Defined as the “provision of limited forms of medicine by clinically trained medical practitioners in emergency situations” (Allen 2018, 207), medical humanitarianism is closely tied to the notion of ‘neutrality’. As representatives of a ‘new humanitarianism’, their focus on universal, recognisable and measurable suffering identifies medical humanitarians as a ‘collective doctor’ who independently delivers short-term medical assistance to avert emergencies outside of political or ideological struggles (Redfield 2010, 61; Ticktin 2011, 3). Despite this seemingly straightforward approach, diverging perspectives raise the question if medical humanitarianism can ever be neutral: for instance, the concept has been described as a ‘myth’ (Seybolt 1996), ‘impossible’ (Redfield 2010), and ‘contradictory’ with ‘perverse effects’ (Terry 2000, 2). 

This essay argues that, although relief organisations seek to position their interventions within a humanitarian ‘space’ that is separate from political or ideological struggles, medical humanitarianism cannot ever be neutral. Instead, I argue that medical humanitarians enact political claims and practices that shape the understanding of, response to and experience of suffering. I discuss this argument from two perspectives. First, I look at neutrality as an ‘abstract principle’ and define medical humanitarianism as a specific ‘emergency claim’ (Rubenstein 2015) articulated by relief organisations. Medical humanitarians present emergencies as amenable to short-term and technical biomedical intervention, which competes with and obscures alternative perspectives and de-politicises interventions that perpetuate existing inequalities.  Second, I approach medical humanitarian intervention as an everyday practice and argue that it shapes power relations through the ‘political subjectivities’ (Krause and Schramm 2011) of people in need and humanitarians. In other words, medical humanitarianism shapes how people relate to governance and authorities and how they experience identity and belonging by shaping experiences of subjectification, sentiments of resistance, and strategies of adaptation. The argument draws on the cases of the humanitarian interventions during the 2008/09 cholera epidemic in Zimbabwe and the 2013-15 West African Ebola outbreak. While critiques of medical neutrality primarily focus on violent conflict or genocide (Benton and Atshan 2016), analysing epidemics illustrates the contradictory foundation of medical neutrality in constructing and managing seemingly straightforward biomedical ‘events’ (Rosenberg 1989).  

The argument proceeds in two parts, each drawing on both case studies. First, I define medical humanitarianism as an ‘emergency claim’ which contests and complements other perspectives to shape emergency intervention. The example of the declaration of the Zimbabwean cholera outbreak as ‘national disaster’ illustrates that medical humanitarians contested and obscured alternative political economic understandings of the epidemic. Afterwards, I outline how during the West African Ebola outbreak, medical humanitarian and security perspectives converged to inadvertently perpetuate existing inequalities. In the second part, I analyse the everyday practices of humanitarian intervention and reveal their effects on the political subjectivities of people in need and humanitarians. For residents and medical responders within Harare townships during the Zimbabwean cholera outbreak, the relief intervention revealed the subjectification of township residents and sparked feelings of anger, resistance and impotence. Conversely, the case of a traditional healer who became a humanitarian broker during Sierra Leone’s Ebola response highlights that neutrality relied on and became a strategy, reproducing the unequal logic of the response. 

Neutrality as Principle: Humanitarian ‘Emergency Claims’ 

Looking at medical humanitarian neutrality as an ‘abstract concept’ (Redfield 2013, 117) voiced by medical humanitarian organisations through ‘speech acts’ directed at other actors in international relations (Buzan, Wæver, and Wilde 2022, 27), I argue that medical humanitarianism can be defined as a particular ‘emergency claim’ (Rubenstein 2015). Rubenstein (2015, 102) defines emergency claims as describing an unexpected and sudden event, directed to persuade a given audience that something (people, things, states, or affairs) is valuable but threatened with imminent harm, which can be prevented or reversed through human action. Medical humanitarianism draws on the imaginary of a ‘humanitarian’ emergency: unexpected events that put vulnerable people at risk of harm and require immediate intervention to avert an impending disaster (Calhoun 2018, 83). By focusing on suffering that can be averted through biomedical care, the act of humanitarian intervention is rendered neutral towards political struggles (Ticktin 2011, 3). In other words, medical humanitarian neutrality rests on a claim that suffering is universal, recognisable, and measurable and morally demands a response that can disregard political constraints such as borders to access those in need (Ticktin 2014, 276; Allen 2018, 207).

However, as socially produced and situated representations, multiple emergency claims contest, support, and compete to form an authoritative emergency narrative about a situation (Rubenstein 2015, 101). I argue that this makes medical humanitarian neutrality a political claim that contests competing accounts of epidemics and obscures unequal material consequences as it shapes the form of relief interventions. Drawing on a constructivist perspective, I take epidemics as ideas possessing ‘multiple ontologies’ (Chigudu 2020, 22)whose representations are diverse and “historically, culturally and materially located” (Mol 1999, 75). In other words, while the word ‘epidemic’ commonly refers to “the occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health related events clearly in excess of normal expectancy” (Last in Herring and Swedlund 2010, 14), I do not approach them as universally defined ‘events’ but multiple and overlapping phenomena with many meanings (Herring and Swedlund 2010, 14). Thus, I take international responses to disease not as reactions to objective conditions in the ‘real world’ but as socially constructed and reflecting ideas, interests and power of individuals and communities (McInnes and Lee 2012, 3). The eventual ‘outbreak narrative’, the account through which an epidemic gains meaning and that guides medical humanitarian action (Wald 2008, 18), reflects and reproduces dominant interests and social structures that underly the humanitarian response (De Waal 1997). This makes the articulation of medical humanitarianism as ‘neutral’ contradictory, as it contests and obscures other understandings of epidemics. 

Cholera and the Politics of Declaring a ‘National Disaster’ 

The case of the 2008/09 cholera epidemic in Zimbabwe illustrates that the medical humanitarian perspective obscured and de-legitimised alternative understandings of the outbreak. Infecting over 98,000 people and causing over 4,000 fatalities, the cholera epidemic was the most extensive on record in Africa (Chigudu 2020, 1). Infection with the disease results from the consumption of water or food contaminated by faecal matter or free-standing bacteria or seafood living in water infected with the Vibrio cholerae bacteria. While many acquire asymptomatic or mild cases of the disease, vulnerable and untreated patients can die from the diarrheal disease within hours from acute loss of fluid. However, since treatment is cheap and effective through Oral Rehydration Treatment (ORT), fatalities are preventable (Echenberg 2011, 6–11). Despite this seemingly straightforward option of responding to an outbreak, the Zimbabwean epidemic was only declared a ‘national disaster’ to activate the UN Humanitarian Cluster system and enable foreign resources to manage the outbreak after three months of delay (Chigudu 2020, 89). While the organisation Médecins Sans Frontières (MSF) was quick to declare a humanitarian emergency, the declaration of national disaster was not an ‘objective’ statement but subject to competing perspectives (Chigudu 2020, 97). The contestations of different emergency claims illustrate that humanitarian neutrality reflected a political position that diverted attention from the political economic causes of the epidemic. 

Being present in the country since before the cholera outbreak, MSF played a central role in shaping the outbreak narrative and the eventual relief response. Treating around 45,000 patients in the early stages of the outbreak, MSF drew on its principle of ‘witnessing’ to declare the scale and urgency of the outbreak (Chigudu 2020, 100). With a long history of ‘speaking out’ as a ‘collective doctor’, MSF claims to speak from a position of neutrality (Redfield 2010, 61). Issuing several press statements and reports, MSF acknowledged that the cholera outbreak had resulted from a ‘political crisis’ but did not name political choices or assign responsibility to specific actors for the causes of the epidemic (Chigudu 2020, 100). Instead, MSF demanded that the government facilitate access to a “’humanitarian space’ for independent aid organisations to carry out our [MSF’s] work” (MSF in Chigudu 2020, 100-101). The term ‘humanitarian space’ relies on the imaginary that humanitarian organisations can operate freely and outside of political or ideological struggles to deliver assistance to those in need (Spearin 2001, 22). In other words, MSF presented the outbreak as a ‘humanitarian’ emergency: by speaking out in the name of immediate suffering and calling for humanitarian intervention as the necessary response, MSF placed the outbreak response outside of local or international political struggles of the ‘political crisis’ and legitimised its exceptional role as leader of the intervention.  

However, MSF’s emergency claim was contested by competing perspectives which draw attention to the structural causes and political choices that led to the rise of cholera cases in Zimbabwe. For instance, the organisation Zimbabwe Lawyers for Human Rights (ZLHR) defined the epidemic as “a result of official and criminal negligence” (ZLHR in Chigudu 2020, 101). The organisation’s perspective points to the political economic factors that coincided and made the cholera outbreak a ‘man-made’ disaster (Chigudu 2020, 29). Following the 1990s structural adjustment programmes and a severe HIV/AIDS epidemic, the Zimbabwean health system had all but collapsed. Health facilities faced shortages of key medicine, frequent electricity outages, and an exodus of health workers, which contributed to a lack of familiarity with cholera symptoms and treatment and a lack of national disease surveillance (Chigudu 2020, 67–68). Moreover, a post-2000s national political crisis translated into struggles between government institutions and opposition-run municipalities over the water supply system. Following the nationalisation of the water authority (ZINWA) without compensation for........

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