by Matthew Hunt
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. matthew.hunt@mcgill.ca
References
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.