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Q&A with Stanford Humanities Center international visitor Chiara Lepora

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Humanities Center International Visitor Chiara Lepora is a physician who does humanitarian relief work. She writes about the intersection of medicine and ethics in humanitarian organizations.
Photo Credit: 
Kent Safford

Chiara Lepora, a physician and researcher, is an international visitor in residency at the Humanities Center for the spring quarter. She was trained as a medical practitioner at the Universities of Pavia and Lisbon and the London School of Hygiene and Tropical Medicine. She worked in emergency medicine in Italy and France before joining Médicins Sans Frontières (MSF, also known as Doctors Without Borders) in 2002.  

Lepora has worked as a field doctor and in a variety of coordinator and management positions in Angola, the Democratic Republic of the Congo, Liberia, Somalia, Chad, Cameroon, and South Sudan, including coordinating Women’s Health activities in Darfur, Sudan, in 2004. She has a deep interest in the medical treatment of prison populations, and after her visit to the center is complete, she will join the International Committee of the Red Cross (ICRC) to work as a detention doctor, responsible for ICRC’s health in detention activities in favor of people deprived of freedom in Israel and the West Bank.  

Lepora has published widely on global health and humanitarian ethics, with articles in the American Journal of Bioethics, Journal of Applied Philosophy, and Journal of Political Philosophy, among others. Her book, On Complicity and Compromise (co-authored with Robert E. Goodin, Oxford University Press: 2013), looks at how individuals and organizations, including doctors and humanitarian aid groups, can become tied up in the wrongdoing of others. 

Lepora was nominated as an international visitor by the Center for Ethics in Society at Stanford. Her visit is sponsored by the Freeman Spogli Institute and Stanford Humanities Center. 

She recently sat down with us at the center to discuss her work at the intersection of medicine and ethics. 

Since you are someone who does humanitarian fieldwork why come to an academic setting like the Stanford Humanities Center? 

I work in the humanitarian field, and I work in extremely complex situations in environments that confront us with dire ethical questions. When we are in the field we never have enough time to reflect: we're forced to react rather than to delve deeply into some ethical questioning. 

So to me, spending two months here is the most amazing opportunity to be able to step back from that life, and take advantage of the intellectual community that the Center provides to reflect on some ethical questions more specifically and more in-depth. 

It allows me to feel more confident about the next choices that I might have to make, but it also allows colleagues and students here to better understand the challenges of humanitarian fieldwork. And what are the ethical questions that we should ask ourselves not only as humanitarian workers, but also as communities.

What are you researching while you are at the center?

I'm focusing on the responsibility that humanitarian organizations might have in the context of international kidnapping crises. Unfortunately, humanitarian organizations have a long history of dealing with kidnapping, but there have been scandals involving humanitarian organizations, accused of wrongdoing because of their unwillingness or refusal to negotiate for the sake of hostages who are not humanitarian workers but are caught in the crossfire. 

Humanitarian organizations often negotiate on the basis of the work they do, and the benefits that the local population find in it. As appealing as that might sound, it's not easy to simply say, "Okay, we're just going to extend our negotiation argument to any other hostage who might be there at the same time." This is just one of the complex aspects of the question. But it's important for humanitarian organizations to ask themselves the question—whether or not they have a special duty to intervene on behalf of other hostages, aside from what they already do for their own employees. 

While at the center, I am writing an article that offers a framework for reflection on this issue. What are the significant ethical aspects of kidnapping negotiations? What are the significant aspects that determine [one actor's] responsibility? I aim to provide a framework on how to think through a variety of cases. I’m starting with one specific, tragic case, but then I'm also creating a variety of other imagined examples to test the framework and its value in different situations that might arise in the future. Then MSF, and any other organization interested, will have to take this framework and check its effectiveness with real cases they deal with, and with all the constraints of real fieldwork. 

How do you conduct your research?

I'm basing my research purely on open source data—things that are in the media. A lot of kidnapping crises have a variety of confidential aspects that I do not take into account because the framework should function not only for the organization, but also for the public to understand why an organization makes a certain choice. If the public, say, the American public has a negative understanding of a choice that MSF makes with regard to a specific kidnapping crisis this should not simply be disregarded as, ‘Oh, okay, but they don't have all the specific details of the case.’ Or, ‘They don't know enough about kidnapping. They don't understand.’
    
No. Public opinion and public scrutiny are essential components of the “informal legitimacy” provided to humanitarian organizations. Public opinion ought to be taken seriously and used as an opportunity for reflection and improvement, whether that implies changes of policies or better communication. This is why I want to work only on data and information that are publicly available: people that support MSF will be informed and form their idea of whether the choice was right or wrong on that basis. 

So it's a challenge, of course, because some information ought to be retained, maybe to protect the victim, or the family of the victim or somebody else involved. There are valid reasons not to share all information. Nonetheless, MSF has a commitment to the general public to act in a transparent way, and MSF values public scrutiny. I do think that a framework of decision-making for MSF ought to be something public.

What drew you to work on this topic? 

I've been working in the Middle East for five years. It really is a context that humanitarian organizations had limited exposure to in the past. There were very specific interventions in some countries, but not a broad presence as in sub Saharan African contexts, for instance. 

But considering how unstable [the Middle East] has been in the past years, and the fact that some of the crises are protracted and have tragic consequences for the population, there is a need for humanitarian organizations to function better and to be more effective, and to work more safely in those environments.

I was responsible for different projects in the Middle East and definitely being able to answer to people's needs was the first concern. But insecurity might hamper that, and is therefore a second important concern. 

What has surprised you about your research while at the center?

Not only does virtually everyone have very strong ethical opinions concerning kidnapping cases, but also opinions can easily change when provided with some new facts or general notions on the subject. And this seem to be true not only for lay people who read the newspaper and have never had to deal with a hostage crisis; the same strength of convictions, easily shaken just by showing another perspective, can be found in professional hostage negotiators, for instance, or in survivors of kidnappings, or even in kidnappers. Each of them is intimately linked with the others, but in such fundamental conflictual stances as to rarely confront their preconceived ideas. Each of them has to construct their behaviors in context of great risk and great uncertainty, creating beliefs in the absence of knowledge.

Academic literature concerning hostage crisis is very scarce, and practice rather than solid objective reflection seems to guide action. Considering how people’s lives are at risk, this is very surprising. 
Another thing I've been surprised to learn just by talking to people here is that often times, people assume the organization has amazing means and amazing capacity to stretch in order to cover different issues. 

Sometimes constraints are thought to be merely financial, thinking that more money allows humanitarian organizations to do everything needed. But a main problem for a lot of organizations is lack of qualified experienced human resources. It's the fact of having people who are willing, capable, competent, committed to work and to work constantly and for a sufficient period of time in this type of situation. 

So for instance with regards to kidnapping one might say, "Yes, of course, a humanitarian organization should work on any kidnapping crisis it can help with it." But then intuitions change when looking at the necessary trades-off it would require. Should a humanitarian organization devote its most experienced and competent human resources to managing kidnapping crises or to run aid projects for entire communities? 

There is an enormous disconnect between the reality of limited resources, particularly limited human resources and what we expect of humanitarian organizations. Yet, I value the fact that humanitarian organizations are open to question their own priorities in terms of resource allocations: if we think that managing kidnapping is an ethical priority for humanitarian organizations, we ought to give ourselves the means to do it.