the welfare state’s withdrawal from the provision of services to migrants and other marginalized populations. In many cases they thus help to build legitimacy for the state’s retreat from social responsibilities. Human rights organizations play an important role in advocating for migrants’ rights, but in many cases they represent a legalistic and individualized conceptualization of the right to health that limits their claims for social justice. This paper analyzes the interactions and tensions between the discourses of medical humanitarianism, human rights and political advocacy using the example of an "Open Clinic" run by an Israeli human rights organization as a case-study: In 2007 dramatically increasing patient numbers provoked an intense internal debate concerning the proposal to temporarily close the "Open Clinic" in order to press the government to take action. Based on protocols from internal meetings and parliamentary hearings and in-depth interviews, we have analyzed divergent contextualizations of the Clinic’s closure. These reflect conflicting notions regarding the Clinic’s variegated spectrum of roles – humanitarian, political, legitimizing, symbolic, empowering and organizational – and underlying conceptualizations of migrants’ “deservingness”. Our case-study thus helps to illuminate NGOs’ role in the realm of migrant healthcare and points out options for a possible fruitful relationship between the divergent paradigms of medical humanitarianism, human rights and political advocacy.

A New Paradigm for Military Humanitarian Medical Operations: Mission-Generic Metrics

We report the history of military humanitarian medical operations, define the current science of process and outcome evaluation, and propose a set of generic metrics for monitoring and evaluation in military humanitarian operations. We comprehensively reviewed the unclassified literature and used our own experiences in military humanitarian activities. Our literature review shows that efforts to evaluate the relative quality or cost-effectiveness of military humanitarian missions have been largely unsuccessful. In response to this finding, the authors propose a monitoring and evaluation checklist system with generic metrics, which are broadly applicable but also can be customized specifically for the user. Military humanitarian operations can provide substantial security value to their many different stakeholders. Refinement of our proposed mission-generic metrics list is one method to measure performance and relative quality. Better assessment of outcomes can clarify decisions about the utilization of limited military medical humanitarian funds and personnel.

(P2-102) Lessons Learned from Medical Humanitarian Mission During Somalia Civilian War 1992–1994. Moroccan Experience

Lessons learned from medical humanitarian mission during Somalia civilian war 1992–1994. Moroccan experience L. Safi. Chirurgical Intensive Unit Mohammed V Military Hospital Hay Riad Rabat Morocco Introduction Natural disasters and civilian war in Africa demonstrate a similar critical need for national preparedness. As one of a team of military physician who went on a medical mission, I would like to share glimpses of our experience and reflect our thought about humanitarian mission.ObjectiveTo report our experience during medical humanitarian mission.BackgroundDuring Somalia civilian war Morocco deployed level 2 hospital to provide medical and social aid to soma liens during united Nations interventions UNISOM. The specific mission was to provide immediate relief to the affected population of Mogadishu, to minimize loss of life, and to mitigate human suffering. A team of 21 physicians specialists and 40 nurses were deployed in an university campus to provided medical assistance.MethodsData were collected from interviews, observations, field notes, memos, and retrospective study of medical statistique.Results80% of all patients we examined have infection disease in all fields: dermatology, ophthalmology, ORL, pneumology etc 90% of childs have denutrition Only the emergency surgery was involved.Discussion and ConclusionIn doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. A successful medical humanitarian mission will depend on accurate and relevant medical intelligence and socio-geographical mapping in advance of deployment.

(A266) Huma Disaster Relief Medical Mission for Flood-Affected Victims in the Islamic Republic of Pakistan

A Flood disaster struck the Islamic Republic of Pakistan in July 2010. It affected 3 million people and caused 1,400 deaths. Humanitarian Medical Assistance (HuMA) is a non-profit organization in Japan. The organization dispatched three personnel to Islamabad on 20 August in order to conduct an initial needs assessment. They discovered that medical assistance and supplies could not reach all of the victims, especially in the North. Their visits to the surrounding regions highlighted the Nowshera district of KPK province, which had not received enough assistance from the government or aid organizations despite the fact that there were thousands of Internally Displaced Persons (IDPs) with health issues such as diarrhea, eye and skin disease, and upper respiratory tract infection (URTI). On 03 September, the HuMA Disaster Relief Mission began with the purpose of providing medical treatment and promoting public health for the flood victims in the Nowshera District. Eleven medical providers and coordinators from HuMA operated field mobile clinics in the district in collaboration with a local counterpart non-governmental organization, Nippa Welfare Association (NWA). This project was supported financially by the grant funding from Japan Platform. Humanitarian Medical Assistance served seven sites in Nowshera Districts as mobile field clinics, and consulted 2,216 patients. Total distribution of disease was: (1) URTI = 18.1%; (2) skin disease = 17.9%; (3) musculoskeletal = 15.2%; and (4) others = 19.7%. The team considered continuous medical consultation in the Nowshera District after 2010. The HuMa medical activities ended at the end of September, and the organization donated multi-vitamin tablets, syrups, FE tablets, and anti-biotic cream in order to assist NWA's continuing assistance for the affected communities. The medical providers also left lists of medicines for local doctors and medical staff. Humanitarian Medical Assistance also provided basic supplies needed to prevent victims from experiencing further sanitation problems.

Haiti Disaster Relief: One Third-World Humanitarian Medical Mission Group's Experience

Editor's Note: This is the last in a series of articles regarding disaster relief efforts in Haiti. Work continues as this country battles ongoing problems during the rebuilding efforts. Remember Haiti and other countries that experience natural disasters that put them at risk every day and continue to engage in activities that assist in their regrowth. Thank you to each and every author who has contributed to this series. Lesa Beth Titus is Trauma Coordinator, Mercy Medical Center, Roseburg, OR.

Medical Humanitarianism and Physicians' Organized Efforts to Provide Aid to Unauthorized Migrants in Germany

Universal notions of a right to health for unauthorized migrants operate together with incongruous state and international policies. These ambivalent policies demand ethnographic attention, since they have resulted in a two-tiered system in host countries and foster short-term, improvisational remedies. Medical care for unauthorized migrants is typically left in the hands of non-governmental organizations (NGOs) and permitted under the guise of sympathy and generosity rather than anchored in policy. This paper draws upon ethnographic fieldwork in Germany to present the viewpoints of physicians engaged in medical humanitarianism and discuss the complications associated with filling access gaps through NGOs. It explores the range of motivations—political, religious, and humanitarian—that drive physicians to provide care to marginalized populations. In recent years, I argue that NGO demands upon the state have moved from requests to decriminalize medical aid to demands for compensation for the significant ...

Effective Monitoring and Evaluation of Military Humanitarian Medical Operations

Non-military government agencies and non-governmental organizations (NGOs) have made great strides in the evaluation of humanitarian medical work, and have learned valuable lessons regarding monitoring and evaluation (M&E) that may be equally as valuable to military medical personnel. We reviewed the recent literature by the worldwide humanitarian community regarding the art and science of M&E, with focus toward military applications. The successes and failures of past humanitarian efforts have resulted in prolific analyses. Alliances of NGOs set the standard for humanitarian quality and M&E standards. Military medical personnel can apply some of these standards to military humanitarian M&E in complex and stability operations. The authors believe that the NGO community?s M&E standards should be applied to improve evaluation of U.S. military medical humanitarian operations.

Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Strategy at the Crossroads: Medical Humanitarian Assistance Missions for Navy Hospital Ships

Strategy at the Crossroads: Medical Humanitarian Assistance Missions for Navy Hospital Ships

Beyond Absolutism: Guiding Principles Needed for Humanitarian Medicine: Letter to the Editor

To the Editor: In their article in the March issue of this journal, Welling et al. [1] performed an admirable job highlighting many of the common pitfalls of humanitarian biomedical interventions and developed a series of prescriptive warnings of specific faults that should be avoided. The accompanying commentary [2] further commends the authors for their unique perspective as both physicians and members of the United States military. In their effort to caution how humanitarian medicine can cause more harm than good, however, the authors may have overstated their argument. An important unmentioned premise of humanitarian interventions is that these ventures are rarely wholly good or bad. These projects typically fall into legal and ethical gray areas that deserve qualification rather than absolute judgments of right or wrong. Welling et al. [1] frame their argument by comparing common humanitarian mistakes to the medieval concept of cardinal sins. By definition, cardinal sins were errors in action or thought that were never justifiable. This concept of moral absolutism seems an inappropriate metaphorical device for the complex relativism inherent to most humanitarian work. The disordered chaos that characterizes most humanitarian crises invites moral ambiguity, and ethical commandments that attempt to dismiss this intrinsic complexity grossly oversimplify the reality of work on the ground. For example, the authors note that politics and medical training often distract from the real ‘‘service’’ component of humanitarian biomedical interventions. To attempt to separate these various elements seems unrealistic and efforts to decouple indirect benefits of humanitarian work from direct service provision may distract from the greater purpose of undertaking such projects in the first place. Given that most humanitarian work requires institutional support (e.g., military, university, faith-based organizations), there will always be special interests beyond direct service that must be evaluated and managed appropriately. But trying to eradicate these secondary objectives is very likely impossible and could very well alienate many of the organizations that currently support such service efforts. Planning and implementing effective and appropriate biomedical humanitarian interventions is fraught with obstacles. Rather than crafting a series of ‘‘thou shalt nots’’ for medical humanitarians, what the greater community needs is a consensus-driven framework for humanitarian intervention. Lists of common mistakes are helpful, but guiding principles that encompass the clinical, educational, logistical, and ethical-legal issues surrounding medical humanitarianism are dearly needed. Such guidelines would recognize the inherent problems of these interventions and provide realistic guidance to managing the complexity and moral ambiguity of such work.

Third World Humanitarian Medical Trips—Are They Safe?

Third World Humanitarian Medical Trips—Are They Safe?

No task fit for a soldier? Canadian forces medical personnel and humanitarian relief missions since the Second World War.

Modern armies of the industrialized world operate in accordance with a doctrine, that is to say a philosophy linked to a series of procedures themselves determined by the tactical and strategic environment. These same armies, however, answer to civilian governments that do not limit their demands or instructions to the types of operations an army might list in its doctrine. For Canada's armed services, such seems to have been the case in regards to humanitarian operations which, even if they were not part of these services' operational philosophies, have nonetheless been of no little importance in the history of the air force, the navy, and the army since the end of the Second World War. This study will explore humanitarian operations from the second half of the 1940s to the formation and first missions of a unit specializing in such work in the 1990s. It will focus mainly on medical practice during these missions and attempt to determine whether medical practitioners had to change their basic approach to accomplish their tasks, or whether it sufficed to adapt procedures in accordance with the operational situation.

Exposing Poverty and Inspiring Medical Humanitarianism

How the Other Half Lives Although Rabelais coined this adage in 1532, Jacob A. Riis made it a household expression in his 1890 magnum opus, How the Other Half Lives, in which he exposed the horrible living conditions of New York City’s Lower East Side, one of the most crowded areas in the world and most famous immigrant ghettos in human history. With more than 523 inhabitants per acre, this neighborhood of less than 1 square mile of tenements and poverty was largely ignored by other New Yorkers, not to mention the millions of Americans who lived west of the Hudson River. Not exactly the most elegant of prose stylists, Riis was initially frustrated by his inability to get newspaper readers to ameliorate a miserable situation within their own backyard. Soon enough, technology buttressed Riis’ case where his literary technique could not. In 1887, Riis read about a new type of magnesium flash powder that when lit allowed photographers to illuminate hitherto dark and hidden recesses. Armed with his bulky camera and accompanied by several journalists, city officials, and “do-gooders,” Riis scoured the murky corners of the Lower East Side and captured shocking pen and photographic images of those who lived there. Apparently the combination worked. How the Other Half Lives became an instant best-seller and Riis an international authority on poverty. Almost voyeuristic in expression, Riis described a neighborhood distinguished for its overcrowding, dirt, foul odors, unsanitary living conditions, and cacophony of harsh and guttural tongues. Yet even as Riis portrayed his subjects in terms many today would find stereotypical and even derogatory, his approach was not to blame the individual but the environment and to encourage citizens to act based on altruistic principles. As Riis concluded his powerful story, “I know of but one bridge that will carry us over safe, a bridge founded upon justice and built of human hearts.”

Designing a Medical Humanitarian Assistance Course for Advanced Practice Nurses in the Uniformed Services

The U.S. uniformed services frequently respond to natural and man-made disasters worldwide. Disaster management and humanitarian assistance has been a major focus of military medicine for well over a decade. Training for these missions is a priority for the U.S. military, specifically as a result of the Gulf War. The Medical Humanitarian Assistance Course for advanced practice nurses is a course available to train advanced practice nurses in disaster management and humanitarian assistance. This article will describe the evolution, design, format, and implementation of the Medical Humanitarian Assistance Course.

Seventeenth Conference on Military Medicine June 2-6, 2003 Theme: Military Medical Humanitarian Assistance

Seventeenth Conference on Military Medicine June 2-6, 2003 Theme: Military Medical Humanitarian Assistance

To the Editor:

Recent years have seen significant growth in both the size and profile of the humanitarian sector. However, little research has focused upon the constructions of humanitarian practice negotiated by agencies and their workers that serve to sustain engagement in the face personal challenges and critique of the humanitarian enterprise. This study used the public narrative of 129 website postings by humanitarian workers deployed with the health-focused international humanitarian organization Médecins Sans Frontières (MSF) to identify recurrent themes in personal, organizationally-condoned, public discourse regarding humanitarian practice. Data represented all eligible postings from a feature on the agency's UK website from May 2002 to April 2012. The text of postings was analysed with respect to emergent themes on an iterative basis. Comprehensive coding of material was achieved through a thematic structure that reflected the core domains of project details, the working environment, characteristics of beneficiaries and recurrent motivational sub-texts. Features of the co-construction of narratives include language serving to neutralize complex political contexts; the specification of barriers as substantive but surmountable; the dominance of the construct of national-international in understanding the operation of teams; intense personal identification with organization values; and the use of resilience as a framing of beneficiary adaptation and perseverance in conditions that – from an external perspective – warrant despair and withdrawal. Recurrent motivational sub-texts include ‘making a difference’ and contrasts with ‘past professional constraints’ and ‘ordinary life back home.’ The prominence of these sub-texts not only highlights key personal agendas but also suggests – notwithstanding policy initiatives regarding stronger contextual rooting and professionalism – continuing organizational emphasis on externality and volunteerism. Overall, postings illustrate a complex co-construction of medical humanitarianism that reflects a negotiated script of personal and organizational understandings adapted to evolving demands of humanitarian engagement.

Stress and Health during Medical Humanitarian Assistance Missions

The present research examined stress and health among service members deployed on a medical humanitarian assistance mission to Kazakstan. Team members were surveyed before and during their deployment. Team members underestimated how much stress they would experience in terms of isolation and inability to help the local population. Team members also used less adaptive coping mechanisms than anticipated and showed elevations in alcohol and cigarette consumption. Despite these negative experiences, reports of depression and physical symptoms did not increase during the deployment. This may have been a function of team members being personally involved in important and relevant work during the humanitarian operation.

Operation Pacific Haven: Humanitarian Medical Support for Kurdish Evacuees

This article reviews the medical aspects of the humanitarian assistance mission Joint Task Force Operation Pacific Haven from September 1996 to April 1997. It reviews the effectiveness of the deployable medical units used to support the medical screening, treatment, and processing of more than 6,600 Kurdish evacuees applying for political asylum in the United States. The distinct cultural mores and language barriers of the Kurdish population made the provision of even basic medical care a challenge. Designed for combat service support, these deployable medical units were successful in the performance of the comprehensive public health and humanitarian assistance medical support mission because of the support of two on-island military treatment facilities. In short, for military medicine to successfully conduct humanitarian assistance and/or disaster relief missions, deployable medical units need to be designed, equipped, staffed, and trained to perform these operations.