This essay explores several different concepts of ‘emergency,’ looking primarily at complex humanitarian emergencies. The idea and function of ‘emergency’ is explored within the western—specifically American—recent tradition of emergency interventionism. ‘Emergency’ is an imperative concept—it is a call to our action to assist or save others. Contrasts are drawn between three episodes. The first is the 1992 intervention in Somalia which occurred at the dawn of America’s ascendancy to global dominance. A second, the call for intervention in Darfur, has taken place in its long dusk. The similarities between these two instances conceal important differences, which reflect the changing global position of the U.S. and the changing nature of humanitarian advocacy. A third instance of ‘emergency’ is notable for a wholly contrasting response—the African HIV/AIDS epidemic and the U.S. President’s Emergency Plan for AIDS Relief.

The concept of emergency implies an aberration from a norm. This may be the case for some crises. However, a closer look at contemporary complex emergencies suggests that they are better seen as an accelerated and traumatic manifestation of social and economic change. But the label ‘emergency’ justifies both the humanitarians’ actions and the aspirations of the affected people to return to a form of idealized ‘normality.’ Emergency responses are transient, even when they are protracted. For example, they overlook the ubiquity of urbanization, redefining migrants and urban squatters as ‘displaced people.’ The manner in which the international ‘emergency’ AIDS response has been mounted underscores these points—arguably the most effective function of the global HIV/AIDS apparatus has been to nurture civil-society organizations and a doctrine of epidemiological individualism. An important concept and function of ‘emergency’ is that instrumentalized by host country professionals in relief agencies, who find some salaries, protection and opportunities for professional advancement, and also keep alive the model of a benign service delivery institution.

The argument in this essay is built around series of key words: emergency, humanitarian international, (challenged) hegemony, tragedy, (epidemiological) individualism, and trauma. The last is shorthand for a sociological definition of ‘emergency’ as ‘traumatic and accelerated transition.’ Using these concepts, it asks, who ultimately ‘owns’ an emergency?

Emergency

First, emergency. ‘Emergency’ both a descriptor and a prescription. It describes a state of human suffering, usually including violent disruption to ways of life, hunger and death. It is also a prescription to action—it derives an ‘ought’ from an ‘is.’ An emergency impels us to do something, with urgency and exceptional measures. The operationalization of emergency response, as in the emergency response of a hospital, privileges the expertise, authority and life of the emergency responder over the patient—by definition, passive. The practice of triage gives actual power of life and death to the physician. By defining an event as an emergency, and therefore creating an obligation to respond, we place power in our own hands.

‘Emergency’ also has the connotation of the emergency powers assumed by a government that override normal legal procedures, and can abrogate civil liberties. Emergency underwrites exceptionalism. Mechanisms such as consultation with affected people and transparent and competitive commercial contracting can be suspended during an emergency.

Many of the concepts that buttress ‘emergency’ have as their object the agent of emergency response and not the suffering or needy individual. The doctrines of humanitarian intervention and protection have grown up around the need for those delivery aid to be secure. In Somalia, Operation Restore Hope was mandated ‘to provide a secure environment for the delivery of relief,’ not a secure environment for Somalis. In Bosnia, UNPROFOR protected relief agencies, not civilians. The ‘responsibility to protect’ might be seen as a welcome shift of focus to the civilian population, but (in the case of crises in which state authorities are unable or unwilling to provide protection) the locus of agency of the doctrine lies with the intervener. An alternative formulation might have been ‘the right to security,’ which does not preclude options whereby an affected population can provide protection for themselves.

Generally speaking, emergencies are therefore the opportunity for the extension of political power and coercive administration, albeit with the greater good as the goal.

There is an interesting exception to the rule. The international HIV/AIDS response of the last 25 years has been ‘exceptional’ in a different sense which is—in important respects—diametrically opposite to traditional emergency responses. Historically, public health emergencies have been typically marked by state action that restricts the rights of people, especially intruding into their privacy and restricting their freedom of movement and—for those feared to harbor an infectious disease—controlling their contact with others. States’ privileges to abrogate civil liberties for reasons of public health are enshrined in the Universal Declaration of Human Rights. But in the case of HIV/AIDS, the converse has happened—the emergency has been the occasion to promote human rights and civil society (with some important exceptions).

Humanitarian International

Second, humanitarian international. By this I mean the western-dominated humanitarian agencies with global reach and aspiration. There is a long history of philanthropic imperialism by western powers. This is a complicated phenomenon, a mixture of idealism and greed, of altruism, self-delusion and self-interest. There are plenty of forerunners of contemporary American humanitarianism, notably in the missionary enterprises of Victorian Britain. There are also variants of the American Wilsonian tradition of voluntary action in support of the avowed core values of the government of the Republic, for example the British mixture of establishment radicalism and empirical relief science, and the French preference for theatrical and candidly reflective ‘sans frontièrism.’ This humanitarian imperium is a dream, a fantasy of using power, technology and goodwill to rescue the world from evil.

Hygiene lies at the historic center of philanthropy. Disease control was both an essential servant to imperial expansion and trade, and on occasions a rationale for it. For Europeans, the Suez Canal, the Muslim pilgrimage to Makka and control of cholera became three axes of administrative intrusion into the internal running of the Ottoman Empire that ultimately led to annexation. For Americans, the Panama canal and yellow fever lay close to the center of comparable exercises in hemispheric domination. Exotic diseases define the frontiers of civilization, while the reach of sanitary administration coincided with that of imperialism. Internally within metropolitan societies, hygiene and medicine were instruments of town planning and conditional enfranchisement of the citizenry. The science of public health provides both justification and method for the administration of populations according to defined rules.

Philanthropic voluntarism reaches beyond the frontier of administered populations, into areas of barbarism. Its rationale and method differs. To be precise, humanitarian public health is a contested sphere. Public health professionals tend to seek hard data on which to plan their activities and assess their outcomes. By contrast, charity is its own justification and its own reward, and the rigorous assessment of outcome is considered distasteful or inappropriate. The evaluation of a state public health policy is made on the basis of lives saved and disease burden reduced, relative to the cost. The evaluation of a humanitarian operation is almost always according to whether the resources have ‘reached’ the ‘beneficiaries.’ It is remarkable but revealing how little we know about whether humanitarian activities beyond the frontier of state control actually save lives, or don’t.

Perhaps the most important aspect to the humanitarian enterprise is the one least remarked upon by its advocates and practitioners, namely the fact that these organizations espouse, and to an important extent, actually follow a model of principled, rule-governed benign public service. In many countries where they operate—‘fragile states’ in Africa or central Asia—the existence of these values and practices in government service is little more than a half-remembered dream. Relief agencies are a standing rebuke to the decay and corruption of state public services.

What dream are they remembering? Most of these states never possessed anything resembling a modern administration beyond the limits of towns. The aspiration of late colonialism and the independence leaders was for such rational bureaucracies to extend themselves throughout the nation. The modernization dream did not materialize, but it gripped the political imagination nonetheless.

(Challenged) Hegemony

Third, challenged hegemony. Following the end of the Cold War, the U.S found itself, without preparation, as the sole superpower. In the bright dawn of that new world order, the U.S. soon came to see this undisputed supremacy as the natural order, the end of history (an hubristic claim if ever there was one). The triumph of American arms in Kuwait was followed by the rashly over-optimistic adventure in Somalia, an inglorious episode that has been rewritten as the heroism and tragedy of Black Hawk Down. Fifteen years on, we see that this unchallenged imperium is fast becoming history, a history that we thought had ended. We are not yet in a multipolar world, but we are certainly in an era of disputed unipolarity, of challenged hegemony. The end of America’s unchallenged supremacy was certainly hastened by Iraq, which wounded the superpower and encouraged others to defy it. We should also recognize that a bloodied and threatened power can be more dangerous than a secure one. It is also an attractive, if untested, hypothesis that empires become more ideological in their waning years. After all, territorial expansion is own reward, while defending an enterprise whose day is past requires greater investment in self-justification.

It is interesting to compare the clamor for intervention in Somalia in 1992 with that for Darfur since 2004. The situations on the ground have a great deal of similarity—each is a combination of war and ethnic cleansing arguably amounting to genocide, fought principally by irregulars. The chief difference on the ground is that whereas Siad Barre, having threatened that he would take Somalia to hell if he were driven from power, made good on that threat in his political afterlife, while the government in Khartoum is making good on that threat while still in power, five hundred miles away. The two wars have been portrayed very differently—the former as famine and anarchy, the latter as genocide (or, in the case of the Holocaust Memorial Museum, ‘genocide emergency’). Both have been subject to manipulation in their media and advocacy presentation. But perhaps the greatest difference is in the domestic political context in the U.S. The Somali intervention was mounted by the elder Bush, a realpolitik statesman who in his years at the CIA would never have recommended to his President that American troops be dispatched to protect relief agencies. Perhaps for that reason, the elder Bush made sure the intervention was handled on the ground in a very practical, not to say cynical manner. It is clear from the operationalization of Restore Hope that its architects didn’t believe their own rhetoric—they were very judicious in their use of force when they were in charge.

The smartest advocates for intervention in Darfur recognized from early on that there is almost no prospect of them getting what they want. No professional peacekeeper seriously believes that any of the tasks theoretically assigned to the intervening troops, such as protecting large numbers of civilians, stopping the war, or disarming the Janjawiid militia, can actually be achieved. Perhaps it is this that has facilitated the extraordinary breadth and staying power of this campaign—there has been no reality check. But there is also a notable contrast with the Somali intervention concerning the American role. In Somalia, the elder Bush launched the intervention with a sense of the burden that came with superpowerdom—he was a visibly reluctant philanthropic imperialist and was anxious to bring as many other countries into the operation as possible. The battle for Mogadishu was an unplanned deviation from what was envisioned as a clean charity mission. In Darfur, America spends much time criticizing its rivals (like China) and its allies (like Europe) for their reluctance to intervene. The campaign is in part about the U.S. asserting its moral leadership in a world where its political leadership is failing. And the clamored-for intervention is not charitable—it is political, aimed at eradicating evil by killing its agents. If the intervening force in Darfur gets into combat, it is not deviating from its mission, it is fulfilling it. Somalia was a humanitarian operation planned as ‘other than war’; Darfur would be a humanitarian war.

We see this most sharply in Chad today. In Darfur, the UN-African Mission has the accoutrements of a peacekeeping mission such as a Ceasefire Commission (albeit non-functioning) and a peace process (albeit stalled), so it has at least the theoretical possibility of achieving neutrality in the conflict. The European force in Chad has no such trappings. It is to deal solely with the government of Chad with no mechanisms whatsoever for dealing with the other side of the conflict, save shooting or being shot at. Given that a substantial proportion of the troops will be French, and that France is itself a belligerent party in the Chadian war, neutrality is not even a fiction.

Tragedy

Fourth, tragedy. The tragedy of Black Hawk Down is a one-dimensional tragedy: it is the layperson’s use of the word tragedy to stand for simple suffering. For the advocates and architects of Operation Restore Hope it was unimaginable that their good intentions—and I have no doubt that there were good motives mixed in with others—should be so misinterpreted as to lead to the calamity that overtook the American troops in Mogadishu in October 1993. U.S. military doctrine led the American forces in Mogadishu to use overwhelming force in urban combat, so as to achieve near-zero U.S. casualties, regardless of the many hundreds of Somalis who died as a result. The double standard whereby the U.S. army valued the lives of its soldiers many times more than the lives of Somali civilians was not lost on those Somali civilians. The Americans thought the Somalis were just ungrateful, like the drunken hobo who assaults the ER nurse.

There is another sense to tragedy: the clash of rights. The velvet revolution that ushered in American supremacy was won by the force of argument—the inability of Soviet Communism to crush the spirit of civil society and human rights, and the vocal and principled solidarity of human rights activists in the west. The point of human rights activism was to dream. Its finest exponents were publishers and playwrights. On the great wave of its success in 1989, human rights grew, becoming professionalized and institutionalized. Its paradigmatic adversary, the enemy that shaped its principles and practice, was dictatorship. But as dictatorships became fewer and the human rights organizations concerns became more global, they turned their attention to wars as well. They also found themselves on territory occupied by relief agencies. The ICRC had been there from the outset, but others were joining, newly flexing their political muscles as the straitjacket of Cold War restrictions on where and how they could operate was relaxed.

Advocating for human rights and justice is different from delivering relief assistance and different again from ending war. These three aims can in fact come into contradiction, and some of the great crises within the humanitarian, human rights and foreign policy worlds in the 1990s were the result of this clash—Bosnia and Rwanda stand as clear examples. Relief agencies, concerned with outcomes, were stung by criticisms in the wake of the Rwanda debacle and began to get their house in order. Human rights organizations were less ready to accept criticism. A new style of advocacy organization emerged from the mix, exemplified by International Crisis Group, which can make recommendations on human rights, peace, democracy and humanitarianism all at once. It is of course impossible to pursue all of these at once except in the Utopian fantasies of advocates who are far away from the engine room of governmental practice. But as such advocacy agencies gained greater leverage in foreign policy circles, without the commensurate accountability for the outcomes of their actions, tragedy was inevitable. The influence of such advocacy groups is in fact the institutionalization of tragedy—not because they are wrong, but because they are unconstrained in their advocacy of what is right.

They are unconstrained but not indiscriminate. The silences of groups like ICG are as instructive as their campaigns. A revealing example is the recent ENOUGH recommendations on the crisis in Chad, which focus on sanctioning the Sudan government and dispatching international forces. No mention is made of democracy and human rights in Chad.

(Epidemiological) Individualism

Public health grew up as part of the science of state-building. The administration of populations including abrogation of their liberties was a prerogative of governments. The HIV/AIDS epidemic seized public attention in the U.S. at a moment in which liberals and conservatives agreed on their dislike of government, though they disagreed on what kind of government they would prefer to dislike. Both could agree too that health should be a matter of personal choice, though they disagreed on what those personal choices should be. Amid the vociferous and bitter disputes over U.S. policy towards domestic HIV/AIDS in the 1980s and 1990s, one point of consensus persisted—the U.S. government should not use coercive public health measures to deal with the epidemic. AIDS would not be treated as a regular infectious disease but rather as an individual ailment like cancer or diabetes. The responsibility for controlling it should not be borne by the state but by the individual, who was required to be a good epidemiological citizen.

This approach has been translated into international AIDS policy. It is epidemiologically individualistic—focused on changing personal behavior. It is anti-statist, cultivating civil society organizations to the extent of representing them on the boards of international agencies and initiatives. Remarkably, international AIDS response has become a meeting place for left and right in an otherwise sharply-divided U.S. political landscape. Similar disagreements over appropriate personal behavior to those that marked the 1980s in the U.S. have resurfaced in America’s international AIDS policy, but the same intersection of left and right on epidemiological individualism has also persisted. This is ‘AIDS exceptionalism’ and it is the antithesis of normal emergency exceptionalism, which does the precise opposite—it subjugates the individual and civil society to state prerogatives.

Yet the language of ‘emergency’ recurs. We have PEPFAR—the President’s Emergency Plan for AIDS Relief. We have HIV/AIDS raised as a security threat in a national intelligence estimate and taken to the UN Security Council as a threat to international peace and security. If it were indeed such an exceptional threat, we would expect the kinds of emergency responses that we saw for SARS and envisage for bird flu or bio-terrorism.

What does this illustrate? There are, I think, two separate processes. In developed countries, there is a generalized shifting of the burden of public health to the individual, associated with the decline of infectious disease and the rise of ‘lifestyle’ disease. In no developed country is AIDS a sufficient threat to warrant abandoning this paradigm of public health. In sub-Saharan Africa, where HIV/AIDS is indeed an exceptional threat, but where there is no confidence that states could actually implement public health policies to control the disease, we shift to charitable mode in which the point is to try, and be seen to try, not to succeed. Indeed, the key indicator of success—HIV incidence—is nowhere measured, and the indicators of prevalence have been shown to be highly unreliable. More important than success in overcoming HIV/AIDS is the promotion of a particular model of citizenship, which is liberal and individual. The international HIV/AIDS apparatus is very good at promoting this and rather less good at overcoming HIV/AIDS.

The roll-out of AIDS treatment is likely to intensify this process: it demands the establishment of modern curative health facilities at scale. This is a hugely ambitious exercise which, if undertaken successfully, will change the nature of the African state, making it far more complex and capable, but not coercive.

The promotion of the values and institutions of epidemiological individualism is a structural or systemic outcome of international AIDS policies rather than a deliberate one but real nonetheless. If the international AIDS apparatus succeeds in its stated aim of overcoming HIV/AIDS, it will do so less because of the efficacy of the policies and programs it proposes, and more because of the social and economic transformation of the countries concerned. This transformation that will mean that public health policies based on epidemiological individualism can actually work. We may in fact already be seeing this in Asia, where patterns of sexual behavior and drug taking are changing in line with rapid economic growth, so that HIV/AIDS epidemics in Asian cities come to resemble European and American urban epidemics.

Trauma

Finally, trauma, or, to be precise, traumatic and accelerated transition. By this I refer to the experience of the people in the grips of an emergency. There are many varieties of humanitarian crisis, but I will focus on what are called protracted complex emergencies, namely those civil wars in weak states that involve horrendous levels of human suffering. Let me enumerate some characteristics of these crises.

The first is that they kill rather fewer people than famines did in the past, certainly many fewer than the great agrarian famines of Asia and the Communist famines of attempted transformation. About seventy million people died in famines in the 20th century, and only one African famine hovers on the edge of the top (or bottom) ten, namely Ethiopia in 1984-85. In fact, relief technologies including child feeding and public health are now sufficiently advanced that major food peacetime crises such as Ethiopia in 2002 or Southern Africa at the same time, pass off without a measurable increase in mortality among the general population. Famines, for the most part, no longer kill people, though they do leave them impoverished. Even wartime famines are characterized by much better relief responses. The best estimates for excess mortality from hunger and disease in Darfur are about 150,000, with mortality rates back to normal—in fact below normal—as early as 2005. This is much, much less than the figures projected early in the crisis, projections now taken as fact by some activists.

The most notable experience of these crises is uprooting and disruption. What we see is the destruction of a previous way of life, with an onslaught by government and rebel forces on land and livelihoods. The motivations for this onslaught are mixed. They include the simple military fact that unsophisticated counterinsurgency involves targeting whole populations believed to be sympathetic to a rebellion. More than killing them, this means removing their autonomy by forcing them into displaced camps where they can be more easily monitored. Governments use proxies which they pay with the promise of looting. Perhaps most important, neo-patrimonial states sustain themselves in power by licensing their allied elites to strip assets from weak peripheral peoples and accumulate capital in the most primitive way. The nature of conflict as criminalized primary accumulation often makes for collusive forms of conflict, as rebel leaders too can benefit from protection rackets and asset stripping.

The outcomes of a protracted complex emergency include rapid urbanization, the disruption of previous forms of social organization and authority, the commoditization of land, and the extension of security and administrative control over the affected populations. In Darfur, for example, the population has been transformed from being 18% urban five years ago to about 35% urban today, with a further 30% displaced—urban in all but name. In the camps, authority is vested in ‘sheikhs’ who, despite their traditional name, are a creation of displacement, residence in the camps, and the distribution of relief. Many are traders. Some run mafia gangs fencing stolen goods. Others run businesses—there are internet cafes, vehicle workshops, furniture warehouses in IDP camps. Many have their private security. Old forms of land tenure are irreparably ruptured, despite the clamour of the displaced and their leaders to return to their version of the traditional land tenure system—plots in the towns and camps are bought and sold, and it is unlikely that rural land will ever revert to its old system of communal restraint on land transactions. In camps, the population is counted and registered, reliant on relationships with the authorities for rations and residence. In some camps there is either a direct security presence or there are proxies who control the camp on the government’s behalf (for a price). In most, the government cannot go. Humanitarian agencies play a role of governmentality in part, the camp sheikhs control the larger balance. In time, as those camp sheikhs become more powerful and prosperous, they will collude with the security services—each will buy off the other and come to a mutual accommodation.

We talk about ‘internally displaced persons’ or ‘IDPs.’ Sociologically, the IDP is a migrant who lives in a camp and is entitled to received international assistance. For governments, the most important thing is camp residence—IDPs are a population subject to control by the ministry of the interior. For humanitarians, the label carries with it an implication of impermanence pending a future return home—being placed back again in the correct location. Most IDPs will in fact turn out to be migrants, transiently occupying the role of a recipient of assistance during a transition to an urban livelihood and residence.

For a predatory government and its peripheral peoples alike, the ‘emergency’ is that moment of traumatic uprooting, in which the pace of social and economic transformation runs beyond control. Typically, what a relief agency calls a ‘complex emergency’ coincides rather precisely with a government’s declaration of state of emergency. In declaring such an emergency, the government suspends the rule of law and gives exceptional powers to the security agencies and army. The derivation of the two concepts of ‘emergency’ is very different, but it is more than coincidence that they refer to the same time and place.

Among humanitarians and displaced alike, there is a dream of a return to a pre-crisis ‘normality’. This not the status quo ante, it is a formalized version of it, typically with ethnic lines cleanly drawn. This often takes the form of holding on to idealized versions of the past and refusing to engage in the rough and tumble of regular civil politics. Transitions are times when tradition is invented most actively (there’s no need to invent them when life is more stable). In Darfur this is clear—the displaced demand the ‘restoration’ of an idealized status quo plus the deployment of an international force that will remove the government from Darfur, thus creating an idealized form of self-government with all necessary services but no intrusion of the Khartoum authorities. If this ever happens, it will be through an act of collective violence and ethnic cleansing aimed at the groups identified as enemies. But there is no organization capable of anything other than a rampage through the adjacent city, and as time passes, the material interests of the camp elites will preclude this happening on any scale.

This returns us to another dimension to the concept of emergency with which we began. ‘Emergency’ also implies a temporary aberration from a stable or benign normality, which can be more or less restored at the end of the crisis. Just as the humanitarian responder—relief provider or military saviour—dreams of a clean rescue, the uprooted person dreams of restoration.

The reality of the trauma is that it is accelerated socio-economic change. After the emergency is over, most of the displaced will remain in the cities. The new forms of political authority will not hand back their power to the old chiefs. Land will not become subject to allocation by non-monetary norms. And the forms of administration that penetrated the population during the height of the crisis will not withdraw.

Humanitarian engagement is a handmaiden to this process, fuel to this locomotive of history. By providing rations that keep people alive, and temporary residence rights within a camp plus materials for shelter, relief agencies reduce the suffering and thereby reduce the friction associated with transformation. It is rare for international agencies to provide sufficient assistance for people to have a livelihood based on relief alone. Rations are typically part rations, and in any case people require more than food and shelter to lead a life. When IDP camps are established in rural areas, the residents typically become agricultural laborers, their wages subsidized by food aid. In urban areas, relief provides an economic cushion that allows the city’s economy to grow to catch up with the labor supply provided by the new migrants.

Emergency relief and its apparatus—including labels such as ‘IDP’—allow for all concerned to pretend that what is happening is something other than accelerated socio-economic change. The denial of reality may be adaptive or not. It may ease the traumas of urbanization, or it may sustain a myth of return to a pristine pre-crisis life, thereby freezing a conflict.

Whose Emergency Is It?

Humanitarian action is not only a lubricant for accelerated social change. It certainly does facilitate some of these processes, but it also threatens and challenges the exclusive control of political authorities, whether governmental or rebel. One of the functions of humanitarian agencies is as employer, protector and platform for local educated people, often with a liberal bent. Host country professionals often complain that they are treated as second class by foreign relief workers who are typically younger and less competent. But most would still far rather work for a foreign NGO, or a local NGO with foreign funding, than pursue a career in the civil service. It is better paid, provides some protection against the arbitrary actions of the security services, provides opportunities to travel abroad, pursue further education or training, meet journalists and other opinion makers, and act as a spokesperson for the community. The NGO also provides a model, however flawed, of how to provide services in a principled and professional way, of how to run an institution according to rules. Governments rightly see international humanitarian agencies and local NGOs as harbouring political opposition in disguise. This is the other dream: the dream of a modern, competent and benign state.

In this context, the concept of ‘emergency’ serves one more purpose—it is an alibi for those host country professionals that allows them to maintain the pretence that their employment in foreign organizations is a temporary expedient, a form of transient internal exile from serving their own government.

Who owns the ‘emergency’? The answer is of course that it is contested and the outcome varies from one place to the next. In many cases it is too early to judge who may have won this contest, but usually there is little difficulty in identifying the losers—the people who suffer and are uprooted. They have lost one thing, much valued but impossible to measure, which is their sense of dignity and self in the world they left behind. They may have other gains—urban life typically involves better education, health and upward mobility. And the victims of emergency have another source of solace, which is that they survive in far greater numbers than they would have done even a single generation ago.