Do No Harm is a concept in humanitarian action that encourages aid deliverers to examine how their aid might reinforce and support conflict.
The idea is encapsulated in Mary B. Anderson’s 1999 book of the same name where the author cites an example of a situation where aid may have caused harm taking place in Sudan.
In the example, an aid agency responds to a factional split by building two health facilities, rather than continuing with their original plan for one. An aid worker later realizes that this decision reinforced the conflict, brought twice as many resources into the area, and missed an opportunity for inter-factional dialogue and cooperation.
Another example of a violation of Do No Harm is aid deliverers prolonging war by providing combatants with supplies, either inadvertently or through agreements. While Anderson’s book focuses on aid in conflict situations, the idea of Do No Harm can and should also be applied to aid in other settings.
By stepping back and examining how their aid not only helps, but also has the potential to harm communities, humanitarian agencies can work towards truly providing for people in need.
North Korea has been a recipient of international humanitarian aid for over two decades. Since 1995, over 200 international non-governmental organizations (NGOs) and 20 international organizations, including United Nations (UN) bodies, have worked to deliver aid in the country.
Many of the challenges for humanitarians working in the DPRK are well-documented and discussed, including diversion of aid, lack of access to aid recipients, inability to independently monitor aid, and difficulty in negotiating terms with DPRK authorities.
DOING NO HARM IN THE DPRK
However, it is also worth considering the capacity for aid in the DPRK to harm recipients and the general North Korean population. How can the humanitarian community in the DPRK conduct their work in a way that does not violate Do No Harm?
There are three potential answers to this question.
The first, often shared by human rights advocates, is that aid strengthens the Kim regime and is therefore inherently harmful. In this viewpoint, aid can bolster the regime in a number of ways: it can provide valuable inputs, freeing resources for other pursuits such as gifts for the elite or the development of the DPRK’s nuclear program.
Aid can also fulfill basic human needs, eliminating one reason for North Koreans to revolt against the regime. In this viewpoint, aid can also serve to legitimize the regime: by supporting a regime that causes harm to its people, including the recipients of aid, aid is guilty of causing harm and prolonging the suffering of the North Korean people.
But several assumptions in this viewpoint weaken its veracity. First, it is unlikely that ending humanitarian aid would cause the regime to collapse.
Second, it is dangerous to assume that regime collapse would automatically result in less suffering for the North Korean people: it is not difficult to imagine scenarios which could result in increased food insecurity, communicable disease, human rights violations, and/or violence.
By asserting that aid props up the regime and thus is inherently harmful, this viewpoint fails to address the shortcomings of these assumptions.
It is unlikely that ending humanitarian aid would cause the regime to collapse
TIME AND PLACE
The second perspective is one that can be applied to many humanitarian situations: aid can do harm depending on how it is delivered but is not automatically in violation of the principle.
From this perspective, humanitarian groups in the DPRK must actively work to ensure their aid is not co-opted for harmful use and that aid recipients are truly needy.
Project design is key in ensuring that aid does not cause harm. In a hypothetical example: a tuberculosis treatment program (TB) in the DPRK that does not have adequate monitoring in place to ensure that patients follow through with their course of treatment could result in patients prematurely exiting care and assisting in the creation of stronger, more resistant, strains of TB.
Patients who have not completed treatment could also come home, believing their improvement or lack of symptoms means they are cured and infect their families and communities.
This example demonstrates three key points. First, violation of Do No Harm is possible in non-conflict settings such as the DPRK. Second, this hypothetical situation shows how even the most positive of intentions can result in harm without proper program design.
Finally, this scenario highlights the dilemmas humanitarians must face – if they cannot ensure that patients will follow through treatment, perhaps due to lack of regular access to patients, is it better to walk away?
If the North Korean authorities are diametrically opposed to any aspect of project design that would lessen the chance of harm for aid recipients, can aid agencies reach compromises or should they maintain hardline stances?
The view that aid in the DPRK can, but does not automatically, violate Do No Harm does not provide simple answers to complex questions. However, this perspective is valuable for both aid practitioners and DPRK analysts to consider both the positives and negatives of humanitarian aid delivery.
Project design is key in ensuring that aid does not cause harm
On the other side of the spectrum from the first viewpoint is the opinion that aid is so desperately needed in the DPRK that all efforts should be welcome. This perspective blatantly ignores the concept of Do No Harm and places a kind of immunity upon aid deliverers. Even the most fervent supporters of aid to the DPRK must be willing to admit that aid has the potential to do harm.
Ignoring this fact is unrealistic, naïve, and dangerous for the well-being of the North Korean people.
The concept of Do No Harm should manifest in practical considerations in program design and goals. Humanitarians working in the DPRK must ask themselves how their aid has the potential to do harm, and realistically evaluate steps they can take to avoid causing harm to aid recipients.
One simple and practical way aid practitioners, scholars, and analysts can incorporate Do No Harm into their work on the DPRK is through vocabulary. Aid recipients should not be referred to as ‘beneficiaries’ – this term implies aid recipients benefit from aid and reinforces the erroneous idea that all aid is helpful.
Humanitarian agencies operating in the DPRK considering how to best adhere to the principle of Do No Harm will encounter many of the same dilemmas captures by the humanitarian principles. The principle of impartiality states that humanitarian aid should be given out according to need. Humanitarians in the DPRK may be satisfied with their ability to reach the needy, even if they are unable to reach the neediest.
However, by applying Do No Harm, it is possible for aid to reinforce inequalities if it is withheld from certain groups. In the case of the DPRK, aid groups are unlikely to be able to reach needy individuals who are not in good standing with the government. A strict interpretation of Do No Harm would thus deem humanitarian groups as reinforcing loyalty to the government.
The concept of Do No Harm should manifest in practical considerations in programme design and goals
Evaluation and monitoring of aid projects in the DPRK is a challenge for humanitarians due to limited access to aid recipients. Without robust evaluation techniques, can aid practitioners be sure their aid is not causing harm? If aid cannot be adequately monitored, can humanitarians accurately believe it is not causing conflict or harming communities?
Considering the concept of Do No Harm in the DPRK raises more questions than answers, raising issues of morality and how to best honor and value human life, making them extremely difficult and weighty.
However, it is vital for humanitarians and others interested in the DPRK to ask these tough questions. By taking a realistic and unbiased look at how aid has the potential to harm recipients, aid practitioners can design better projects and better serve the people of North Korea.
Edited by Oliver Hotham
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Featured Image: Chongsan-ri Farm, North Korea. by (stephan) on 2008-06-10 11:35:22