The first is the identification and designation of target-subjects for recruitment strategies and a new form of involving them in prevention through initiation into serological surveillance. The second addresses the diversification of testing spaces and the way in which sexuality, affect and gay sociability have become implicit in the prevention discourse.
These debates have problematized the naturalization of constructed and reified categories according to the logic of specialists. The 65 articles in this review corroborate this observation. Rarely is it made explicit if participants were classified based on self-classification of their identity, or if the researchers used behavioral criteria ex.
We noted that the literature uses different criteria when classification is based on sexual practices. In a survey about cases of non-identified infections conducted in homosexual sociability locations in the United States 2 , the categorization MSM was applied to those that referred to at least one sexual relationship with a man in the last year. In another study about access to MSM among people who frequent saunas, parks and bars in Bangkok 3 , the criteria was reporting oral or anal sex with men in the last six months.
Some publications reveal that the types of strategies chosen are linked to determinant identity molds, affective relationship forms or gay sociability.
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In some cases, the researchers report that sexual identity is defined according to self-classification, but it is not explicit if the categories are predefined by the study or referred to by the participants. We identified a concern in the literature with the level of surveillance and self-care in relation to HIV.
The articles commonly describe measures of testing frequency, which is coherent with the topic studied. Nonetheless, it is worth noting how these studies and narratives of experiences use the sexual identity of study participants to interpret or explain higher or lower testing frequency. In the same way, the analyzed literature explains that risk perception decreases the further away subjects are from the gay universe. We cite an example. A survey with users of a mobile HIV testing unit in Spain 6 included interviewees who had distinct sexual practices and were classified as MSM, MSW men who just have sex with women and women.
The authors describe the higher acceptance of the test among MSM, interpreting it to be a result of a higher risk perception among this group. In these articles, the connections between experiences and HIV vulnerability are not discussed, especially in sexual-affective relationships. Stigma is highlighted primarily in terms of the obstacles it presents in accessing the test. The literature also tends to approach structural questions, like AIDS stigma or healthcare coverage only in relationship to access to testing.
Similarly, the literature treats sexual identity and discrimination from the point of view of its implications for public health strategies. The routine offer of the HIV test is one topics covered in articles about testing strategies for people with homosexual practices. According to the new prevention model logic, testing permits the identification of people infected and the reduction of transmission through adequate medical treatment.
Testing should be facilitated and stimulated. In diverse countries, like the United States, Canada and Australia, the periodic prescription of the HIV exam is part of a health service protocol promoted in the name of efficiency, especially for the groups most affected by AIDS.
This entire apparatus of intense initiation and prescription of the test is what we call serological self-surveillance, which is promoted especially towards MSM. In the review, we only found one study that problematizes the relationship between testing and coming out in the current scope of global AIDS policy. The analysis demonstrates how recruiting subjects for testing through these means makes revealing MSM who traditionally would remain hidden in the official rates of heterosexual transmission possible.
Some articles defend the expansion of testing by affirming that after diagnosis, there will be an increase in condom use, a reduction in partner numbers and treatment adherence, therefore reducing infection even in situations of being exposed to the virus. In synthesis, recruitment strategies and the technologies for expanding testing depend on revealing a sexual identity. In the literature, there is a narrative that intersects the identity dimension with the offering of the diagnosis. This point is intertwined with the idea that these investments should involve making MSM responsible for their self-surveillance, as we will discuss below.
It is important to emphasize that articles about prostitution focus on female prostitution and that studies about MSM and prostitution were not identified. The literature about prostitution and the trans population is less expressive numerically and prioritizes prevention strategies that do not place testing as a central component. The testing actions for sex workers are characterized by strategies that promote health and highlight the importance of a right to autonomy and confidentiality 14 through projects that recognize rights, citizenship and community mobilization In addition, they focus on strengthening social organizations and strategies to combat stigma and stimulate access to health services.
The largest offering of testing and technologies considered as innovative for recruiting MSM are marked by their emphasis on testing via the internet, relationship sites, apps, telephone, and OPT-IN the continuous offer of testing in health services that only requires verbal or written consent.
It is worth nothing that these health strategies do not apparently seek to control the sexual practices of MSM. However, by enthroning themselves in affective and social scenes, they seem to stimulate new elements of socio-sexual dynamics, such as the practice of serosorting choosing partners based on their serological status.
In addition, as we discuss in the following section, they seem to produce new classifications of MSM based on their relationship with the test. In our analysis of the literature we found that the previously mentioned testing technologies are validated or proven in sexual contexts considered to be typical of the homosexual universe.
In the study descriptions and narratives of experiences, there are frequent references to the sexual interactions of those referred to as MSM. Casual sex is tacitly associated with arguments about the higher HIV incidence and prevalence rates within this group. Such assertions related to masculine homoeroticism are expressed though the characterization of men according to their sexual practices.
In a unique way, differentiation in terms of their sexuality is only specifically mentioned when the people enrolled in the testing recruitment strategies are homosexual couples, or when the technologies are integrated into spaces like saunas or electronic relationship apps. Testing initiatives for gay couples are an example of this differentiated concern regarding the sexuality of those referred to as MSM.
They highlight how infection in these cases occurs in the context of affective relationships in which the practice of anal sex involves feelings of trust, intimacy, etc. HIV testing is positioned as a crucial resource for establishing an agreement among the couple, that through testing could make a safer decision to abandon condom use. We are referring here to testing among partners as a way to abolish condom use.
Another aspect that is surreptitiously evoked in the literature analyzed is the association between the use of sex and relationship apps and higher risk for acquiring HIV. Some studies propose subsidies for planning prevention actions among MSM who use apps as they are considered as more exposed to infection. The way in which specialists comprehend the relationship between sexual risk and the use of apps stands out in the literature.
This is intensified even more when these relationships are mediated by technologies, as we identified in the studies that conduct mappings of sexual and social networks of telephone app users. One of the articles reviewed, for example, presents a map of these networks with the aim of identifying geographic areas with the largest concentration of black and Latino MSMs in Atlanta USA. On the other hand, a French study of knowledge and access to the self-test among men who use gay websites proposes a certain homogeneity among those who use the web to find partners and those that benefit from a health intervention via the internet.
Testing recruitment strategies in the context of hook-ups clubs, saunas, apps correspond to determinate premise of specialists regarding the unequivocal relationship between risk and casual sex. The articles do not argue why the risks associated with relationship apps use would be exclusive to homosexuals.
It can mean everything from one sexual relation with an unknown partner to sporadic sex with someone without an affective tie, to inconsistent condom use with a casual partner. Based on the literature analyzed, the only exception was a survey conducted in the United States with the objective of identifying concrete scenarios for exposure to HIV infection.
The study explored the nuances of different forms of relationships between MSM, the places where they met their sexual partners and if they had a history of sex with people who were seropositive. It is important to highlight how these new HIV prevention strategies enter into the intimate scenario of couples and contexts of homosexual sociability. The introduction of the rapid test and the oral fluid fest, especially for home use, inaugurate new possibilities for biomedical intervention in contexts of sexual interaction.
The symbolic consequences and practices of these tests deserve close attention. In the literature reviewed, few studies pay attention to the social effects of the introduction of these innovations. We cite one of them. The research describes how young gays that received oral test kits for daily use reported on their initiative to do the test with sexual partners, sometimes on the first date. The situations in which there was a positive diagnosis of one of the sexual partners provoked less of a preventive effect than an interruption in the sexual routine and reorganization of the relationship, as such situations required mutual support among the people involved.
In summary, as signaled by Knight et al. It is important, therefore, to question how much a diagnosis molded on liberal-individualistic principles, dissociated from the structural factors responsible for the origin and maintenance of AIDS stigma, could intensify stigmas in detriment of the benefits of a timely diagnosis. The literature review attests to the differentiated nature of the interventions offered with a focus on MSM that involve routine testing, as well as its incorporation into sexual-affective negotiations through self-diagnosis technologies, among others.
An exploratory review the studies focused on sex workers and the trans population provided a comparative dimension to our hypothesis and raised questions regarding the large investments in the population referred to as MSM. In populations considered priorities in current prevention policies, like female sex workers, these types of studies and analyses are practically inexistent. The argument that the focus on MSM is justified due to anal sex being typical and more frequent in this group also deserves to be questioned. The articles reviewed about testing rarely take sexual practices as an object of their analysis.
In general terms, we found that sexuality has received tangential attention in the current biomedical prevention approaches.
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Topics such as identity, practices and experiences of discrimination are rarely objects of empirical analysis in the literature about testing. These topics only come into play in arguments to justify choosing the population, a way to access them or an explication of the epidemiological frame. Even in the surveys in which researchers seek to assess sexual practices, it is worth questioning why anal sexual practices are approached as being exclusive to MSM when sociological studies have highlighted the importance of understanding the contexts of this practice in the heterosexual universe GAGNON, The analysis of the selected literature sought to understand the moralities actioned by specialists and their understandings about the sexuality of the intervention target groups.
The moralities implicit in arguments about testing recruitment strategies point to aspects that deserve close accompaniment, especially due to their unintended consequences. On the one hand, the specialized scientific discourse reveals meanings about male homosexuality that can be stereotypical at times, or only attentive to the overlaps between stigmas related to AIDS and sexuality when they are about barriers to test access.
Namely, stigma related to sexual orientation and gender identity is evoked as one of the barriers to accessing testing and to justify the pertinence of testing services focused on MSM. On the other hand, while arguments that the use of apps for sexual encounters is a risk factor gain prominence in recent biomedical articles about prevention, hypotheses about the relationship between commercial heterosexual sex and technology use and its prevention implications continue to be absent.
It is necessary to consider how the MSM category is defined to understand the sexual moralities at play. The use of this category in prevention discourses underpinning testing follow the path of the universalization of sexual experiences and identities. Parker and Aggleton , in particular, contribute to this discussion in their reflection about how distinct expressions of homosexuality roles, identities, etc. The way in which testing focused on MSM is presented seems to depart from an assumption that it is strengthening a consolidated public health strategy.
This occurs despite the debates starting in regarding the loosening of testing guidelines, such as counseling and informed consent, as part of its expansion MORA et al. The mercantilization of the body and its fluids are highlighted in this scenario, as is the very close relationship between the interests of biotechnology companies and public policy development. In addition, as discussed by Monteiro et al. We identified a relevant characteristic within this arena of technological innovations and their implicit assumptions that is also discussed by Camargo et al.
The recent specialized scientific discourse reveals a tacit understanding that the effective control of the epidemic will not be achieved through attempts to introduce socio-behavioral changes into the arena of sexuality. Expectations are projected in the identification and treatment of the largest contingent possible of infected people, considering evidence that an undetectable viral load annuls the possibility of sexual transmission.
In the case of MSM, they also bet on the routine offering of testing and the adoption of prophylaxis medications before and after sex as a means through which people could have greater self-control and improve their self-care. Given our findings, it is crucial to reflect on the place, and possible symbolisms, of sexuality in the context of offering the test.
In this way, the strategies discussed in the literature have made the homosexual population more than visible: interconnections between diagnostic technologies and sexual, affective and social practices have emerged. The social history of AIDS is marked by a singular dynamic of tensions that arise from the predominance of medical and behavioral knowledge alongside to the construction of responses nourished by diverse knowledges political, religious , social agents professionals, activists, scientists , and the protagonist role of community movements NGUYEN et al.
As such, it is fundamental that the current proposal for a new prevention paradigm be analyzed and discussed with all of the agents involved, especially in terms of their social consequences, symbolisms, and categorizations. Am J Pub Health, v. Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India.
J Epidemiol Community Health. London, 66, suppl 2, p. Will to live. New Jersey: Princeton University Press, Cultural Anthropology, v. Male circumcision and HIV: A controversy study on facts and values. DOI: Rio de Janeiro, v. American Sociological Review, v. Sex, Technology and Public Health. London: Palgrave Macmillan UK, Successes and gaps in uptake of regular, voluntary HIV testing for hidden street- and off-street sex workers in Vancouver, Canada.
AIDS Care, v. Was it a phase? Journal of Personality and Social Psychology, v. New York: Haworth Press, Berkeley: University of California Press, The fluidity of sexual preference and identity: A challenge for social movements and AIDS prevention programs in Brazil. Bodies and Borders in Latin America. Stockholm: Stockholms Universitet, Gaceta Sanitaria, v. Cochrane Database of Systematic Reviews, issue 9, FORD, C. American Journal of Public Health, v.
FRY, P. Rio de Janeiro: Zahar, Sexualidades Brasileiras. Rio de Janeiro: Garamond, Health Education Research, v. Between individual agency and structure in HIV prevention: understanding the middle ground of social practice. Am J Public Health, v. Revista Estudos Feministas. Sociology of Health and Illness, v. Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil.
S, Rio de Janeiro, set. Rio de Janeiro: Fiocruz, , p. Making prevention public: The co-production of gender and technology in HIV prevention research. Social Studies of Science, v. MORA, C. Salud Colectiva, v. MSM: resurgent epidemics. AIDS, v. PAI, M. In reality, MSF delegated much of its security and logistics management to the belligerents, in the belief that they should do their share of the relief work. In Eritrea and Afghanistan, for example, the teams crossed the borders in guerrilla convoys, in a bid to stay safe. This practice remained in use in Angola until the mids. Such alliances of convenience were not without their difficulties.
Logistics did not always follow, communications were erratic, the armed groups could make excessive financial demands and sick volunteers sometimes received poor care. Yet such problems did not cast doubt on either the modus operandi or its legitimacy; this was simply how things were done. In spite of its rapid growth, MSF was still small and relatively unknown outside France. Meetings with political and military groups in countries where MSF wanted to work were less a time for negotiations than an opportunity to make itself known.
The ultimate response to risk was to withdraw. Programmes were suspended in Uganda in because of safety incidents and again in in Iran due to widespread insecurity and problems with obtaining access to the population. The decisions to withdraw were made at head office, and in some cases, for example Uganda in July , against the wishes of the field teams.
The number of international volun-teer posts increased from in to in Head office also expanded, from fifty employees to some during the same period. By the year , MSF had developed into an international organisation with sections in nineteen countries and an increasingly well-established reputation. But, like the rest of the world, it was facing the geopolitical changes brought on by the end of the Cold War. The situation is becoming more and more complex; the increasingly acute security problems are difficult to even think about. In post-Cold War conflicts, as in the wars breaking out in Somalia, Liberia, the former Yugoslavia and the Great Lakes region, it was now possible to work on both sides of the frontline.
In a context marked by a horrific succession of mass crimes, MSF was forced to become more self-reliant in terms of security. He seemed to anticipate the worst, however, and, by the next General Assembly, he was lamenting the deaths of two volunteers killed when their plane was shot down over southern Sudan in December , and of another who was killed in Afghanistan in April MSF-France ceased operations in both countries.
The conflict in Somalia—where, along with Iraqi Kurdistan, the first inter-national military interventions in the name of the protection of humanitarian assistance were launched—ushered in a decade of mass violence and UN interventionism. Countless incidents were reported during meetings of the Board of Directors. In October , as a convoy of wounded was being evacuated in Vukovar, Croatia, an MSF vehicle hit an anti-tank mine, which undoubtedly had been planted deliberately.
Four people were wounded, one of them seriously. In Liberia, in addition to all sorts of violent incidents, MSF was plagued by large-scale looting, as were all the other aid agencies. What set the crises in West Africa and the Great Lakes region apart was not only the extreme violence against civilians, as witnessed directly by the teams in Rwanda, Burundi and Zaire from to , but also the gravity of the security issues. Although there are no precise figures, more than MSF employees were estimated to have been killed between April and June during the genocide in Rwanda. The conflict in Chechnya in the Russian Caucasus also caused its share of incidents—notably kidnappings for ransom—and four international staff members of MSF-Belgium and MSF-France were abducted in In June , a Portuguese doctor was assassinated in Baidoa, Somalia.
He was the first international staff member to have died from an act of violence since The deployment of aid workers into the heart of conflict zones considerably increased their exposure. Deprived of the ideological and strategic framework of East-West confrontation, wars were now, so the thinking went, driven solely by ethnic or religious resentment and economic predation.
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Such was the context in which the safety of humanitarian workers made it onto the agenda of international institutions. The increasing number of security incidents led to a veritable paradigm shift within the aid system as the European Community became a prescriber of security management practices. A European Commission discussion paper on the security of humanitarian workers recommended that institutional donors require partners to demonstrate their ability to assess situations, track and investigate security incidents, establish security guidelines and commit to training and briefing their staff.
EU Commission, op. Van Brabant greatly influ-enced the professionalisation of security processes. The humanitarian security market was booming, fuelled by former military personnel returning to the private sector with the post-Cold War downsizing of Western armed forces. See, in particular, Larissa Fast, Aid in Danger. The year saw an all-important addition to the golden rules which established a red line whereby any team being specifically targeted must be withdrawn.
Concerned by this change in the nature of their responsibilities, and reckon-ing that they regularly violated the withdrawal-if-targeted rule, the programme managers made known their disquiet to the Board of Directors. Meanwhile, militias in Somalia were targeting infrastructure and aid workers and MSF recruited armed guards to ensure their security. This was a shift from earlier practices in Afghanistan, Eritrea and Angola as the de facto political authorities no longer provided protection.
MSF teams—now managing small military units—saw their position weakening in negotiations with this new breed of employee. Equally controversial was the decision not to pull out the teams from Burundi in the second half of the s. The situation was dire, as massacres were occurring not far from MSF teams, frustrated by their inability to provide assistance, and missions lived from one evacuation to the next. The Board of Directors held numerous discussions on the question of the risk to staff and whether to continue activities.
Why were people being killed, they pondered? Was it because of where they were, or because they were humanitarian workers? The debates provided no satisfactory answers to these questions. Although the decision was ultimately taken not to pull out, at times the association appeared to be feeling its way forward in the dark, with no roadmap to guide it. Programme managers there had for some time viewed it as inadequate, given the high degree of exposure—especially in the case of projects where humanitarian workers were subject to direct attack on a regular basis.
However, what was striking in those chaotic times was the intensity of the discussions and the involvement of the Board members, some of whom monitored missions, conducted field visits for example, in Somalia and Yugoslavia and shared their analyses on their return. MSF might have been expected to embrace technological and bureaucratic advances in security—especially given that, in the mids, it supported more than it challenged the normalisation and professionalisation process that had accelerated significantly within the aid sector since the African Great Lakes crises.
Despite strong pressure to change its practices, however, the association attempted to resist the increasingly technological and professional direction that humanitarian security was taking. Some organisations are offering their volunteers can we still call them vol-unteers? Some NGOs actually advocate sharing information and communication networks in sensitive areas with official intelligence agencies! At the same time, the importance of protective measures and their rein-forcement—such as calling in experts in the case of kidnappings—was dis-cussed regularly.
There was no shortage of security procedures, quite the opposite in fact. The s were marked by sustained growth for humanitarian organisations, in terms of both resources and ambitions, due in particular to the Afghanistan and Iraq invasions and the considerable humanitarian funding that accompa-nied them. Yet it was during those years of growth that the narrative of the narrowing humanitarian space and increasing dangers to staff escalated.
The deadly strikes in on the UN and ICRC headquarters in Baghdad were considered emblematic of an unprecedented rise in deliberate attacks against humanitarian workers. Fear was being fuelled by the difficulties facing relief organisations in the Middle East and Sahel, due to the expansion of radical jihadist groups and repeated kidnappings for ransom.
While in the s the upsurge in attacks against humanitarian workers was associated with the deliberate targeting of civilians in conflict situations, a view emerged at the turn of the s condemning the targeting of humanitarians as such. To use the words of Larissa Fast, Fast, op. Statistics would prove a powerful ally in this victimisation device. Starting in the early s, relief and research organisations conducted numerous quantitative studies on violence against humanitarian workers, all of them concluding that increasing insecurity was a scientifically established fact.
See Chapter 4, p.
Educational institutions began offering degrees in security management. See Chapter 5, p. From to , the number of national staff7 under contract grew from approximately 3, to more than 5, Those growth years were also years of grief and anxiety for MSF as the organisation suffered a series of assassinations and kidnappings. See Chapter 8, p. Held for almost two years, his release caused a public dispute between MSF and the Dutch government, which took the organisation to court to demand payment of the ransom it claimed to have paid.
Between and , six international staff" members were assassi-nated while on mission. The following year, two international staff" members of MSF-Holland and their Somali colleague were killed when their car was hit by an exploding roadside bomb in Kismayo in Somalia. Those events lent credence to victim discourse and statistics on the worsen-ing security situation, which were echoed by MSF.
Indeed, the internationalisation of MSF also contributed to the rise in security concerns. In , the partner sections became responsible for paying their national personnel, who had previously been under contract to MSF-France. In response to this increasing legal pressure, the contracting sections sharpened their requirements.
Such was the background for debates at General Assemblies and meetings of the Board of Directors, which were dominated by at least three issues: the persistent unease created by the discrepancies between the rules instituted in the early s and what was actually happening in the field, the role of head office and the Board of Directors in evaluating risk and making decisions and the legitimacy of transferring risk to national staff or to nationalities at lower risk. In reality, and since time immemorial, it is not independence that conditions access to victims, or even the safety of our teams.
Most often, it is negotiation and logistics. He recognised that the conflict between what was being said and what was being done had to be elucidated. Yet, as we have seen, that conflict already existed back in the s. He challenged this shift all the more since in his view what it achieved was not justified by the operational results. Hence, it was precisely because he believed in the usefulness of delivering aid in Baghdad when the US invaded Iraq that he supported keeping teams on the ground. These questions prompted a new round of discussions about the respective roles of the head office, the Board of Directors and field volunteers in taking risks.
At a Board of Directors meeting on Central African Republic a little more than a year after the death of a volunteer logistician there, the programme manager asked that the directors collectively assume mission-related risks and make a greater contribution to operational discussions. They asked naive questions, sometimes painful, and then they went back to report to the other directors, to share and have exchanges with the field. It is hard not to see this comment as barely veiled criticism of administrators less involved than some of their predecessors in the s.
Remote control raises questions about the status of national staff are they MSF, like the others? The setting up of remote control coincided with a discussion on the place and role of national staff that went far beyond the issue of security. Under discussion was a proactive policy intended to raise the status of national employees through better remuneration and access to expatriation, training and association membership.
It should be noted that MSF only started keeping records of its local employees in , and, except for a few anecdotal cases, it would take the organisation almost another ten years to seriously take account of their security. We should be careful not to underestimate the risks they take. Far from considering withdrawal an option—except in situations where the association is directly faced with the death of its international volunteers, like in Somalia and Afghanistan—MSF views the adjustments to its modus operandi as a pragmatic response to allow it to continue to work in settings where it is highly exposed.
The technical and procedural components of security are expanding and becoming increasingly centralised. While it is difficult to determine objectively what the dangers are and whether they are worsening, it is an established fact that fear—as a social construct—is mounting. In light of this, the use of technology may appear to be a solution that reassures. Thanks to all the collaborators and colleagues involved, Roger MacGinty, Roisin. The concepts of danger, risk, security and protection—none of which are self-evident or simply observable realities—require a broad historical frame to make sense of their meanings in current debates.
They have been borrowed, shaped and reinvented in the discharging of humanitarian policies as ways of engaging with aid work. Humanitarians have consistently made their deployment in the face of danger a badge of honour this use of a nineteenth century notion is deliberate, as it conveys the origins of numerous contemporary issues. In the face of danger, while taking risks, aid workers have always paid attention to their security and sought to define how their work could be made safer, often combining practical measures on the ground with more discursive claims to provide and obtain protection for and through their work.
Evaluation and management of risk to establish secu-rity measures as well as calls for protection turned out to be, for the historian, essential tools for representing and comprehending, not only the world in which humanitarians work, but also the humanitarians themselves.
This chapter comprises three parts. The first provides a brief history of the tools at the centre of risk and protection measures, the second, a longer view of the relationship between security and protection, and the third, how the two concepts have been set, since the s, as a dialectic challenge to human-itarians. Humanitarian aid was for the most part deployed throughout the nineteenth century to mitigate the consequences of disasters and industrial accidents, principally fires, shipwrecks, floods and mining disasters. The notion of risk is closely linked to that history, on several accounts.
The concept of risk assess-ment stems from the legal and insurance policy language adopted in the mid-nineteenth century, when the term was adopted by loss adjusters and actuaries whose task it was to anticipate the full extent of risk-taking, even in dangerous but nevertheless insurable occupations. Smee and Thomas G. Their main challenge was to establish who was taking the risk and to what extent exposure to danger represented evidence of negligence. Was danger preventable and, if so, by whom and in what timeframe? Was an employee taking a risk a wilful or negligent act?
Did people step unknowingly into the path of danger? These rather obscure points of law are of importance to the humanitarian sector on two levels. Firstly, the history of risk in the wider social context is rooted in the history of legal as well as insurance policy thinking including social insurance policies , and secondly, the manner in which humanitarians and organisations think about danger relates to the legal history of accidents and criminal negligence trials. There are numerous examples of a voluntary compensation culture whereby funds were raised to compensate the losses of innocent victims and rebuild the lives of survivors, providing the model for reconstruction and rehabilitation relief in times of war.
In , the English Quakers decided to disregard soldiers even though they were viewed as the primary humanitarian subjects to focus instead on rebuilding civilian lives after the ravages of the Franco- Prussian War. William K. Like other humanitarian workers in the United Kingdom, they did not venture unequipped into the field and, similar to most voluntary societies or relief funds, they relied on evidence drawn up by accountants.
They were particularly dependent on reports compiled by the actuary, a new profession in accountancy. Graham Benjamin et al. Funds committed to relieve the sufferings of widows and orphans had to serve over the long-term because they were pledged to provide until the natural death of the beneficiaries. Consequently, the long lives of beneficiaries were viewed as a risk to the fund. Charities were therefore keen to provide enough for long enough, but not too generously.
Combined with legal requirements, these moral and practical financial considerations defined risk. Security issues were to be understood in relation to those arising from limited or unlimited liability. In Anglo-American common law, the codification of danger is related to the notion of peril. In many ways this term defined the concept of preventable danger, the responsibility of individuals in relation to each other and the relative degree of negligence of each party involved in an accident. The legal obligation to intervene in order to prevent harm was defined in court primarily as a duty to assist those in peril.
Huey B. If the notion of danger and obligation to intervene were thus established early on in Roman and common law, the relationship and unnecessary exposure to danger have a rather more complex and controversial history. In other words, when a person puts themselves in danger out of negligence and the danger itself was created by the negligence of others typically a moving vehicle or an industrial accident , the two negligent acts do not cancel each other out and the victim might still seek redress or compensation. In humanitarian doctrine, the negligent party at the origin of the danger to which other negligent parties would subsequently expose themselves was still the source of the accident.
In practice, this meant that careless employees exposed to unnecessary risks by their employers could still seek legal redress against them. In medicine, the notion of risk was often raised in relation to insanity and the danger a patient might present to themselves or others, making risk assessments a common prerequisite for internment in secure hospitals.
Buying into the system
Humanitarian efforts of the late nineteenth century and the contemporary humanitarian matrix originated from this capitalistic social context. The logic and structure of these early efforts were in line with the practices of their promoters. The founders of Western humanitarian aid—such as the bankers and lawyers of Geneva, or, in the British Empire, Lord Sutherland and his Stafford House Committee—used a language and logic acquired from their legal and financial practices.
See Sarah Roddy et al. They were applying their professional standards to the management of resources mobilised for humanitarian relief. The humanitarians responsible for dispatching medical relief to France during the Franco- Prussian War in , the Ottoman Empire in and South Africa during the Boer War adopted the same cautious approach as they would for their own investments. For example, the administrator of the Stafford House Committee, which raised resources for a wide range of humanitarian operations and ran field hospitals during the Russo-Turkish War, demonstrated full accountability, precision, prudence and responsibility.
In practice, this meant that the Committee, which in funded fifty medical staff, maintained twenty hospitals, handled three evacuations by train and treated over 75, surgical cases, exercised careful management of its funds while appraising the nature of its work, the duration of its operations and its exit strategy according to the rules of risk management. Notably, it had to fend off allegations of corruption that arose from working too closely with Ottoman politicians.
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Yet this language of prudence was also melded with recognition of the dangers and risks inherent to war. The two were perfectly compatible because intervening during a war was not expected to be without danger. In many respects, perils and dangers belonged to a different semantic and cultural register, highlighting and valuing danger as an opportunity to reveal individual valour, masculinity, compassion and character. This language of danger was to be found in travel narratives often recounting the risks taken by travellers, missionaries and vicarious humanitarians and their overcoming of danger.
In the twentieth century, polar explorer Fridtjof Nansen, who embodied the humanitarian agenda of the League of Nations, was himself an adventurer in the same noble tradition of danger-seeking individuals. This relationship between travel narratives, heroics and humanitarian aid has not entirely disappeared. Interview with Jacques Pinel, 7 March Some of the field experience so prized in humanitarian circles is still expressed through rhetorical tropes and sometimes tones of orientalism dating back to the late nineteenth century.
Courage is, to this day, a highly valued humanitarian virtue. For instance R. In the dry language of reports and in first-hand accounts, humanitarians would high-light danger in self-reinforcing terms, often dictating a new economy of relief and practice. Henry Dunant, A Memory of Solferino.
Yet such reasoning was by no means precise. Calculating the precise number of war victims was no less straightforward. For instance, as the Crimean War was fought on land at least on a peninsula accessible only by ship, it should have been relatively easy for the authorities to calculate casualty numbers, given that they knew how many soldiers had been sent in and how many returned. But it would take them over three years to produce detailed statistical accounts and narratives. Still today, war casualty accounting is a source of debate and controversy.
Humanitarian concerns reshaped the perception of war, not simply as danger faced in battle but also, and often predominantly, as biohazard. Evidence shows that during the pre-World War One era humanitarian workers were far more likely to succumb to diseases contracted by soldiers and refugees than to physical violence.