Principles are guides for action, not excuses for inaction. The principle of Do No Harm (DNH) was never meant to prevent physicians from providing treatment or care, and it does not restrict humanitarians from intervention.
In a recent New York Times op-ed, “When Do No Harm Hurts”, David Keen argues that a great deal of harm results when “do no harm” shades into “do nothing”. As professionals devoted to effectiveness of international aid and development, we could not agree more.
We do not agree, however, that “the ‘do no harm’ principle is leading to harmful results”. Rather, a misinterpretation of the principle can result in harm—as appears to be happening in Syria. It is a common misunderstanding that the principle simply calls for avoiding actions that might make any aspect of the situation worse—in this case, as Keen argues, potentially reinforcing Syrian militants. When donors and aid workers feel confused and uncertain, they blame the principle rather than use it to provide guidance through admittedly challenging ethical waters.
Mary B. Anderson foresaw this potential misuse of the principle in her book Do No Harm: How Aid Can Support Peace – Or War. She wrote that “it is a moral and logical fallacy to conclude that because aid can do harm, a decision not to give aid would do no harm.”
“Do No Harm” is the principle that the wellbeing of the people we are trying to help is our primary concern. The cure must not be worse than the disease and the intervention must not destroy that which it meant to save.
Over the past twenty years, CDA’s Do No Harm Program has been providing practical guidance for translating the principle into practice. Along with thousands of aid workers, we have been continuously developing simple and practical techniques for addressing the ethical and operational challenges of working in conflict situations.
Keen reports that the amount of aid in Syria is small compared to the needs, and with donors’ restrictions on how they will provide resources to the organizations in the field, local people are resentful. Simultaneously, ideological groups are using the relative scarcity of aid to shore up support for their own control over populations.
Do No Harm asks whether the wellbeing of the population in Syria is supported by reducing the amount of assistance from Western sources. Do the donor-imposed restrictions help the people they claim they want to help? If fighting groups in Syria appropriate aid, will it ultimately cause more harm to the population than would the lack of assistance?
The concepts and practical tools developed from this extensive collaborative effort help us to first define the context and then understand how to avoid worsening those aspects we’ve carefully and specifically identified.
A usable understanding of the context identifies what is deepening the divisions in the society, and which things continue to support healthy connections. Knowing the context allows us to shape our responses to deal with those realities, and avoid misguided cookie-cutter solutions.
Many aid agencies have proven that it is possible to know the context, to examine the details of their program interventions and how they will interact. When they pay attention to these dimensions, they are able to adapt to the local context, both before they intervene and continuously, during their intervention.
The Do No Harm tools work. We have seen them used in Kenya to prevent election violence, in Afghanistan to support returning refugees and in Colombia to think about land restitution. These tools help people make practical choices about how to provide assistance well in contexts that are seemingly beyond comprehension.
I am not an expert in the Syrian conflict. Luckily, I do not need to teach Syrians about their own context; they are already more expert in their situation than any outsider will ever be. I do have extensive experience in applying Do No Harm, both the principle and the tools, in conflict contexts. More than anything, our responsibility as humanitarians or development workers is to help people see that they have options. They are not caught between doing harm or doing nothing – nor are we.
By Marshall Wallace, Do No Harm Program Director, CDA in response to David Keen’s New York Times op-ed “When Do No Harm Hurts”