How to be wise and compassionate in working for peace through health.

As a species, we are prone to share, help, and cooperate with each other, especially in our families and their extensions to the group we consider “like us.” We are equipped with a humanitarian impulse – when someone is in distress, we want to come to their aid. Slowly, the circle of compassion, to use Einstein’s wonderful term, has widened and until now it is globe-encompassing. With our technologically-enhanced capacity to know what is happening in Bhutan or New Orleans and our enhanced ability to respond, we, or at least some of us, want to share, help, and relieve distress all over the world. We have moved even further, and decided that these are not optional charitable impulses, but duties, and that those with insufficient resources or security and those in distress from natural or man-made disaster have a right to receive help. People have a right to development (a share of resources at least to levels of sufficiency) (1), in particular a right to health (2), a right to peace (to live without being attacked, oppressed or exploited) (3), and to humanitarian assistance (4), although this last is incompletely institutionalized in international law. This is one of the most wonderful aspects of humanity, and we are deeply inspired by those who enact such giving. However, we must attend to problems that arise in giving across distances and to people who are not like us, problems such as an assumption of superiority of the giver over the recipient, especially if reciprocity is thought to be unlikely (this can be seen even in families); an assumption by the giver of no reciprocity if the recipient is materially poor; erroneous assumptions about what is wanted or needed, with inadequate consultation with the recipient about this; cultural blindness (unawareness that cultural differences between giver and recipient will determine a great deal about the meaning of actions and words); unawareness that changes to (possibly volatile) social, political, or economic dynamics may entrain negative consequences, especially in a situation of resource poverty and conflict (5); and problems with people in any situation handling large-scale resources with insufficient accountability. Mary Anderson has carefully researched situations where poorly informed projects intended to help have actually harmed the recipients. Her famous “Do No Harm” (5) is required reading for all who would try to help. Ken Bush has developed the now much-used Peace and Conflict Impact Assessment (PCIA) for enhancing the sensitivity of project workers working in conflict situations (6,7). This process, which is intended to be used before, during, and after a project, structures an examination of the risks and opportunities presented by the conflictual context on the project, and then an examination of the impact of the project on the conflict. Based on an analysis of the conflict, the project team, which is expected to include local people, examines the potential impact of the project on the following areas: (a) conflict management capacities of individuals, groups or the state; (b) militarized violence and human security; (c) political structures and good governance in both state and civil society, including structures of accountability and strengthening of human rights measures; (d) economic structures and processes, such as whether the project counters or strengthens a war economy, increases or decreases dependence on the military for employment; and (e) social empowerment, such as impact on gender equity. Bush gives detailed examples of positive and negative impacts in all of these areas and emphasizes the potential of development projects to enhance peace. It is coming to be considered a necessary element of good practice for those working in conflict zones to incorporate a “conflict-sensitive approach” (8). Anne Birouste and Anthony Zwi at University of New South Wales School of Community Medicine and Public Health have worked on a tool more specifically for Peace through Health projects. It is, for now, called the Health and Peacebuilding Filter (9), and is intended to call to mind for the donor, project worker, or recipient all the necessary dimensions of a project based on compassion and deep respect for all involved, together with acknowledgment of the complexity of the context of such projects. The “filter” attends to five broad dimensions needed for an excellent project. These dimensions are cultural sensitivity, conflict sensitivity, social justice, social cohesion, and good governance.