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Table 4 Examples that illustrate the potential intersection between humanitarian principles and ethical obligations

From: Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review

Intersection Example description Example quotation Emphasis added
Neutrality and highest attainable quality of care Delivering high-quality care may not be viewed as “neutral” in a conflict when delivering that care comes under the authority of one side or the other. Once the international community’s resolve to enforce international law was revealed as a sham, Hutu-supremacist camp authorities were able to close down humanitarian space to a point where agencies were faced with a stark choice: either provide assistance to refugees under terms set by the camp authorities or get out. Most agencies chose the former, while continuing to call for “political action.” Finding accommodation with camp authorities involved accepting some diversion of relief goods through the taxation of beneficiaries by their political masters. (Fennell 1998)
Humanity and highest attainable quality of care The goal of relieving the suffering of all in settings of extreme violence may mean the highest quality of care cannot be met. The participants report concern of medical competence as a potential source of ethical problems. They state that in general [health care workers] sent to disaster settings are not properly trained specifically for disasters…Some of them state that lack of proper education makes it difficult to be benevolent to victims. (Civaner et al. 2017)
Independence and supporting a locally led response When local groups are on one side or the other of a conflict, an organization supporting a locally led response could be perceived as no longer fully independent. Armed actors—both state and non-state—will frequently seek to associate themselves with aid efforts to enhance their legitimacy in the eyes of affected people. Agencies cited examples of this in all four settings [i.e., Afghanistan, South Central Somalia, South Sudan and Syria]. One agency representative working in Damascus said that questions about whether the government could be taking credit or profiting from the aid effort “keep [them] up at night.” Non-state armed groups such as IS and Al-Shabaab sought to associate themselves positively with aid projects, for instance by turning up at distributions or, in the case of IS, making a propaganda film about a health clinic. (Haver 2016)
Impartiality and equity Providing aid to all victims impartially supports the obligation of an equitable distribution of the benefits and burdens of aid. Access can diminish both as a direct result of violence and as a consequence of the obstacles and conditions created by militaries, governments, and non-state actors that hinder the impartial provision of aid. In an effort to maintain their presence and continue to deliver on their humanitarian commitments, a number of humanitarian organisations have strengthened their risk management capabilities…increasing their access to affected populations. (Egeland et al. 2011)
Independence and honesty and transparency Being honest and transparent about, for example, witnessed atrocities could be perceived as compromising independence. Humanitarian aid workers from Médecins Sans Frontières (MSF, Doctors Without Borders) were present in the town before and during its fall. For months before the genocide, certain headquarters staff members believed the situation of the “safe area” was untenable, but the organization refrained from conducting advocacy in light of the tenuous presence the aid workers had in the town… In contrast, over the roughly two weeks that the town was falling and its inhabitants were targeted and terrorized, the organization did go to the media with testimony from its two international staff members. (Fink 2007)