Setting: A remote health clinic in the Horn of Africa

Scenario: An international medical NGO is staffing a health clinic in a remote village located near a large-scale agriculture enterprise operated by a multinational corporation. Many of the clinic’s patients are migrant workers who have come to the region seeking work at the commercial farm. Employees receive low wages by local standards, work very long hours, and have poor living conditions. Many of the workers and their family members present to the clinic with signs of malnutrition. A number of them also report respiratory complaints and skin and eye problems, which they associate with their handling of pesticides on the large farm.

The staff of the health clinic are concerned that their presence is enabling this pattern of mistreatment by providing free healthcare to the farm workers. They worry they are directly assisting a for-profit industry by taking over the company’s responsibility for the health and welfare of its employees. There are even reports that the agriculture corporation is using the promise of free healthcare at the clinic to recruit migrant workers from other regions. Although clinic staff do not want to see their work being co-opted by a multinational corporation, they also recognize the need to provide healthcare to the migrant workers, who might otherwise continue suffering from treatable illnesses.

Analysis: Apply this case to the Humanitarian Healthcare Ethics Analysis Tool (HHEAT). The HHEAT  is intended to facilitate discussion and deliberation for those involved in ethically challenging situations and will assist humanitarian healthcare workers in implementing well-considered decisions.  The six steps are designed to help you or your team structure reflection and deliberation on the ethical dilemma presented in the case study. You may skip questions that appear less relevant to the issue or explore dimensions pertinent to the context but not listed in the tool.

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Disclaimer: Case studies in the ENHA (Ethics Narratives in Humanitarian Aid) series are based on the reflections of humanitarian healthcare workers on ethical challenges experienced in the field. While the stories presented in the cases draw on real events and the accounts of real persons, many stories are composites in which similar experiences are woven together. In all of the stories, details such as names, dates, locations, career and life stage, gender, and profession have been changed, obscured, or omitted. Any resemblance the stories may bear to actual persons, places, and events is co-incidental.

While the stories often aim to show what the protagonist is thinking or feeling, the Humanitarian Healthcare Ethics Research Group’s intent as the stories’ author is not to suggest that the values and assumptions held by a story’s protagonist are those of all or many humanitarian healthcare workers. Similarly, the values, opinions and actions of a protagonist or other actors in a story should not be understood to reflect those of, or be endorsed by, the Humanitarian Healthcare Ethics Research Group.

How to cite: Humanitarian Healthcare Ethics. 2014. ENHA Case Study Series: Co-opting of Aid Organizations. www.humanitarianhealthethics.net.

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