Medical humanitarian organizations are increasingly the primary healthcare providers for unauthorized migrants in high-income countries. Existing studies of medical humanitarianism in the Global North reveal tensions between principles of traditionally apolitical humanitarianism and human rights. In practice, these tensions translate into organizational debates about prioritizing direct service provision to meet immediate needs or advocacy to effect long-term systemic change. Informed by these debates, this paper asserts the importance of immigration and health policy contexts as central to shaping the relationship between healthcare provision and political advocacy within medical humanitarian NGOs. Drawing from twelve months of fieldwork with medical humanitarian NGOs in Arizona, I analyze data from ethnographic participant observation and interviews with volunteer healthcare providers at a medical humanitarian organization I call Community Clinic of Phoenix (CCP), a free clinic for uninsured, undocumented immigrants. I find that, in the context of Arizona\'s anti-immigrant rhetoric and policies, CCP employs medical humanitarianism as both a discourse and a model of care to challenge immigrants\' exclusion from health coverage and criminalization through immigration enforcement. The clinic\'s emphasis on immigrant health justice shapes their critiques of the structural failures of U.S. immigration and health systems, their approach to providing equitable access to quality healthcare for uninsured immigrants, and their work to create broad social change for immigrant rights and health justice. Driven by their mission of \"not replicating a free version of a broken system,\" the clinic\'s healthcare provision amid a climate inhospitable to immigrants demonstrates the importance of both conceptualizing and practicing medical humanitarianism as healthcare advocacy.

During the 2013 Gezi protests in Turkey, volunteering health professionals provided on-site medical assistance to protesters faced with police violence characterized by the extensive use of riot control agents. This led to a government crackdown on the medical community and the criminalization of \"unauthorized\" first aid amidst international criticisms over violations of medical neutrality. Drawing from ethnographic observations, in-depth interviews with health care professionals, and archival research, this article ethnographically analyzes the polarized encounter between the Turkish government and medical professionals aligned with social protest. I demonstrate how the context of \"atmospheric violence\"-the extensive use of riot control agents like tear gas-brings about new politico-ethical spaces and dilemmas for healthcare professionals. I then analyze how Turkish health professionals framed their provision of health services to protestors in the language of medical humanitarianism, and how the state dismissed their claims to humanitarian neutrality by criminalizing emergency care. Exploring the vexed role that health workers and medical organizations played in the Gezi protests and the consequent political contestations over doctors\' ethical, professional, and political responsibilities, this article examines challenges to medical humanitarianism and neutrality at times of social protest in and beyond the Middle East.

Exclusionary practices in dominant market-based systems are recognized as contributing to global health inequities. Undocumented immigrants are particularly vulnerable to unequal access to healthcare. Humanitarian NGOs strive to respond meaningfully to these health inequities among migrants and undocumented immigrants. Few studies describe the work of humanitarian NGOs that advocate for the right to health of undocumented immigrants in high-income countries. This paper discusses immigration, health, and human rights while examining solidarity, spirituality, and advocacy using a U.S.-based example of medical humanitarianism: the \'Our Lady of Guadalupe Free Clinic.\' In 2011, the Free Clinic began in the basement of a Catholic parish in Minnesota in response to the lack of access to medical services for undocumented immigrants. Run by a local grassroots organization, it is held every six weeks and offers free primary healthcare to Latino immigrants and the uninsured. In this article, we examine the tricky relationship between humanitarianism and human rights in the U.S. Using ethnography, we draw on participant observation and interviews with 30 clinic volunteers, including health professionals, administrators, language interpreters, and spiritual leaders. The study was conducted September 2012-December 2013 in southern Minnesota. We examine how notions of solidarity, spirituality, and advocacy structure faith-based medical humanitarianism in the U.S. and explore the underlying tensions between the humanitarian mandate, spiritual teachings (social justice, solidarity), and political advocacy. Examining a moment of \"crisis\" in the Clinic, our study shows that volunteers experience the alliance between spirituality and advocacy with uneasiness. While a spiritual calling may initially motivate volunteers to serve, an embrace of human rights advocacy is important in a sustained effort to provide humanitarian medical care to individuals who fall outside of the political and moral community in the U.S.

Social scientists have fiercely debated the relationship between non-governmental organizations (NGOs) and the state in NGO-led development projects. However, this research often carries an implicit, and often explicit, anti-state bias, suggesting that when NGOs collaborate with states, they cease to be a progressive force. This literature thus fails to recognize the state as a complex, heterogeneous, and fragmented entity. In particular, the unique political context within which an NGO operates is likely to influence how it carries out its work. In this article, we ask: how do NGOs work and build relationships with different types of states and--of particular relevance to practitioners--what kinds of relationship building lead to more successful development outcomes on the ground? Drawing on 29 in-depth interviews with members of Partners in Health and Oxfam America conducted between September 2010 and February 2014, we argue that NGOs and their medical humanitarian projects are more likely to succeed when they adjust how they interact with different types of states through processes of interest harmonization and negotiation. We offer a theoretical model for understanding how these processes occur across organizational fields. Specifically, we utilize field overlap theory to illuminate how successful outcomes depend on NGOs\' ability to leverage resources--alliances and networks; political, financial, and cultural resources; and frames--across state and non-state fields. By identifying how NGOs can increase the likelihood of project success, our research should be of interest to activists, practitioners, and scholars.

This article focuses on current trends in scholarly literature concerning the evaluation of short-term medical missions. The paucity of information on short-term medical missions in general has contributed to the lack of sufficient frameworks for evaluating them. While examples in the scholarly literature are sparse, in those rare cases where missions are evaluated, they tend to (1) produce their own criteria for evaluation, and (2) evaluate themselves based on metrics that emphasize their perceptions of accomplishments. I draw on interviews (n=31) as well as participant-observation regarding medical missions, to critique these trends. The data analyzed derive from an on-going ethnographic study began in Sololá, Guatemala in 1999, which since 2011 has been directly focused on short-term medical missions. More specifically, my data suggest potential conflict of interest inherent to both volunteering and hosting a short-term medical mission. NGO hosts, who maintain long-term residence in Sololá, may differ from short-term volunteers in both how they understand volunteer obligations as well what they consider helpful volunteer activity. These same organizations may remain financially tied to volunteer labour, limiting their own perceptions of what missions can or should do. I argue that these conflicts of interest have created an evaluation environment where critical questions are not asked. Unless these hard questions are addressed, short-term medical mission providers cannot be certain that their own activities are consonant with the moral imperatives that purportedly drive this particular humanitarian effort. This study demonstrates how ethnographic methods can be instrumental in attempts to evaluate humanitarian endeavours.

After more than 20 years of sporadic separatist insurgency, the Free Aceh Movement and the Indonesian government signed an internationally brokered peace agreement in August 2005, just eight months after the Indian Ocean tsunami devastated Aceh\'s coastal communities. This article presents a medical humanitarian case study based on ethnographic data I collected while working for a large aid agency in post-conflict Aceh from 2005 to 2007. In December 2005, the agency faced the first test of its medical and negotiation capacities to provide psychiatric care to a recently amnestied political prisoner whose erratic behavior upon returning home led to his re-arrest and detention at a district police station. I juxtapose two methodological approaches-an ethnographic content analysis of the agency\'s email archive and field-based participant-observation-to recount contrasting narrative versions of the event. I use this contrast to illustrate and critique the immediacy of the humanitarian imperative that characterizes the industry. Immediacy is explored as both an urgent moral impulse to assist in a crisis and a form of mediation that seemingly projects neutral and transparent transmission of content. I argue that the sense of immediacy afforded by email enacts and amplifies the humanitarian imperative at the cost of abstracting elite humanitarian actors out of local and moral context. As a result, the management and mediation of this psychiatric case by email produced a bureaucratic model of care that failed to account for complex conditions of chronic political and medical instability on the ground.

For several decades, control programmes for human African trypanosomiasis (HAT, or sleeping sickness) in South Sudan have been delivered almost entirely as humanitarian interventions: large, well-organised, externally-funded but short-term programmes with a strategic focus on active screening. When attempts to hand over these programmes to local partners fail, resident populations must actively seek and negotiate access to tests at hospitals via passive screening. However, little is known about the social impact of such humanitarian interventions or the consequences of withdrawal on access to and utilisation of remaining services by local populations. Based on qualitative and quantitative fieldwork in Nimule, South Sudan (2008-2010), where passive screening necessarily became the predominant strategy, this paper investigates the reasons why, among two ethnic groups (Madi returnees and Dinka displaced populations), service uptake was so much higher among the latter. HAT tests were the only form of clinical care for which displaced Dinka populations could self-refer; access to all other services was negotiated through indigenous area workers. Because of the long history of conflict, these encounters were often morally and politically fraught. An open-door policy to screening supported Dinka people to \'try\' HAT tests in the normal course of treatment-seeking, thereby empowering them to use HAT services more actively. This paper argues that in a context like South Sudan, where HAT control increasingly depends upon patient-led approaches to case-detection, it is imperative to understand the cultural values and political histories associated with the practice of testing and how medical humanitarian programmes shape this landscape of care, even after they have been scaled down.