1 comment on “The Global Migration Crisis in an Age of Moral Austerity: Reflections in Humanitarian Ethics”

The Global Migration Crisis in an Age of Moral Austerity: Reflections in Humanitarian Ethics

by John Pringle

Dire words abound: “Global forced displacement hits record high”[1] and “We are currently witnessing the largest and most rapid escalation ever in the number of people being forced from their homes”.[2] The number of people in flight has grown steadily over the last four years to the point that there are more than 65 million people forcibly displaced from their homes, a level not seen since the Second World War.

Numbers say a lot, but they don’t tell us everything. They don’t tell us about traumatic journeys, about the anguish of taking impossible risks and navigating complex networks of saviors and swindlers.[3] They say nothing of the despair endured by the internally displaced whose needs get overlooked.[4]

As a teen, I was highly influenced by the writings of the moral philosopher Peter Singer. His book “Animal Liberation” was unlike anything I had read. [5] Singer validated my decision to adopt a vegetarian diet against much societal pressure. His writings also helped me to frame my understanding of the gross imbalances of wealth in the world and to view disparity as other than natural or inevitable.

Famously, Singer devised the thought experiment of a drowning child: [6]

On your way to work, you pass a small pond. … You are surprised to see a child splashing about in the pond. As you get closer, you see that it is a very young child, just a toddler, who is flailing about, unable to stay upright …. If you don’t wade in and pull him out, he seems likely to drown. Wading in is easy and safe, but you will ruin the new shoes you bought only a few days ago, and get your suit wet and muddy. What should you do?

Obviously a decent person would wade in and save the child. Singer uses the thought experiment of the drowning child to argue that those of us in affluent countries have an ethical duty to help distant strangers as we do to help those in close proximity: that distance (geographic or affective) does not justify deadly neglect. So then what of the estimated 5.9 million children who will die before reaching age five as a result of diseases that are readily and affordably prevented and treated?[7] Although Singer’s thought experiment is problematic and subject to critique,[8] it is influential and compelling.

Its parallel with the Global Migration Crisis is stark. Singer’s drowning child has drowned, is drowning.

 

Image generated by Robert Sharp using Waterlogue, after a photographs by Nilufer Demir.   http://www.robertsharp.co.uk/2015/09/05/photo-aylan-kurdi/photo-04-09-2015-22-46-39/

 

In April 2015, the humanitarian organization Médecins Sans Frontières (MSF) took the unprecedented step of launching search, rescue and medical aid operations in the Mediterranean Sea. Its aid workers quickly discovered that more was required than pulling people from the water. An MSF nurse put it best, “Their bodies tell us about the horrible things they’ve been through.”[9]

As with so many crises of humanity, humanitarian and other civil society organizations are wading in where governments refuse to tread. The humanitarian response to the Global Migration Crisis is an act of defiance and solidarity. It involves care for victims of rape and psychosocial support for survivors of detention, torture, sexual exploitation and human trafficking. While these are noble efforts, they are increasingly thwarted by official indifference, obstruction, and outright belligerence on the part of governments and anti-immigration forces.

It seems we live in an age of moral austerity.

To make sense of moral austerity, it helps to look to the social, economic and political forces that shape the realm of the possible. The prevailing dominant ideology in our social and economic lives is neoliberalism.[10] The neoliberal paradigm situates us in an era of economic austerity in the wake of the global financial crisis (of its own making). Economic austerity requires moral austerity as our governments impose deep cuts that affect the most vulnerable members of our societies while channelling trillions of our public dollars to private banks and corporations.[11] The system of imposing regressive policies on the heels of destabilizing shocks is aptly described as disaster capitalism.[12] It is a neoliberal logic that sees first to the wants of banks and corporations. Corporate hegemony doesn’t demand our compassion as it does our life savings, and thankfully morality is not finite. So instead, let’s direct our compassion to Singer’s drowning child.

On the basis of Singer’s thought experiment, this is my simple argument for providing succor to the victims of the Global Migration Crisis, for rescuing people in immediate distress, for providing medical and psychosocial care, for opening up safe routes to sanctuary, for allowing people to cross borders with or without travel documents, and for resettling people who require it.[13]

To be clear, the solution to the Global Migration Crisis will be neither medical nor charitable. We must not disassociate the crisis from broader injustices that are forcing displacement, including war and political violence, the bombing of schools, hospitals and civilians with impunity, climate crisis and ecological collapse from ruthless resource extraction and agribusiness, and what political theorists call accumulation by dispossession.[14] We can expect to see more and more drowning children in an ever expanding pond. But by exercising our compassion, supporting humanitarian and other civil society organizations, and holding our governments accountable, there may be hope yet for Singer’s drowning child and for us.

John Pringle can be reached at johndpringle@gmail.com.

You can find an additional commentary at John’s Huffington Post page: http://www.huffingtonpost.com/entry/the-worlds-your-detention-center-as-humanity-wrings_us_5919b5dee4b02d6199b2f168

_________________________

[1] http://www.unhcr.org/afr/news/latest/2016/6/5763b65a4/global-forced-displacement-hits-record-high.html Accessed 29 May 2017.

[2] http://newirin.irinnews.org/global-refugee-crisis/. Accessed 29 May 2017.

[3] Peter Tinti & Tuesday Reitano (2016). Migrant, Refugee, Smuggler, Savior. Hurst Publishers: London.

[4] http://www.internal-displacement.org/global-report/grid2017/. Accessed 29 May 2017.

[5] Peter Singer (1975). Animal Liberation: A New Ethics for Our Treatment of Animals. Random House: NY.

[6] Peter Singer (1972). Famine, Affluence and Morality. Philosophy and Public Affairs, 1(3): 229-243. See also:

http://www.nytimes.com/2009/03/11/books/chapters/chapter-life-you-could-save.html. Accessed 29 May 2017.

[7] UNICEF (2016). The State of the Word’s Children 2016: A fair chance for every child. United Nations Children’s Fund: https://www.unicef.org/publications/files/UNICEF_SOWC_2016.pdf. Accessed 31 May 2017.

[8] See for example: Scott Wiser (2011). Against shallow ponds: an argument against Singer’s approach to global poverty. Journal of Global Ethics, 7(1): http://dx.doi.org/10.1080/17449626.2010.548819

[9] http://blogs.msf.org/en/staff/blogs/moving-stories/search-and-rescue-their-bodies-tell-us-about-the-horrible-things-theyve. Accessed 30 May 2017.

[10] David Harvey (2007). A Brief History of Neoliberalism. Oxford University Press

[11] https://www.forbes.com/sites/mikecollins/2015/07/14/the-big-bank-bailout/#4b324d712d83. Accessed 31 May 2017.

[12] Naomi Klein (2007). The Shock Doctrine: The Rise of Disaster Capitalism. Random House

[13] http://www.huffingtonpost.com/entry/the-worlds-your-detention-center-as-humanity-wrings_us_5919b5dee4b02d6199b2f168. Accessed 31 May 2017.

[14] David Harvey (2004). The ‘new’ imperialism: accumulation by dispossession. Socialist Register 40: 63-87.

0 comments on “Ethics and Unmet Promises: Syrian refugees healthcare in Lebanon”

Ethics and Unmet Promises: Syrian refugees healthcare in Lebanon

The New York Declaration for Refugees and Migrants, adopted by the United Nations GEneral Assembly in September 2016, stresses that root causes should be addressed “through the prevention and peaceful resolution of conflict, greater coordination of humanitarian, development and peace-building efforts, the promotion of the rule of law at the national and international levels and the protection of human rights”. The international community has thus recognized “a shared responsibility to manage large movements of refugees and migrants in humane, sensitive, compassionate and people-centered manner”.

UN Document A/71/L.1. (paragraph 11)

Refugees & Migrants and Ethical Responsibility for their Health Care:

  • It is more than simple generosity, simple charity.
  • It aims to build spaces of normalcy in the midst of what is abnormal.
  • More than offering material assistance, we aim to enable individuals to regain their rights and dignity as human beings.

Nobel Lecture by James Orbinski, Médecins Sans Frontières, Oslo, December 10, 1999

The Context

Since the start of the Syrian conflict in 2011, Lebanon has been host to incoming refugees. The UNHCR estimates 1,050,877 Syrians are now in Lebanon, amounting to 25% of the Lebanese population. Refugees are concentrated in the North and Bekaa regions, host communities that are already poor, underserved and vulnerable.[1]

The Issue

The large and constant influx of Syrian refugees into Lebanon has greatly strained the Lebanese healthcare system and economy. Many local and international NGOs, humanitarian organizations and governmental agencies are involved in providing humanitarian assistance and health services to Syrian refugees. Yet, there remain existing structures that limit refugee access to essential health care services, including poor coordination between them. The result is a rise in communicable diseases, increased risk of epidemics, suboptimal control of chronic diseases, and other health related matters.[2]

How can the Lebanese MOPH and other stakeholder organizations secure better access to essential and urgent healthcare needs of Syrian refugees?

Current Health Situation of Syrian Refugees in Lebanon

Access to Healthcare by Syrian Refugees in Lebanon

Roles and Responsibilities of the Lebanese Ministry of Public Health (MoPH)

Conclusion

It is important to promote access to Essential Health Care Services for Syrian Refugees in Lebanon and to recognize the severe shortage in financing and unmet promises by the international community. An immediate action and far greater support from the international community is needed to address the needs of refugees in Lebanon.

Recommendations for the MOPH and international aid agencies:

  1. Develop an essential package of healthcare services for Syrian refugees and Lebanese people.
  2. Develop a mechanism at the level of the government to raise funds to finance the delivery of the essential package.
  3. Expand the number of primary healthcare centers, and hospitals that are within the humanitarian sector.
  4. Developing refugee health information system through:
    • Identifying priority data needs and requirements;
    • Developing guidelines for data collection, and data use;
    • Establishing a mechanism for data monitoring, data sharing between all stakeholders including the private sector.
  5. Invest in building capacities of local infrastructure and local government (municipalities) to handle crisis situations.
  6. Explore mechanisms to increase transparency in the work including resource allocation of NGOs and other agencies in delivering health interventions.
  7. Invest in decentralizing decision making capacity at the level of the government departments to match interventions and aid to the needs of the local community.
  8. Identify research priorities on refugee health.
  9. Strengthen the stewardship function of governmental departments and having a lead organization that is capable to play a major role by coordinating and establishing effective partnerships with local and international agencies.

About the Author:

Michel Daher, MD, FACS
Professor of Surgery, Univ of Balamand
Secretary General, Lebanese National Ethics Committee
Vice-Chair, National Committee for Palliative Care
Saint George Hospital-UMC, Beirut- Lebanon
mndaher@inco.com.lb

 

Photo Credit: One-month-old baby boy, Walid, is comforted by his mother after a check-up provided by UK aid at a Save the Children clinic in Lebanon’s Bekaa Valley. Walid’s mum was worried about him but the diagnosis was just that’s he suffering from colic, which will hopefully get better by itself in time. The UK is supporting Save the Children to provide access to primary healthcare for thousands of Syrian refugee children in Lebanon, as well as ensuring that hundreds of pregnant Syrian women have access to anti-natal care. To find out more about how the UK is responding to the humanitarian crisis in Syria and its neighbouring countries, please see:www.gov.uk/government/news/syria-the-latest-updates-on-uk… Picture: Russell Watkins/Department for International Development

 

[1] (UNHCR, 2014 – WB&UN, 2013; UNHCR. 2015. Syria Regional Refugee Response http://data.unhcr.org/syrianrefugees/regional.php)

[2] (Refaat & Mohanna, 2013)

2 comments on “The Rising Humanitarian Tide”

The Rising Humanitarian Tide

by John Pringle

(version français à la suite)

“Every ship is unsinkable, until it sinks” (Crawley, 2010). So it is with human rights: inviolable until they are denied. The right to protection from war, the right to maritime rescue, the right to seek asylum, the right to life’s necessities, the right to health care, and the right to be treated humanely and with dignity: the words are failing the very people they were written to protect. Who would have thought, that in the 21st century, we would have to argue defensively for pulling drowning people from the sea. The humanity principle – that people are entitled to assistance and to be treated humanely simply by virtue of being human – is not and never has been a given. Lives are not valued equally, some not at all.

That human lives are undervalued may come as a shock. Unless you are an aid worker. As an aid worker, you may have seen a child die for lack of a ten cent measles vaccine – measles kills about 400 children every day (WHO, 2015). You may have seen a patient suffer for lack of an available treatment – diseases of poverty are invisible to pharmaceutical companies (Access Campaign, 2015). As an aid worker, you will have witnessed how the global economic system values people for their wealth. And it values profit. Apart from that, it sees nothing of value (Patel, 2010).

The Global Refugee Crisis is a stark reminder that we live in a world of disparity. The old mantra, “a rising tide lifts all boats”, argues that what is good for the economy is good for everybody. But in the context of a Mediterranean graveyard, the rising tide cliché is not just ironic but grotesque. After decades of neoliberal economic policies, the tide has lifted only luxury yachts and military patrol vessels.