Spending time at the Mason Institute as a visiting fellow in January 2018 afforded me opportunities to engage with members of the MI team and Liminal Spaces project, including prompting me to think about connections between their work on liminality and my own interests in the ethics of humanitarian innovation. In this blog post I reflect on the ways that thinking about humanitarian innovation as occurring in a liminal, in-between space helps foreground its ethical dimensions and signals the need for ethical attentiveness across the cycle of identifying, developing, implementing and diffusing innovations.
Humanitarian health organizations provide care and services to communities affected by war, disaster and epidemics, as well as to people who have been displaced by these events or who experience systematic exclusion. A particularly acute challenge for humanitarians relates to the responsibility to ensure that their interventions are effective and efficient, and to get better at helping those in need. This challenge has several layers: humanitarian action is widely dispersed, occurs in diverse settings, involves disparate actors, is temporally constrained and reactive to events, and is carried out in contexts of elevated and fluctuating risk. As a result, common mechanisms such as formal research and quality improvement initiatives may be more difficult to apply, though are becoming increasingly sophisticated and systematized. A related phenomenon has been the rise of the humanitarian innovation movement. Its origins are linked to a 2009 ALNAP report (Ramalingam, Scriven & Foley), with a key inflection point being the 2010 Haiti earthquake. Since then, each major humanitarian crisis has been associated with the uptake of new innovations and, in particular, novel information and communication technologies. The humanitarian innovation movement has also catalyzed developments such as new funding structures (e.g. Humanitarian Innovation Fund, Transformational Investment Capacity program), humanitarian innovation services and labs within and outside humanitarian agencies, and closer collaborations among humanitarians, the tech sector, and networks of online volunteers. Together, these developments have contributed to changes in how humanitarian action is being carried out, as well as shifts in the language and culture of humanitarian action as innovation became a prominent paradigm in the field (Betts and Bloom, 2014).
The emphasis placed on innovation, and the range of structures put in place to foster it, has contributed to many tangible changes in humanitarian action and the promise of more to come. Examples in humanitarian healthcare projects include point-of-care diagnostics, biometrics for refugee registration and health records, early warning of infectious disease outbreak, live mapping of people injured in an earthquake, 3D printing of prosthetic components in austere environments, and cold chain technology for vaccines, through the use of drones to deliver aid supplies or ferry patient samples to distant laboratories. While there have been efforts to articulate ethical principles for humanitarian innovation (Sheather et al, 2016; Betts and Bloom, 2014), on the whole, the connection between values and innovation has received limited discussion. As described by Sandvik, Jacobsen and MacDonald, a fast pace of innovation “can be observed with respect to many forms of humanitarian technology and humanitarian action based on the use of digital data. Yet, these practices are commonly framed in a humanitarian innovation language in which the possibility that humanitarian principles could be compromised is omitted.” (2017, p. 3)
It is here that the metaphor of liminality can be helpful in signaling the need for attention to ethical values and commitments in domains of action such as humanitarian innovation which lie between the more bounded – and regulated - domains of research and practice. Such attention is not only needed at the point where a new approach is being rolled out in a humanitarian project, but throughout its development and through to its evaluation and scale up. While acknowledging the benefits of developing new or refining existing processes and products, humanitarians and their partners should be attentive to how values and innovation intersect. The uncertainty and risks associated with trialing new innovations in a crisis setting should not be taken lightly. The experimental nature of humanitarian innovation is reflected in a description of the 2010 Haiti earthquake as a “living laboratory” for new technology deployments (Knight Foundation, 2011, p. 15). Settings of conflict, disaster or epidemic are inescapably tumultuous, strained and insecure environments. Introducing emergent technologies or other innovative approaches in these settings can make important contributions and improve responsive to the needs of local populations. They also raise ethical concerns (Hunt et al, 2016), such as widening asymmetries of power or undermining the dignity of individuals receiving assistance. Humanitarian organizations and their innovation partners should thus carefully consider how innovations relate to the principles of humanity, independence, impartiality and neutrality, and avoiding harm, demonstrating respect, protecting and sustaining dignity, being accountable, and promoting justice, amongst other ethical commitments. To achieve this goal, humanitarian organizations will need to demonstrate ethical attentiveness in the liminal space of humanitarian action, extending “a temporally continuous thread of attention” (Springer, 2013, p. 141) and critical self-awareness of the “social fabric of action.. taking stock of relationships, background expectations, and the ways in which [they] could come across” (p. 9). Ethical attentiveness across the innovation cycle is thus critical for promoting humanitarian innovation that is responsive to and upholds ethical commitments.
Matthew Hunt, PT, PhD, is an Associate Professor at McGill University in Montreal, Canada. He conducts research related to global health, ethics and rehabilitation, and co-leads the Humanitarian Health Ethics Research Group. In January 2018, he was a visiting scholar at the Mason Institute, University of Edinburgh. firstname.lastname@example.org
Betts, A., & Bloom, L. (2014). Humanitarian innovation: The state of the art. UN.
Hunt, M., Pringle, J., Christen, M., Eckenwiler, L., Schwartz, L., & Davé, A. (2016). Ethics of emergent information and communication technology applications in humanitarian medical assistance. International health, 8(4), 239-245.
Knight Foundation. (2011). Media, information systems and communities: Learning from Haiti. https://knightfoundation.org/reports/media-information-system-and-communities-lessons-h
Ramalingam, B., Scriven, K., & Foley, C. (2009). Innovations in international humanitarian action. ALNAP 8th Review of Humanitarian Action.
Sandvik, K. B., Jacobsen, K. L., & McDonald, S. M. (2017). Do no harm: A taxonomy of the challenges of humanitarian experimentation. International Review of the Red Cross.
Sheather, J., Jobanputra, K., Schopper, D., Pringle, J., Venis, S., Wong, S., & Vincent-Smith, R. (2016). A Medecins Sans frontieres ethics framework for humanitarian innovation. PLoS medicine, 13(9), e1002111.
Springer, E. (2013). Communicating Moral Concern: An Ethics of Critical Responsiveness. MIT Press.