Abstract
For decades, sociological studies of “development” have primarily revolved around analyses of why some nations have higher levels of economic development than others. Significantly less attention has been paid tothose individuals and organizations professing to do development. How do practitioners within the expanding, transnational development industry understand and enact their work, and how is this multi-billion dollar industry consequential for the lives of those targeted for service?
The two books reviewed here—Monika Krause’s The Good Project and Rene C. Fox’s Doctors Without Borders—represent the best in a welcome and expanding new area of scholarship investigating a subset of this development industry: transnational humanitarian organizations. Both books examine the complexities encountered by humanitarian organizations as they aim to stem humanitarian crises in developing nations or to promote human rights for distant others. Both find that the peculiar dynamics of humanitarian organizations, more so than the needs of the potential beneficiaries, determine which actions are taken, where, and for whom. Explaining the complexities and potential consequences of these organizational processes is the goal of each book, although each author’s approach to this goal is quite distinct.
Krause’s main argument is clearly stated and well reasoned. In a world full of need, humanitarian organizations are in the unenviable position of selecting who to help, and how, with the limited resources available. To negotiate this dilemma, Krause finds that humanitarian organizations have entered the business of producing “relief.” Specifically, humanitarian organizations package relief into “projects” and then market those projects to the “consumers,” or donors, willing to pay for them. The beneficiaries of the projects—those targeted for relief—are therefore considered an integral feature of the project itself, and not the clients ofthe organization. The more marketable the beneficiaries, Krause suggests, the moremarketable the project. As a consequence, humanitarian organizations regularly undertake those projects that are deemed especially feasible and especially marketable, perhaps at the expense of projects that serve populations most in need.
The book’s main object of analysis is theshared social space, or transnational field, in which humanitarian organizations operate. According to Krause, managers seeking to design good projects do not do so in a vacuum, but rather as individuals embedded in an organizational field characterized by shared logics and practices. These shared logics and practices are sometimes generated through formal statements (like Sphere and HAP initiatives, or ideologies of “human rights”) and other times through shared technologies like the “logframe.”
The logframe is a relatively standardized form for planning projects that emphasizes feasible goals and measurable outcomes (e.g., number of patients immunized, number of latrines built). Because donors often ask to see project logframes before deciding to invest, logframes have become standardized practice across the field, thus incentivizing projects that maximize measurable outcomes for a particular investment. As a result, Krause argues, certain populations are regularly excluded from consideration for relief. To illustrate, projects targeting denser, more accessible populations would look much more attractive on a logframe than targets treating less dense, less accessible populations, given that the latter would require significantly more resources to reach and ultimately help fewer people. In short, Krause argues that organizations must subscribe to these shared practices and common technologies if they are to make their projects intelligible to funders and other organizations in the field, even as these shared logics fundamentally limit the kinds of projects that can be envisioned and for whom they can be targeted. Understanding the historical development and present-day implications of these shared logics of practice is the central goal of the book.
Krause’s book provides important new insights into how the organizational structure of the burgeoning aid industry incentivizes particular kinds of relief efforts in developing countries. This theoretical complexity is a welcome advance over the stalled macro-level debates about whether aid is “good” or “bad” for poor populations. By exposing the inner workings of humanitarian organizations, this book also provides a fascinating and highly accessible learning tool for students, both undergraduates and graduates, who endeavor to save the world through humanitarian actions. In addition, Krause raises important, provocative questions for future research, such as how populations in need become “beneficiaries,” and how beneficiaries might not be passive recipients of aid, but rather active agents in promoting their own assistance. At times, Krause’s thoughtful theorizing does feel like it comes at the expense of thick data, leaving the reader to wonder sometimes how the evidence collected supports the arguments she makes. But overall, Krause’s exemplary logic and novel theoretical insights provide a powerful new model of transnational humanitarianism that I anticipate will transform how scholars investigate aid and its impacts.
Fox’s book, despite the similarity of the topic, is a strikingly different read from Krause’s. Over the course of two decades, Fox investigated in detail the historical development, internal workings, and aid decisions of one of the world’s most famous and influential humanitarian organizations: Doctors Without Borders (referred to throughout the book as MSF, short for the French Médecins Sans Frontières). Whereas Krause actively theorizes about the actions and decisions of humanitarian organizations, Fox’s book is striking for the almost complete lack of analysis by the author. Instead, Fox strives to let her respondents speak for themselves, organizing their debates and discussions into a manuscript that elegantly demonstrates how MSF workers are constantly and profoundly engaged in analyses of “the numerous dilemmas of the humanitarian act.” Capturing in careful detail MSF aid workers’ thoughtful and passionate struggles with these dilemmas is the primary goal of this ethnographically rich, often inspiring analysis.
MSF was founded in 1971 by thirteen Frenchmen, primarily physicians, who wanted to change the guiding ideas and practice of humanitarian health care. These founding fathers had been volunteers in the French brigade of the International Committee of the Red Cross (ICRC) during the Nigerian Civil War. As volunteers, they sought to publicly denounce what they believed to be the “genocidal” actions of the Nigerian government. However, the ICRC strictly forbade such statements, believing that the only way to maintain long-term access to populations in need was to promise discretion to political leaders. MSF was therefore founded as an alternative to the apolitical humanitarian notions of the ICRC. For MSF, humanitarian care required not just treating people, but witnessing for them, where witnessing involved listening to the people treated, raising awareness around their conditions, and, when necessary, publicly denouncing the actions of political elites who allowed or caused the humanitarian tragedies.
MSF’s internal debates around “witnessing” were a central theme throughout the book. As an organization, MSF grew quickly, opening new headquarters in a number of other (mostly European) nations and extending their projects, or “campaigns,” to more than 60 nations worldwide. MSF also garnered remarkable international fame for its work, including winning the Nobel Prize for Peace in 1999. Yet despite its increasing size, scope, and fame, MSF maintained its culture of intellectual debate and self-criticism as a cornerstone of its organizational practice.
Throughout the book, Fox provides extensive quotes from interviews, observations from MSF meetings, and analyses of MSFdocuments to demonstrate how MSF members regularly wrestled with questions about whether they should enter a field site and how, the difficulties of sharing power and decision-making across multiple organizational offices, how much “risk” to allow their doctors and staff to take when entering dangerous field zones, and, centrally, how their commitment to “witnessing” was complicated by the realities of the field. Indeed, as the ICRC had predicted, witnessing did sometimes interrupt MSF’s ability to provide care; and in these moments, MSF had to decide whether to provide the care or the advocacy, because doing both was simply not an option. More recently, the question of the potential paternalism of witnessing, as embedded in historical north-south global power disparities, has also been the subject of debate and internal critique.
This is a rich book filled with thick descriptions of conversations, meetings, arguments, and decisions as they occurred both in European organizational offices and in the field sites of Greece, South Africa, and Russia. On several occasions, Fox deftly reconstructs the process of how a project was first envisioned at high levels of the organization and how those visions changed, and sometimes faltered, when carried out on the ground. In addition to projects that fulfilled and even superseded MSF’s lofty expectations, Fox also shows moments where MSF’s careful planning and high ideals nevertheless resulted in projects that imploded, such as an attempt to tackle drug-resistant tuberculosis within a Siberian prison. It is the interaction between these moments of brilliance and moments of vulnerability, and MSF’s willingness to own them all, that makes this book so engaging.
The depth of Fox’s access to MSF, and the resulting magnitude of the data she collected, is evident on every page, and I often marveled at her ability to organize these complex ideas and arguments, over time and across the mammoth geographical spread of the organization, into a cohesive and compelling story. Fox offers little in the way of analysis and no sociological theorizing of her own. Rather, she leaves it up to readers to construct their own ideas about what MSF signifies for humanitarianism. This is one of those books that you anticipate will generate another interesting insight every time you read it.
The Good Project and Doctors Without Borders, when read together, raise provocative questions for the future of humanitarian studies. Whereas The Good Project describes an increasing isomorphism across the organizational field of humanitarianism, Doctors Without Borders examines how humanitarian work within one specific organization is overwhelmingly messy, contentious, and filled with angst as practitioners struggle to negotiate their ideal of humanitarianism within the practical limitations of providing relief. Whereas The Good Project theorizes donors as the consumers of projects, and therefore arbiters of what projects should entail, Doctors Without Borders asserts that MSF, perhaps uniquely, is adept enough at raising money from its reputation alone that finances quite simply do not influence project selection. The lack of financial concerns does not eliminate the difficulty of choosing the right relief site, however. The limitations of MSF’s organizational capacity, the frequent difficulties negotiating entrance to sites where individuals need assistance, the complications that arise from sending staff into violent or otherwise dangerous situations, the disagreements across organizers of where and how aid should be delivered, and concerns about the best way of treating beneficiaries still result in situations where compromise is regularly required, if always debated and often lamented.
In sum, these two books represent a new and exciting meso-level approach to studying the complex realities of humanitarian aid. Understanding humanitarianism as a product of organizations and organizational practices will provide a powerful theoretical foundation on which future studies can build, especially as scholars continue to wrestle with questions of how humanitarian relief efforts affect the lived realities of distant others. Both books would be excellent teaching tools in advanced undergraduate and graduate classes. And both books should be required reading not just for scholars of humanitarianism, but also for scholars of globalization, development, and organizational studies.