Lancing a boil? The Lancet on the aid industry – Logistics for global health and aid: A Humourless Lot - A Humourless Lot

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Lancing a boil? The Lancet on the aid industry

by Michael Keizer on January 23, 2010

Various scalpels When a leading professional journal like The Lancet writes an editorial that is scathingly critical of aid organisations, people sit up and pay attention. And scathing it is: according to the article, large aid agencies are “[p]olluted by the internal power politics and the unsavoury characteristics seen in many big corporations”, and “… can be obsessed with raising money through their own appeal efforts”. They “… sometimes act according to their own best interests rather than in the interests of individuals whom they claim to help” because “… humanitarianism is no longer the ethos for many organisations within the aid industry”. The result: “… relief efforts in the field are sometimes competitive with little collaboration between agencies, including smaller, grass-roots charities that may have have better networks in affected counties and so are well placed to immediately implement emergency relief.”

Wow. That is quite something. The point of all this seems to be in these two sentences:

Given the ongoing crisis in Haiti, it may seem unpalatable to scrutinise and criticise the motives and activities of humanitarian organisations. But just like any other industry, the aid industry must be examined, not just financially as is current practice, but also in how it operates from headquarter level to field level.

Allow me to make five observations here. The first is that The Lancet does not offer any evidence to back up their claims. They might be right, they might be wrong – but without the evidence we will never know.

Secondly, I happen to think they make valid points, which are sadly invalidated by the way they are phrased as blanket statements. Organisations, including aid organisations, are not monoliths and exhibit widely divergent behaviour on different occasions. The same organisation that acts disgracefully on one occasion can be a beacon of selfless and ethical behaviour in another setting; sometimes even at the same time. Obviously this holds true even more when one makes this sort of pronouncements across a whole industry.

Thirdly, the article conflates all types of aid into one, prescribing humanitarianism as the overriding principle for all aid. The authors ignore that not all aid is humanitarian aid; e.g. bilateral reconstruction aid or nation-building aid has nothing to do with humanitarianism, unless one would stretch the concept to a point where it becomes meaningless. I am writing an article on typologies of aid (and let me tell you, it is not easy going) because this sort of conceptual confusion is actually quite common and leads to meaningless discussions.

Fourth, shorn of its rhetoric, The Lancet makes a valid point when they say that more scrutiny of the sector would be beneficial. The critiques that I have seen up to now are mostly (perhaps even almost exclusively) very superficial, and are for a large part either hagiographic on the one hand or bludgeoningly hypercritical on the other; and most of them are thin on evidence (more so when looking at emergency and humanitarian aid than development aid). It is high time for more critical scrutiny that is balanced and based on evidence, mainly because it could be a catalyst for huge improvements in our practices.

Fifth, I am disappointed by a lack of suggestions for improvement. It is easy to be critical, but then please tell us what and how we can improve – and in slightly more detail than that we need to ‘coordinate better’. I am not suggesting that should have been in the same article – after all, an editorial has its limits – but as it was published in a special issue on violent conflict and health, there would have been ample space for a more in-depth article in that same issue, spelling out how to get the sector to the next level. Sadly, the editors did not do so.

All in all, I think the editorial suggests rightly that more scrutiny is necessary – but that point is sadly overshadowed by the article’s conceptual fallacies, lack of evidence for its claims, and general emphasis on rhetoric over content.

Update: sparked by some comments and pushed by some of my ‘followers’ (how I hate that word) on Twitter, I sent an edited version of this comment to The Lancet as ‘correspondence’. After several weeks, I received a polite form letter saying that they could not publish it for reasons that remained unexplained. So much for The Lancet.

{ 4 comments… read them below or add one }

Cynan January 23, 2010 at 8:59 pm

I just find this really quite odd.
The genuine global image, brand and basis of the Lancet is one of scientific rigour. But this editorial screed is playing on that reputation to slag off a strawman of the aid industry and unnamed corporate-ish aid agencies, sans supporting evidence or particulars of any kind.

I agree there are genuine questions, and tsunami-like problems of an NGO scrum in Haiti emerging. There are some NGOs who should be taking a f..king hard look at whether they should be there. Unfortunately I can see a least one DEC member agency in this category.

But this level of unsupported generalization would not be tolerated in one of the Lancet’s articles, and shouldn’t be happning on their editorial page either.

I’m also trying to be very restrained in what might seem an ad hominem attack, querying what particular expertise the editor of a science journal brigs to humanitarian practice anyway.


Dr. Alden Kurtz January 25, 2010 at 8:08 pm

bastards – they just try to pick on us forgetting that we’re putting our lives in danger and so on and should be above scrutiny if you ask me.

“It seems increasingly obvious that many aid agencies sometimes act according to their own best interests rather than in the interests of individuals whom they claim to help.”, they say. Lies!

On behalf of HRI, can i please deny that? i propose we’ll then get angry, just before offering the Lancet a bargain.


Michael Keizer January 25, 2010 at 8:28 pm

@Dr. Alden Kurtz
Thanks, for that comment, Dr. Kurtz.

Could I use this opportunity to congratulate you with the sterling work of HRI? As far as I am concerned, your organisation is a shining light for us all, right up there with INEPD. I am honoured that you have taken the effort to comment in my post.


Gun Trust Dallas March 11, 2013 at 12:55 pm

Everyone has their own personal mission to contribute something good to the world, and when their approach is criticized they feel like people are saying they have been wasting their time, and that’s not a fun thing to discover. This criticism forces them to re-evaluate what they have devoted themselves to for the past 2, 5, 10 years and either try to solve some difficult problems or look into a new approach, neither of which are easy choices. I think that’s why aid professionals can be particularly defensive when it comes to criticism.


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