The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic

Abstract

One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of "humanitarianism" itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals' capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person "humanitarian" without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana's national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions. [humanitarianism, global health, expertise, semiotics, Botswana, HIV/AIDS] RÉSUMÉ Une des conséquences du récent progrès de l'intérêt des anthropologues pour l'humanitarisme est l'apparenteévidence et stabilité conceptuelle de «l'humanitarisme» lui-même. Dans cet article, je soutiens que l'humanitarisme n'est pas un concept stable et un phénomène aisément identifiable mais ne devient apparent que mis en relation avec d'autres catégories. En somme, l'humanitarisme est contingent: il dépend des circonstances et varie d'un contexte a l'autre. Par surcroît, sa perceptibilité repose sur la capacité des individusà faire valoir des similarités et distinctions catégorielles. Une personne ou un objet ne peuventêtre appelés «humanitaire» sans que ne soit nié le caractère humanitaire d'un autre objet ou personne. En me fondant sur des recherches menées dans des espaces cliniques où se chevauchent le programme national botswanais de traitement du VIH et les institutions privéesétasuniennes, j'examine les processus par lesquels les individus déclarent «humanitaires» des personnes, des espaces et des pratiques, les contrastes qu'ils constituent pour soutenir leurs déclarations et les positions morales qu'ils tentent ce faisant de prendre. Davantage que des questions simplement terminologiques, ces processus de catégorisations et d'oppositions servent de creuset aux luttes sur des questions de souveraineté, d'inégalité et d'héritages coloniaux qui hantent les interventions de santé globale définies par lesÉtats-Unis.[humanitarisme, santé mondial, compétence, sémiotique, Botswana, VIH/SIDA] RESUMEN Una consecuencia de la expansión reciente del interés antropológico en el humanitarismo es la aparente obviedad y estabilidad conceptual del "humanitarismo" en sí mismo...

When places come first: suffering, archetypal space and the problematic production of global health

“…It is therefore far harder to tease apart the relationship between blame, victimhood and suffering when people may not be entirely ‘blameless’ for some of the suffering engendered by non‐communicable diseases. It is also far trickier to animate global health's – admittedly ‘contingent’ (Brada ) – humanitarian zeal when individuals may be partially or inadvertently complicit in the genesis of their own suffering (Sridhar et al . ).…”

“…It is therefore far harder to tease apart the relationship between blame, victimhood and suffering when people may not be entirely 'blameless' for some of the suffering engendered by non-communicable diseases. It is also far trickier to animate global health'sadmittedly 'contingent' (Brada 2016)humanitarian zeal when individuals may be partially or inadvertently complicit in the genesis of their own suffering (Sridhar et al 2011). In the context of global health research, we are still quite far from even tacit acknowledgment that suffering might not only be ambiguous, but can also be willingly self-inflicted through the short-term pleasure-seeking that comes from so many 'unhealthy' behaviours (see Berlant 2011).…”

“…As a consequence, here I aim to drive geographies of global health in a new direction by examining how medical anthropology's commitment to suffering and its relative dominance of the field have combined to actively produce and render global health visible by and through certain archetypal spaces of suffering, a process that is not without consequence. Indeed, with global health such an elusive concept (MacPhail ), it is often only through these archetypal spaces that we come to ‘know’ what it is or might be (see Brada ). Thus the largely biomedical ‘enclaves’ (Nguyen and Peschard ) of hospitals and clinics of the global south – and most notably, Africa (Geissler ; Horton ; Tilley ) – have become global health's most visible face, sites of investment and knowledge creation.…”

Neutrality

“…Neutrality is thus often a claim seeking evidence, and humanitarians must frequently submit their actions, and their status as humanitarians, to the evaluation of others who might have their own ideas about what constitutes "neutrality" or "politics." Indeed, neutrality is a semantic shifter; that is, its meaning can only be defined relatively and in relation to other definitions and categories (Brada 2016), such as "politics" (as that which it is not). Consequently, to successfully claim neutrality requires intervening in socially complex and culturally diverse contexts in order to secure the recognition necessary to maintain a humanitarian field of operations (Gilbert 2016).…”

Uneasy translations: vernacularizing demography for post‐Soviet statecraft

“…Because of the discipline's sensitivity to the interactional and experiential nature of expertise, anthropologists have focused on ‘the dynamics of expertise‐in‐practice’ and demonstrated its inherently social and performative character (Carr : 19). An authoritative performance using a linguistic and non‐verbal repertoire with which to frame and interpret one's object of expertise is a major semiotic mechanism through which expertise is enacted (Brada ; Mertz ). In other words, one becomes an expert by learning not only what to say but also how to say it authoritatively (Carr ).…”