‘Do No Harm’ Revisited: Assessing the Challenges of Its Relevancy in Post-Earthquake Haiti

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Introduction

The notions of humanitarianism, aid, and development assistance have long been associated with committing to the greater good.[1] Figures displaying public support seem to speak for themselves:  in response to one of the greatest humanitarian emergencies since the 2004 tsunami, the UK public alone donated £107m to agencies of the Disasters Emergency Committee working to ease human suffering following the 2010 earthquake in Haiti.[2] However, criticisms of humanitarian aid have become more prominent. One common argument implies a disregard for local dynamics and the existence of underlying motives that lead aid agencies to act to maximise their profits, negatively impacting and prolonging conflict.[3]

Rising criticism may be linked to increased interest in aid as a foreign policy tool. The international community gradually reinforced links between security and development, at which nexus we now find chronic poverty and deprivation potentially endangering global security.[4] Against this background, the distinction between short-term humanitarian aid and long-term development assistance has become blurred, challenging aid agencies’ commitment to the guiding principle of neutrality by linking development and peace-building and thus making complex emergencies even more obscure.[5]

It has been argued that Mary Anderson initiated a debate about this uneasy connection with her ‘do no harm’ principle (DNH) which advocates continued commitment to aid despite its potential negative effects.[6] Arguing aid is never neutral and always becomes part of the local context, she challenged the traditional understanding of humanitarianism.[7] However, the applicability of DNH can be questioned in situations in which deeply rooted social frictions affect the provision of emergency aid.

Despite the attention that post-earthquake Haiti has received, it is often forgotten that the country’s humanitarian situation is not only caused by this natural disaster, but also by violent conflicts within its society.[8] These conflicts have been reinforced by biased external humanitarian interventions shaping domestic politics and social tensions over more than a century.[9]

This essay discusses the challenges of applying Anderson’s DNH to the delivery of aid in conditions of violent conflict and natural disaster. More precisely, it uses the case of Haiti to test its theoretical relevance and underline its practical difficulties. Firstly, it frames the main components of Anderson’s arguments and elucidates the contemporary socio-political situation in Haiti. Secondly, it analyses the challenges and the impact of aid delivery in Haiti. Ultimately, by drawing on the findings of an interview with an aid worker deployed to Haiti in 2010, the essay evaluates the findings against the background provided in the first section.

Background

Before placing the present analysis in context, a word on methodology is necessary. A distinction is made between humanitarian aid, focusing on the alleviation of human suffering, and development assistance, which follows a more long-term strategy to prevent the return to conflict and to minimise vulnerability to natural disaster.[10] However, this distinction becomes blurred throughout the analysis, mirroring the reality of increased interdependence between humanitarian aid and development assistance.[11] This interconnectedness is widely disputed, but a discussion on such arguments lies beyond the scope of the present research.

Moreover, a mere theoretical discussion of the challenges involved in applying DNH seems inadequate in grasping the entirety of issues involved. Therefore, the case of Haiti is discussed to complement the theoretical analysis. This essay takes a holistic approach in doing so, i.e. it draws on different actors and assessments to identify challenges rather than analysing the influence of a selected few. This is due to the underlying understanding that the collectivity of aid and development actors impacts the situation on the ground, particularly when considering that already before the earthquake, 8000-9000 aid agencies and NGOs were deployed to Haiti.[12] Additionally, due to funding liabilities, it needs to be considered that reports by aid agencies and cross-agency committees might still provide a biased view. Thus, the findings of a semi-structured interview with an aid worker deployed to Haiti between January and July 2010 complements an assessment of the available literature.[13]

Anderson’s ‘Do No Harm’ Principle

Prior to examining the substance of DNH and its practical challenges, it seems necessary to highlight the core suppositions from which Anderson develops her argument.

Given that she perceives the notion of ‘conflict’ in its negative terms implying destruction and violence, and sees a co-dependence between peace and justice, three presumptions guiding her argument can be identified.[14] According to Anderson, (1) aid can never be provided in a neutral setting, but always influences local structures. She acknowledges (2) aid can both prolong and alleviate conflict, but should never be understood as the cause of violence itself.[15] Given this dismissal of aid agencies’ involvement in violence and their commitment to putting an end to human suffering, she stresses (3) it is crucial to keep a formal line between aid and peace-building.[16] This is not to say that aid cannot positively influence violent contexts and facilitate harnessing peace. However, the mandate should be clear in prioritising the mitigation of human suffering.

Drawing on these propositions, for their approaches not to have reverse effects, Anderson argues that aid agencies need to be aware of the systemic underpinnings of a conflict.[17] Thus, in complex emergencies, aid workers firstly need to identify the motivations fuelling the conflict on the ground. These can be obscurely interwoven and appeal to inter alia, sub-group identities, or historical grievances.[18] Second, aid agencies need to understand the kind of conflict they are encountering. In doing so, this facilitates the holistic assessment of factors playing a decisive role within the conflict, such as the relationship between warring fractions, their gains and losses, and the values upon which they act.[19] By paying attention to these drivers and the distinction between ‘root and proximate causes of conflict’,[20] aid can be provided in a manner that appeals to existing ‘local peace capacities’.[21]

According to Anderson, there are five categories of shared peace capacities: (1) institutions, (2) attitudes and actions, (3) values and motivations, (4) experiences, and (5) symbols and traditions.[22] Aid that entreats to these connections, transgressing social boundaries, can have a positive impact if it underlines these commonalities through its own ethical messages implied in its actions. For instance, aid workers can stress the importance of tolerance and equality and exemplify the benefits of cross-group cooperation by working with other agencies, which act on the basis of different values and mandates.[23]

Though, in theory, this appears straightforward, there are significant challenges complicating applicability on the ground. Here, Anderson identifies five ways in which aid can negatively impact conflict situations. However, due to present limitations, only two are particularly relevant in the Haitian case by appealing to underlying socio-economic structures: first, aid can reinforce the subsistence of a war economy by undermining local peacetime livelihoods;[24] second, unequal distribution of aid goods can fuel social tensions by reinforcing inequality.[25] Therefore, Anderson emphasises that the main challenge of the provision of aid lies in:

figur[ing] out how to do the good they [aid workers] mean to do without inadvertently undermining local strengths, promoting dependency, and allowing aid resources to be misused in the pursuit of war.[26]

Post-Earthquake Haiti

An analysis of the provision of aid and development assistance in Haiti presupposes the consideration of historical socio-political structures to understand the context that aid becomes a part of. Therefore, this section examines the history of Haiti though, due to formal limitations, it focuses on those aspects most relevant to the present research.

Today, Haiti is foremost characterised by deep divides and inequalities between a small elite who has enjoyed rather continuous foreign, mostly American, backing of its interests, and the poor masses who have been violently suppressed under the Duvalier dictatorship and the military rule that emerged from the turmoil in the early 1990s and mid-2000s.[27] The political failure of the democratically elected Jean-Bertrand Aristide, who was first elected in 1990 to represent the voice of the poor masses and then overthrown twice, exemplifies the deep social divides still existing today.[28]

Here, it is crucial to highlight the role of external influence. Having gone from France’s richest colony to the poorest country in the Americas, foreign influence and intervention in the domestic sphere, or to put it in Shah’s semantics ‘foreign intrigues’,[29] have never disappeared from Haiti’s political landscape.[30] While it may be argued that later the UN peacekeeping forces have attempted to support the country’s way towards stability and democracy, voices criticising international involvement in overthrowing disputed leaders have become louder.[31] Economic sanctions, tied aid, and ‘political support’ in the form of conditionality dictating neo-liberal structural adjustments, such as privatisation, and disregarding the national socio-economic landscape, reinforced social tensions about access to resources, mainly land, and power in the 1990s and 2000s.[32] Today, the electoral system that emerged after the earthquake and out of the above dynamics remains rather weak and prone to violence, reflecting historical instability.[33]

Analysis

Placing the implications of aid in Haiti within Anderson’s theoretical framework requires a thorough understanding of how aid has been distributed, by whom, and to whom. Aid and development assistance in post-earthquake Haiti has arguably helped ease the humanitarian emergency, but has also fallen short on a few aspects. The United Nations Office of the Special Envoy for Haiti (OSE), observes that $12 billion has been disbursed to assist post-earthquake reconstruction.[34] While most has gone to local and international NGOs and other service providers (43.1%), only a small amount has been channelled through the Government of Haiti (GOH) (3.3%).[35] Thus, the Red Cross, the World Food Programme, and the United Nations Children’s Fund are among the main recipients of aid and development funds.[36] Here, most agencies and institutions follow a needs-based and results-oriented approach, though the exact understanding of these terms varies distinctly.[37] The funds made available to achieve set results have been focused on different sectors, including infrastructure, health, governance, public services, and energy.[38] However, these sums exceeded the expenditures of GOH by more than three times.[39] Still, An analysis by the Inter-Agency Standing Committee (IASC) estimates the overall impact of aid has been positive: for instance, 4 million people received food and 1.5 million temporary shelter.[40] Nonetheless, it highlights such numbers need to be seen against short-term goals.

Here, three points of criticism can be identified. Firstly, aid provided to Haitians seems to have been short-sighted. For instance, the provision of temporary shelter eases immediate suffering, but does not tackle issues of poverty and inequality contributing to the need of the provision of temporary shelter in the first place.[41] Thus, a gap between humanitarian aid and development assistance persists and questions the appropriateness of results-oriented approaches.[42] Secondly, the number of actors involved and their different mandates complicates cooperation and challenges efficiency.[43] That mandates vary, from mere humanitarianism to guaranteeing international security, not only affects the relationship among agencies, but also impacts dynamics on the ground.[44] For example, while some actors entirely rely on local structures, others utilised the military to provide comprehensive assistance.[45] Thirdly, despite repeated emphasis on country-ownership, for instance through the Accra Agenda (2008) and the Busan Partnership (2011), practise shows that many actors circumvent GOH channels, thereby increasing inefficiency by undermining local structures.[46] To put this in numbers, only 0.6% of overall aid disbursements went to Haitian institutions and organisations between 2010 and 2012.[47]

Therefore, the complexity within which aid agencies operate and which they, to a certain degree, need to be made accountable for becomes apparent. The following section of the essay assesses to what extent these findings relate to Anderson’s DNH.

Evaluation

Having analysed the assumptions and performance of aid agencies working in post-earthquake Haiti, it can be observed that Anderson’s predictions are partially reflected in the above, but simultaneously seem too simplistic for the present case.

When examining the overlaps of theory and practise, a few aspects are striking. While Anderson warned that because aid is never neutral, it can severely undermine local structures, the fact that only a small amount of disbursements went through GOH implies that the already weak governmental institutions were further weakened by well-intended aid.[48] The emergence of a ‘dual public sector’, i.e. one sector being managed by the government and one by aid agencies, can be helpful in the immediate aftermath of an emergency, but significantly harms local structures in the long-run.[49] The fact that aid significantly exceeded GOH’s expenditures reinforces this dependency and lack of country-ownership. Moreover, the number of actors, mandates, and motivations on the ground can make cooperation with local representatives difficult. Nonetheless, the gravest criticism of the provision of aid in Haiti that is mirrored in Anderson’s argument refers to the lack of attention paid to the underlying class conflict. It can be observed that NGOs and intergovernmental institutions tend to be more reflective of local dynamics than bilateral donors. Whereas the OSE and the Inter-American Development Bank recognise the socio-political and economic inequalities that define the Haitian context, the US Government’s strategy fails to account for these.[50]

However, while applying these findings to DNH implies that aid has done more harm than good by disregarding local structures and following own agendas, the situation on the ground might be more complex than initially apparent. The interview conducted with J. Mayer exemplifies this assumption. While, in line with Anderson’s argument, one of the main challenges lies in being able to distinguish between more superficial problems caused by the earthquake and much deeper problems rooted in the social make-up of the country; this is highly difficult in an emergency.[51] For instance, Mayer notes that his work was complicated by the lack of quality information and functioning infrastructure. Moreover, it can be observed that his accounts hint at the fact that Haitians from wealthier backgrounds found it easier to re-establish their livelihoods through engagements with international NGOs.[52] One could, therefore, draw the conclusion that scant attention was paid to who was installed in the higher professional ranks, thereby supporting one social group and possibly weakening another and potentially re-installing people who had been neglected high offices in usual democratic settings. This lack of attention to social dynamics has been criticised by Anderson.[53]

Nonetheless, underlining the failures of aid agencies is too simplistic. The interview shows that sometimes aid workers have no alternatives.[54] For instance, the emergency setting arguably required the employment of English-speaking personnel to guarantee immediate relief coordination. While the willingness to appeal to local (peace) capacities exists, exemplified by a commitment to local capacity-building and the reinforcement of peaceful community values by cooperating with other NGOs (i.e. sending appropriate ethical messages), severe circumstances might prevent workers from fully acting in line with DNH.[55] The urge to ease human suffering at any short or long-term costs in an emergency has been said to antagonise aid workers on the ground.[56]

Having said that, one could argue that against the background of an increasing overlap of humanitarian aid in emergency settings and development assistance in post-recovery periods, DNH is too simplistic. It certainly provides guidelines for successful development, and Anderson is correct in arguing that not providing aid at all would have disastrous effects. Yet, practically applying DNH in emergency situations, such as Haiti, where social infrastructures have been severely damaged, becomes increasingly difficult if not impossible.

Conclusion

In the case of persistent underlying class conflict in Haiti, the analysis shows that Anderson’s DNH can help identify the shortcomings in the provision of aid, yet it also stresses that DNH cannot practically be applied in its entirety in every context. Here, the main challenge stems from a gap between theory and practise that disregards the difficult context of combined humanitarian emergency and violent social conflict.[57] Thus, it could be argued that Anderson sidelines the moral questions that emerge with the increasing interconnectedness of humanitarian aid and development assistance, transgressing the boundaries of where one ends and the other one begins.[58] However, showing the need for further research, the present limitations do not allow for a more substantiated analysis of what can be done to integrate these questions into Anderson’s DNH. This would, inter alia, entail a more fundamental discussion on the link between aid, development assistance, and peace-building. For example, the case of Syria will become particularly interesting.

Bibliography

Anderson, M. B. (1999). Do no Harm: How Aid Can Support Peace – Or War (London: Lynne   Rienner Publishers, Inc.).

Barnett, M., & Weiss, T. (eds.; 2008). Humanitarianism in Question – Politics, Power, Ethics. (Ithaca: Cornell University Press).

Boyce, J. (2010). Aid and Fiscal Capacity Building in Post-Conflict Countries. In Berdal, M., & Wennmann, A., (eds.), Ending Wars, Consolidating Peace: Economic Perspectives. London: Routledge/The International Institute for Strategic Studies.

Dash, J. M. (2004). The Disappearing Island: Haiti, History, and Hemisphere. CERLAC Colloquia Paper, April 2004 (York University).

Gibbons, E., & Garfield, R. (1999). The Impact of Economic Sanctions on Health and Human Rights in Haiti, 1991-1994. In American Journal of Public Health, Vol. 89(10), pp. 1499-1504.

Goodhand, J. (2006). Aiding Peace? The Role of NGOs in Armed Conflict (Rugby: Intermediate Technology Publications Ltd.).

Hallward, P. (2007). Damming the Flood: Haiti, Aristide, and the Politics of Containment (London: Verso).

Hidalgo, S. (2012). Inter-Agency Real-Time Evaluation of the Humanitarian Response to the Earthquake in Haiti. Inter Agency Standing Committee Final Report. Retrieved February 15, 2013, from http://www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-search-fastsearch&query=Haiti

Holmes, J. (2010). The Haiti Earthquake Response. In Humanitarian Exchange, No. 48, pp. 1-2 Retrieved February 15, 2013, from http://www.odihpn.org/humanitarian-exchange-magazine/issue-48/lessons-learned-from-the-haiti-earthquake-response

Inter-American Development Bank (2011). Country Strategy with Haiti 2011-2015. Retrieved 18 February, 2013, from http://www.iadb.org/en/countries/haiti/country-strategy,1014.html

Keen, D. (2008). Complex Emergencies (Cambridge: Polity Press).

Levine, S. (2012). Haiti two years on: beyond the headlines. Overseas Development Institute Opinion (12 January 2012). Retrieved 17 February, 2013, from http://www.odi.org.uk/opinion/6252-haiti-2012-two-year-anniversary

Lundahl, M. (1989). History as an Obstacle to Change: The Case of Haiti. In Journal of Interamerican Studies and World Affairs, Vol. 31(1/2), pp. 1-21.

Mayer, J. (2013). Name changed due to privacy reasons. Interview conducted by Teresa Lappe-  Osthege, London, 27.02.2013.

McFarlane, I. (1997). Haiti. In Randel, J., & German, T. (eds.). The Reality of Aid – An Independent Review of Development Cooperation 1997-1998 (London: Earthscan Publication Ltd.).

Polman, L. (2010). War Games: The Story of War and Aid in Modern Times (London: Viking).

Schloms, M. (2003). Humanitarian NGOs in Peace Processes. In International Peacekeeping, Vol. 10(1), pp. 40-55.

Shah, K. (2009). The Failure of State Building and the Promise of State Failure: reinterpreting the security-development nexus in Haiti. In Third World Quarterly, Vol. 30(1), pp. 17-34.

Shearer, D. (2000). Aiding or Abetting? Humanitarian Aid and Its Economic Role in Civil War.  In Berdal, M. & Malone, D. (eds.). Greed and Grievance – Economic Agendas in Civil Wars  (London: Lynne Rienner Publishers).

Slim, H. (1997). Doing the Right Thing: Relief Agencies, Moral Dilemmas and Moral Responsibility in Political Emergencies and War. In Disasters, Vol. 21(3), pp. 244-257.

United Nations Office of the Special Envoy for Haiti (OSE) (2012). Can More Aid Stay in Haiti and other Fragile Settings? How Local Investment can Strengthen Governments and Economies. Retrieved 12 February, 2013, from http://www.odi.org.uk/node/18208.

United States Government (2011). Post-Earthquake USG Haiti Strategy -Toward Renewal and Economic Opportunity. Retrieved 12 February, 2013, from http://www.state.gov/documents/organization/156448.pdf.

Williams, P. (2011). War and Conflict in Africa (Cambridge: Polity Press).

Zanotti, L. (2010). Cacophonies of Aid:  Failed State Building and NGOs in Haiti: setting the stage for disaster, envisioning the future. In Third World Quarterly, Vol. 31(5), pp. 755-771.


[1] Slim (1997), p. 251.

[2] ‘Haiti, 3 Years On’ from http://www.dec.org.uk/appeals/haiti-earthquake-appeal/haiti-3-years, 4 March, 2013.

[3] Keen (2008), p. 135; Polman (2010).

[4] Shah, (2009), p. 18.

[5] Keen (2008), p. 108; Barnett & Weiss (2008), p. 3.

[6] Anderson (1999).

[7] p. 1.

[8] Dash (2004); Zanotti (2010), p. 756.

[9] Ibid.

[10] Williams (2011), p. 205.

[11] Goodhand (2006), p. 1.

[12] Zanotti (2010), p. 757.

[13] For privacy reasons, the name of the interviewee is anonymised. He is hereafter referred to as J. Mayer.

[14] Anderson (1999), p. 7.

[15] p. 1; pp. 67-69.

[16] p. 2-3.

[17] Schloms (2003), pp. 44-47; Anderson (1999), p. 8.

[18] Anderson (1999), pp. 8-9.

[19] pp. 11-22.

[20] p. 70.

[21] p. 23, p. 55.

[22] pp. 25-31.

[23] p. 56, p. 58.

[24] p. 42.

[25] p. 39.

[26] p. 2.

[27] Hallward (2007), p. xxiv; Lundahl (1989), pp. 2-7; Shah (2009), pp. 23-29.

[28] Gibbons & Garfield (1999), p. 1499; Hallward (2007), pp. 44-46.

[29] Shah (2009), p. 23.

[30] McFarlane (1997), p. 217; Hallward (2007).

[31] Ibid.

[32] Hallward (2007), pp. 53-55; Shah (2009), pp. 28-29.

[33] ‘Haiti – Freedom in the World 2012’, from http://www.freedomhouse.org/report/freedom-world/2012/haiti, 25 February, 2013.

[34] OSE (2012), p. 15.

[35] p. 28.

[36] p. 25.

[37] Holmes (2010), p. 2.

[38] United States Government (2011); ‘How much programmable cash is required for sector rebuilding in Haiti (2010-2012)?’ from http://www.lessonsfromhaiti.org/assistance-tracker/#/sectorAnalysis, 1 March, 2013.

[39] OSE (2012), p. 15.

[40] Holmes (2010), p. 2.

[41] Hidalgo (2012), pp. 7-8.

[42] Levine (2012).

[43] Holmes (2010), p. 2.

[44] Ibid.; United States Government (2011), p. 8.

[45] Mayer (2013); Holmes (2010), p. 2.

[46] Levine (2012); Holmes (2010), p. 3; OSE (2012), p. 10.

[47] OSE (2012), p. 13.

[48] Anderson (1999), pp. 39-44.

[49] Boyce (2010), p. 102.

[50] United States Government (2011); OSE (2012); IDB (2011).

[51] Holmes (2010), p. 3; Mayer (2013).

[52] See Mayer’s accounts on the recruitment process. Particularly striking is the fact that those people with increased language skills, i.e. combing French and/or English with Creole, seem to have been able to assume higher professional roles, such as his ‘number two’ who eventually became the Logistics Manager.

[53] Anderson (1999).

[54] Silm (1997), p. 257.

[55] Mayer (2013).

[56] Gibbons & Garfield (1999), p. 1502.

[57] Mayer (2013).

[58] Keen (2007); Slim (1997).

[59] Name changed for the purpose of this research.


Written by: Teresa Lappe-Osthege 
Written at: King’s College London
Written for: Prof. Mats Berdal
Date written: March 2013

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