The Aftermath of Aid: Medical Insecurity in the Northern Somali Region of Ethiopia

Abstract

This dissertation explores the lasting effects of recurrent temporary medical humanitarian operations through ethnographic research in communities, clinical facilities, nongovernmental aid organizations, and governmental bureaucracies in the northern Somali Region of Ethiopia. First, I found that medical humanitarian aid has altered persons' subjective experiences and expectations of biomedicine, spirit possession, health, and healing. Popular health cultures and conceptions of "biomedicine" as well as "traditional medicine" were changing, in part due to repeated exposures to relief operations. Second, I documented novel social formations to cope with recurrent aid: new labor relations to enable temporary work with international NGOs; new medical migrations to access comparable care and foreign medical commodities at distant private hospitals; and transnational extra-legal economies of medicine to fill gaps in care. Third, a set of racialized narratives have emerged in the interstices of aid that warn of malpractice and abuse by non-Somali Ethiopian clinicians. Such discourses echo Somalis' historical experiences of ethnic-based conflict with Ethiopian groups as well as their contemporary marginalization from Ethiopian sources of power. Accordingly, although aid is designed to improve immediate access to basic healthcare and medications, I find it also exacerbated medical insecurity. Northern Somalis' discursive expressions of medical insecurity have increased, paradoxically alongside steady improvements in their health and nutrition indicators. Finally, health and humanitarian interventions have altered local notions and practices of citizenship. In the last ten years, as Ethiopia has decentralized its health care delivery system, aid has been progressively channeled through Somali Regional State institutions. Accordingly, many Somalis now discuss the diverse ways in which they are increasingly interpolated into regional politics-often in opposition to the Ethiopian government. Medical humanitarian aid has shaped expectations of government as well as biomedicine. I argue that these new forms of citizenship have emerged primarily because of the intimate and profound nature of medical encounters themselves. The narrow humanitarian mission to minister to what social theorists call the "bare life" of victims, in actuality, is neither dispassionate nor removed from sociality and politics. Medical aid potentially provides spaces in which relations of care-giving, trust, and therefore responsive governance structures can develop.