Ethical Exits: Conceptual and Practical Challenges in Closing Humanitarian Healthcare Projects

Objective One: Book chapter drafted on theoretical foundations: This chapter, informed by my doctoral thesis, will outline the theoretical framework that underpins this book. I will explore power and trust in humanitarian healthcare services and examine possibilities for continuity-focused treatment. Drawing on Didier Fassin’s conceptualization of humanitarianism as a politics of life and the moral economy, I will assess the efficacy, moral politics, and ethical implications of humanitarian healthcare interventions (Fassin, 2007). Additionally, the chapter will delve into the concepts of social determinants of health and biopolitics, building on Tan et al. (2021) and their work on social capital in managing non-communicable diseases (NCDs) among refugees. It will analyze how institutions exercise biopolitical power to justify healthcare interventions and withdrawals, thereby influencing migration trajectories for conflict-affected populations with NCDs. Finally, this chapter will introduce the temporal tension of NGO-run healthcare by developing Zerubavel’s (1985) work on the ‘hidden rhythms’ that shape institutional control of time and their impact on society's biology.

Objective Two: Book chapter drafted on health systems and institutions: Informed by my Doctoral thesis, and interviews and archival research conducted during this Brocher residency, this chapter will open with a short history of humanitarian healthcare. It will detail how over time, the humanitarian healthcare sector has evolved into a complex system of specialised organisations, shaped by geopolitical, cultural, social, and economic forces, that influence global social and political decision-making. This chapter will detail the consequences of this, that patients with NCDs are often left without treatment. This chapter will evidence how humanitarian healthcare settings can be spaces of great power inequity, detailing the two-tier staff systems between national and international staff, and the power inequity between staff and the patients they mobilise to serve. This chapter develops the argument for the necessity to rethink the emergency modus operandi, and incorporate an ethics of care in humanitarian NCD healthcare.

Objective Three: Conduct interviews with major Global Health Stakeholders; Based on key stakeholders involved in both i) humanitarian operations and ii) humanitarian research, identified in the archives, and some already identified through literature review and stakeholder analysis. Online and in-person interviews with stakeholders/institutions including the Global Health Board at the World Humanitarian Forum; The Geneva Centre of Humanitarian Studies; Research Unit on Humanitarian Stakes and Practices (UREPH) of Médecins Sans Frontières (MSF) Switzerland. Finally, Professor Matthew Hunt at McGill University and Professor Lisa Schwartz, McMaster University. These practitioners and academics have invaluable backgrounds in technical areas relevant to my book and broader research project, particularly on the dimensions of power in humanitarian healthcare. My output will be to meet with them and their teams – where relevant - while I am drafting the relevant sections of my book. These meetings will provide an invaluable perspective for ensuring the book is informed by real-world practice, the most relevant academic and grey literature, and concluding the book’s final case studies.

Objective Four: Develop two case studies for future data generation in the Middle East, focusing on NCD treatment and the continuity of care. While researching and writing the two chapters of this book, I will develop the next two case studies to pursue in late 2026 in the Middle East (most likely in Lebanon and Syria). These case studies will deepen our understanding of local perspectives on preparing for an 'ethical exit' from temporary NCD care, explore how front-line staff and patients experience such closures, and examine how this evidence can inform strategies to strengthen health systems.

Objective Five: Network with academics and humanitarian practitioners in Geneva

If time allows, I also plan to use my stay at Brocher to expand my professional network within the humanitarian and global health communities. While I have existing contacts to draw on, I intend to attend seminars and conferences in Geneva to build new connections. For instance, with the