Humanitarianism and the Quantification of Human Needs: Minimal Humanity 9780367222154, 9781003006954

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Humanitarianism and the Quantification of Human Needs

This book provides a historical inquiry into the quantification of needs in humanitarian assistance. Needs are increasingly seen as the lowest common denominator of humanity. Standard definitions of basic needs, however, set a minimalist version of humanity – both in the sense that they are narrow in what they compare, and that they set a low bar for satisfaction. The book argues that we cannot understand humanitarian governance if we do not understand how humanitarian agencies made human suffering commensurable across borders in the first place. The book identifies four basic elements of needs: As a concept, as a system of classification, as a material apparatus, and as set of standards. Drawing on a range of archival sources, including the United Nations Refugee Agency (UNHCR), Médecins sans Frontières (MSF), and the Sphere Project, the book traces the concept of needs from its emergence in the 1960s right through to the present day, and United Nations Secretary-General Ban Ki-moon’s call for “evidence-based humanitarianism.” Finally, the book assesses how the international governmentality of needs has played out in a recent humanitarian crisis, drawing on field research on Central African refugees in the Cameroonian borderland in 2014–2016. This historical inquiry into the universal nature of human suffering will be an important read for humanitarian researchers and practitioners, as well as readers with an interest in international history and development. Joël Glasman is Professor of African History at the University of Bayreuth, Germany.

Routledge Humanitarian Studies Series Series editors: Alex de Waal, Dorothea Hilhorst, Annette Jansen and Mihir Bhatt Editorial Board: Dennis Dijkzeul, Wendy Fenton, Kirsten Johnson, Julia Streets, Peter Walker

The Routledge Humanitarian Studies series in collaboration with the International Humanitarian Studies Association (IHSA) takes a comprehensive approach to the growing field of expertise that is humanitarian studies. This field is concerned with humanitarian crises caused by natural disaster, conflict or political instability and deals with the study of how humanitarian crises evolve, how they affect people and their institutions and societies, and the responses they trigger. We invite book proposals that address, amongst other topics, questions of aid delivery, institutional aspects of service provision, the dynamics of rebel wars, state building after war, the international architecture of peacekeeping, the ways in which ordinary people continue to make a living throughout crises, and the effect of crises on gender relations. This interdisciplinary series draws on and is relevant to a range of disciplines, including development studies, international relations, international law, anthropology, peace and conflict studies, public health and migration studies. International Humanitarian NGOs and State Relations Principles, Politics, and Identity Andrew J. Cunningham Crisis Management Beyond the Humanitarian-Development Nexus Edited by Atsushi Hanatani, Oscar A. Gómez and Chigumi Kawaguchi Urban Poverty in the Wake of Environmental Disaster Rehabilitation, Resilience and Typhoon Haiyan (Yolanda) Edited by Maria Ela Atienza, Pauline Eadie and May Tan-Mullins Disaster Public Health and Older People Emily Chan Humanitarianism and the Quantification of Human Needs Minimal Humanity Joël Glasman For more information about this series, please visit: www.routledge.com/ Routledge-Humanitarian-Studies/book-series/RHS

Humanitarianism and the Quantification of Human Needs Minimal Humanity Joël Glasman

First published 2020 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2020 Joël Glasman The right of Joël Glasman to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Names: Glasman, Joël, 1979– author. Title: Humanitarianism and the quantification of human needs : minimal humanity / Joël Glasman. Description: Abingdon, Oxon ; New York : Routledge, 2020. | Series: Routledge humanitarian studies | Includes bibliographical references. Identifiers: LCCN 2019038947 (print) | LCCN 2019038948 (ebook) | ISBN 9780367222154 (hbk) | ISBN 9781003006954 (ebk) Subjects: LCSH: Humanitarianism. | Basic needs. Classification: LCC BJ1475.3 .G59 2020 (print) | LCC BJ1475.3 (ebook) | DDC 361.2/5—dc23 LC record available at https://lccn.loc.gov/2019038947 LC ebook record available at https://lccn.loc.gov/2019038948 ISBN: 978-0-367-22215-4 (hbk) ISBN: 978-1-003-00695-4 (ebk) Typeset in Baskerville by Apex CoVantage, LLC Cover picture: Central African Refugees volunteers carrying bags of corn on a truck destined for a food distribution, October 21, 2014, Mbile, East Cameroon. © UNHCR/Olivier Laban-Mattei.

Contents

Acknowledgments List of figures List of tables List of boxes List of abbreviations Introduction: Minimal humanity – the commensuration of human suffering on a global scale

vi ix xi xii xiii

1

1

Concepts: Elements of a genealogy of needology

28

2

Classifications: UNHCR and the legibility of refugees in Central Africa

68

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry

92

Standards: The Sphere Project and the universalization of the vital minimum after Goma

122

Registration: Refugees and the emergence of the humanitarian field in Cameroon

170

Vulnerability: Impartial algorithms and analog malnutrition

211

Conclusion: Infrastructure of commensurability

243

Index

256

3

4

5

6

Acknowledgments

This book owes much to the generosity and goodwill of many friends and colleagues, as well as to the humanitarian workers who spoke with me during research. Most will remain nameless here, but this project could not have been possible without their help. The research for this book began while I was working as a lecturer at Humboldt University, continued while I was a research fellow at the Centre Marc Bloch in Berlin, and was completed after I became a faculty member at the University of Bayreuth. I am greatly in debt to these institutions for their financial and moral support. Just as important was the help and inspiration provided by faculty and staff. My former colleagues at the Humboldt University’s Department of African Studies helped a great deal in starting the project, especially Silke Strickrodt, Holger Stoecker, Stefan Hoffmann, Baz Lecocq, Julia Tischler, and Daniel Tödt. At the Centre Marc Bloch, I have learned a lot from sharing an office with Denis Eckert, as well as from discussions in the Experiences of Globalization research group led by Teresa Koloma Beck and Emmanuel Droit. At the University of Bayreuth, I benefited from an extraordinary welcome to the history department, and from the support of Achim von Oppen, Jan Hesse, Susanne Lachenicht, Martin Ott, Ralf Behrwald, Sebastian Teupe, and Kristin Skottki. I also enjoyed the transdisciplinary discussions within the Africa Multiple cluster, especially within the Mobilities research section with Martin Doevenspeck, Uli Beisel, and Jochen Lingelbach. This research also benefited from a grant of the German Research Foundation. I am thus thankful to the members of the SPP1448 Adaptation & Creativity in Africa research program, and especially to its speakers, Richard Rottenburg and Ulf Engel. In all those years wandering from one institution to another, Andreas Eckert has been an invaluable mentor. I owe the greatest debt to the many humanitarian workers who, in spite of their busy schedule, took the time to answer my questions – some of them repeatedly over the years. Although it is not possible to list all of them here, I would like to especially mention Roseline Okoro from UNHCR, Serge Sarkadela from ACF and Max Schott from OCHA. In the eastern region of Cameroon, I owe a debt to the refugees who shared their experiences, as well as to the representatives of Central African refugees, especially Ali Djibril, Liman Abdrahman, and

Acknowledgments

vii

Seleman Mohamed. Damien Peyrera (UNICEF) and Valentin Gague (SENS/ SMART) have helped me a great deal in finding my way in research on acute malnutrition. Jean Yougouda (UNHCR) hosted me on several occasions, providing me with both lodging and invaluable advice regarding the world of refugee protection. Access to archives in Geneva was made possible by Monserrat Canela Garayoa (UNHCR), Juan Michel and Christine Knudsen (the Sphere Project), Manuela Corbolino (ICVA), and Anne de Rivaz and Kinga Kukorellya (MSF). I am thankful to Camille Colleu (Centre Marc Bloch) who helped me collect some of the articles and archival material for Chapter 4. Over the past few years, I have presented and discussed parts of this manuscript and related questions in many venues, including the departments of history at Bielefeld University, the University of Erfurt, the University of Basel, and the University Denis Diderot Paris VII; the Latin America Institute of the Free University in Berlin; the Humanitarian and Conflict Response Institute at the University of Manchester; the School of Oriental and African Studies in London; and the University of Yaoundé II. I am thankful to my interlocutors on these occasions, as well as to the colleagues who organized those events, especially Angelika Epple, Jürgen Martschukat, Iris Schröder, Odile Goerg, Bertrand Taithe, Susanne Jaspars, Tom Scott-Smith, Elizabeth Hull, and Nadine Ndzesop Machikou. I also benefited several times from participants’ comments at Adam Jones’ legendary workshops in Polenz. At the German Network of Forced Migration Researchers, at which I was kindly introduced by Ulrike Krause, I benefited from many discussions and gained much information on refugee studies. A number of colleagues and friends offered help on different parts of the text. Vincent Bonnecase, Robin Frisch, Debora Gerstenberger, Agathe Menetrier, Hanno Brankamp, Romain Tiquet, Klaus Schlichte, Tyler Zoanni, and Peter Lambertz gave me endless advice. Olaf Kleist and the editors of the Journal of Refugee Studies made many suggestions for Chapter 2, while Samuel Moyn and the editorial board of Humanity made valuable comments on Chapter 3. Every time I was stuck with specialized terminology, I was lucky enough to find specialists who helped. Yvonne Grellety, Andrew Seal, and Bernward auf dem Kampe helped me understand medical concepts on malnutrition, while Patrick Kuebart provided insights into international humanitarian law. I am also thankful to the editors of the Routledge Humanitarian Studies Series, Alex de Waal, Thea Hilhorst, Annette Jansen, and Mihir Bhatt, as well as to the anonymous readers of the series for their comments. My sister Manuelle Glasman and my brother François-Loic Glasman have offered several ideas and provocation to the arguments offered here. Molly McLaughlin translated parts of the introduction and Chapter 4. Sophie Schlondorff translated Chapter 2. Fenja Klages, Caroline Garrido, and Jill Pöggel helped with the copyediting of the text. At Routledge, I owe a special thanks to Leila Walker for her patience and her help with the editing process. More than anyone else, I owe a great deal to my wife Julia Eichenberg. She has been a companion, a colleague, and an inspiration for many years. While I was

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Acknowledgments

working on this book, she was writing her monograph on government-in-exile in London during the Second World War. The discussions on our parallel research projects have informed my own thinking probably more than I would care to admit. This book would not have been possible without her support.

Additional acknowledgments A slightly different version of Chapter 2 was published in “Seeing Like a Refugee Agency: A Short History of UNHCR Classifications in Central Africa (1961–2015),” Journal of Refugee Studies, Volume 30, Issue 2, June 2017, pp. 337–362. An earlier version of Chapter 3 was published in “Measuring Malnutrition. The History of MUAC and the Commensurability of Human Needs,” in Humanity: An International Journal of Human Rights, Humanitarianism and Development, Volume 9, Issue 1, 2018, pp. 19–44. Previously published material has been reprinted with permission.

Figures

0.1 0.2 0.3 0.4 1.1 1.2 1.3 2.1 3.1 3.2 3.3 3.4 3.5 4.1 4.2 4.3 4.4 4.5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8

Lolo Refugee camps in East Cameroon, 2014 Sphere Archive in Geneva UNHCR headquarters in Geneva Map of Central African L3 Emergency, 2014 The use of “needs” and “suffering” in digitized printed sources (1830–2000) Maslow’s hierarchy of needs has often been presented as a pyramid The use of “basic needs” in digitized printed sources (1910–2008) A classification code used by UNHCR EU Commissioner for Humanitarian Affairs Kristalina Georgieva with MUAC tape (2012) The height-arm circumference method being conducted by a survey team in the Southeastern State (1969) Insertion tape (1975) The three-colored cord (1974) ACF nurse Serge Sarkadela measures a child’s arm with MUAC tape in Eastern Cameroon, December 2014 Covers of the Sphere Handbook (2000 and 2004 editions) The 1990s: A decade for competing codification projects Chronology of the Sphere Project Structure of the Sphere Project (May 1998) Early draft of the Sphere Handbook with handwritten annotations (health chapter, December 1997) An Excel sheet from the preparation of the OCHA Humanitarian Needs Overview, 2017 Refugee sites and entry points for new refugees from the Central African Republic Kenzou, December 2014: Asylum seekers waiting to register Setting up cables to provide electricity for the laptops A diesel generator provides electricity to register refugees Building an open-air bureaucracy: Tables, chairs, printer UNHCR clerk interview with asylum seeker with the help of an interpreter Handwritten registration sheet

13 14 15 16 30 39 48 72 93 100 105 106 109 124 130 133 135 141 172 175 183 184 185 186 188 188

x

Figures

5.9 5.10 5.11 5.12 5.13 6.1 6.2 6.3 6.4

6.5 6.6 6.7 6.8 6.9

UNHCR-staff enters registration information in the ProGres databank While the UN-staff takes the picture, the whole family is helping Printing registration documents – creating an official “refugee” Will a child unplug the cables feeding the laptops? UNHCR clerk negotiating with asylum seekers Map of vulnerability in Cameroon according to OCHA Cluster sampling with SMART methodology in Cameroon Numerating households with chalk The calendar of events to find out date of birth used for SMART. (extract). UNICEF/ACF August 2015. Courtesy of ACF Household counting via chalk marking. SENS: UNHCR, Adamawa, August 2016 Interview and questionnaire. SENS; UNHCR; Adamawa, August 2016 Interview and questionnaire. SENS; UNHCR; Adamawa, August 2016 Entering the measures into the smartphone. SENS; UNHCR; Adamawa, August 2016 Aid agencies in Cameroon

190 191 192 193 194 212 218 219

220 226 227 227 228 231

Tables

5.1 6.1

People in need in Cameroon according to OCHA Quantitative surveys on hunger in Cameroon (2006–2016)

199 214

Box

5.1

Population census in Cameroon

196

Abbreviations

ACF ACT AHA ALNAP BUCREP CARE CDC CMR DAC DFID ECAM ECHO ERC FAO HC IASC ICARA ICRC ICVA IDP IFCR ILO INGO IOM ISO JEEAR LWF MICS MSF MUAC

Action contre la Faim/Action Against Hunger International Action by Churches Together African Humanitarian Agency Active Learning Network for Accountability and Performance in Humanitarian Action Central Bureau of the Census and Population Studies (Cameroon) Cooperative for Assistance and Relief Everywhere Centers for Disease Control Crude mortality rate OECD’s Development Assistance Committee United Kingdom’s Department for International Development Enquête Camerounaise Auprès des Ménages (Cameroonian Household Survey) European Civil Protection and Humanitarian Aid Operations Emergency Relief Coordinator Food and Agriculture Organization of the United Nations Humanitarian coordinator Inter-Agency Standing Committee International Conference on Assistance to Refugees in Africa International Committee of the Red Cross International Council of Voluntary Agencies Internally displaced person International Federation of the Red Cross and Red Crescent Societies International Labour Organization International non-governmental organization International Organization for Migration International Organization for Standardization Joint Evaluation of Emergency Assistance to Rwanda Lutheran World Federation Multiple Indicator Cluster Surveys Médecins Sans Frontières/ Doctors Without Borders Mid-upper arm circumference

xiv

Abbreviations

NGO NIEO OAU OCHA ODI OECD OFDA OHCHR Oxfam PCIMA PLAN PU-AMI SCF SCHR SENS SMART TCNs UNDP UNDRO UNFPA UNHCR UNICEF UNRRA UNV URD USAID VOICE WFP WHO

Non-governmental organization New International Economic Order Organization for African Unity Office for the Coordination of Humanitarian Assistance Overseas Development Institute Organization for Economic Co-operation and Development United States’ Office of Foreign Disaster Assistance Office of the United Nations High Commissioner for Human Rights Oxford Committee for Famine Relief Integrated Management of Acute Malnutrition Programme Plan International Cameroon Première Urgence-Aide Médicale Internationale Save the Children Fund Steering Committee of Humanitarian Response Standardised Expanded Nutrition Survey (by UNCHR) Standardized Monitoring and Assessment of Relief and Transition Third-country nationals United Nations Development Programme United Nations Disaster Relief Organization United Nations Population Fund United Nations High Commissioner for Refugees United Nations Children’s Fund United Nations Relief and Rehabilitation Administration United Nations Volunteers Groupe Urgence, Réhabilitation, Développement United States Agency for International Development Voluntary Organizations in Cooperation in Emergencies World Food Programme World Health Organization

Introduction Minimal humanity – the commensuration of human suffering on a global scale

In March 2017, the UN Security Council met at its Manhattan headquarters to listen to the Emergency Coordinator, Steven O’Brien. In the months before, the delegates had come several times to hear him talk about droughts in Central America, earthquakes in Myanmar, a hurricane in Haiti, and the civil war in Syria. This time, O’Brien was reporting about the humanitarian crisis in Africa and the Middle East, and, once again, he tried his best to capture the delegates’ attention. He described the ongoing famine in several countries and listed the high figures of persons affected. “More than 20 million people in four countries are facing starvation and famine,” he said. “Without aid, people will simply starve to death. Many more will suffer and die from disease.”1 “We stand at a critical point in our history,” he said. “We are facing the largest humanitarian crisis since the establishment of the United Nations.”2 O’Brien obviously succeeded in capturing his audience’s imagination. News agencies like CNN, Al Jazeera, and the South China Morning Post widely diffused the warning. The “World faces worst humanitarian crisis since 1945,” the BBC wrote.3 Although many have rightly said that O’Brien’s prognosis was a gross overestimation, the aim of this book is not to take part in this controversy – neither is it another lament about the alarmism of humanitarian agencies in the competition for the public’s attention.4 This book is about the invention of “humanitarian needs” and the increased use of quantitative data to compare the effect of catastrophes on different societies. O’Brien’s agency regularly publishes figures on “people in need” on the world scale – and so do UNICEF, UNHCR, WFP, and many others. The UN system, following its former Secretary-General, calls for a new age of international aid shaped by a “data revolution” and an “evidence based humanitarianism.”5 The aim of this book is to historicize the role of quantification in humanitarian governance. While O’Brien’s vision of the world claims to be universal, non-political, and to transcend state boundaries, this book argues that there is more than this minimalist version of humanity. The way humanitarian agencies compare societies, measure suffering, and aggregate individual pain into universal social categories matters. This rationality not only shapes humanitarian workers’ everyday practices and the chances of those whose survival depends on emergency relief 6 – it has also become an intrinsic part of world politics, and it informs our perception of distant societies.

2

Introduction

This book deals with the emergence of humanitarian needology: The bookkeeping of human suffering on a world scale, i.e. a specific way of capturing others’ afflictions through a set of institutions, concepts, classifications, measures, standards, and technologies that allows for global commensurability. My argument here departs from the prevailing – and optimistic – vision of humanitarian quantification. Most observers claim that humanitarian aid has become more efficient, more transparent, and more just due to the professionalization of staff, the accumulation of knowledge, and the use of new technologies. But this narrative overestimates the control that humanitarian agencies have over their tools. I argue here that the tools developed by humanitarian agencies have shaped humanitarian agencies as much as they have been shaped by them, not only in changing the practices of humanitarian aid, but also in displacing its aims, its targets, and its scope. My argument also departs from the now standard criticism that humanitarian quantification is a mere reflection of neoliberal bureaucracy. Although it is true that humanitarian statistics borrow a lot from neoliberal management’s tools and epistemology, I argue that they have gained a certain autonomy and their own logic of quantification. Thus, humanitarian agencies are sometimes less the prisoners of other actors than they are of their own history. Needs assessment entails a tension between the hope of helping others and the fear of chaos, between the will to control and the doubt about our ability to intervene, between empathy and the will to remain at a distance, between the will to humanize and the will to objectify. However, this book is not a nostalgic defense of an earlier regime of humanitarian action that saw human suffering through the lens of compassion, empathy, and an interest for the whole person. Nor is it a condemnation of a new aid regime that cherishes statistics, accumulates Excel sheets, and prefers “cold data” to “warm human relationships.” As we will see, quantitative data are anything but cold. Rather, this is a plea for the redeployment of historical knowledge in the age of big data.7 What do aid agencies mean when they say that there are 125.3 million “people in need” on the planet?8 What does the Emergency Coordinator mean when he says that “We are facing a humanitarian crisis”? How is this “we” composed, collected, and represented? How does this collective hold together – and how might someone legitimately act in its name?

The historicity of humanitarian needs Humanitarian workers have not always attempted to address “human needs” – at least not as the Office for the Coordination of Humanitarian Assistance (OCHA) understands the concept today, both as a universal category of statistical comparison and as a definition of a minimally acceptable standard of living. Consider, for instance, an excerpt from Un Souvenir de Solferino, one of the canonic texts of humanitarianism. Its author, Henri Dunant, founded the Red Cross and is considered to be one of the fathers of modern humanitarian aid. Describing the suffering of soldiers wounded in the battle of Solferino (1862), Dunant wrote: The wounded unfortunates who are hoisted up all day long are pale, livid, breathless; some, and more particularly those who have been profoundly

Introduction

3

mutilated, have a dazed look and seem not to understand what is being said to them, they fix haggard eyes on you, but this apparent prostration doesn’t prevent one from feeling their suffering; the others are restless and agitated by a nervous breakdown and a convulsive trembling; these, with open wounds where inflammation has already begun to develop, are nearly mad from pain, they ask that they be killed, they contort, with contracted visage, in the last grips of agony.9 For Dunant, human suffering was worthy of compassion, regardless of any cultural or national affiliation. Unlike many of his contemporaries, he did not take sides in favor of French, Austrian, or Sardinian soldiers – which is why he received the 1901 Nobel Peace Prize. However, Dunant barely spoke of “needs.” His text illustrates the individuality of pain and the most graphic forms of physical suffering, including soldiers’ “open wounds,” their “pale” wounded complexions, and their “haggard eyes.” His gaze was driven by emotion rather than calculation, by compassion for the suffering individual rather than by a quest for generalization through scientific comparison.10 Let us now consider a contemporary, twenty-first-century description of distant suffering.11 In the following excerpt, the UN High Commission for Refugees (UNHCR) describes the situation of refugees from the Central African Republic who were living in Cameroon: Refugees from [the] Central African Republic in the east of Cameroon are facing a steady deterioration of their living conditions. They are at risk of malnutrition with a 17.2 percent prevalence of acute malnutrition among refugee children and mortality rates are six to seven times higher than the emergency threshold in some areas. Additional interventions are essential to address nutritional problems especially amongst children, pregnant and lactating women. School enrolment rates are low, with less than a third of girls enrolled. Programmes to construct additional school facilities, sensitize parents to the benefits of education and provide school supplies, could help bridge this gap. Additional gaps include lack of access to primary health care, lack of countrywide availability of anti-retro viral treatments for HIV/AIDS, inadequate supplies of sanitary materials and non-food items, and insufficient quantities of drinking water. Living conditions for many urban refugees are deplorable and urgent attention to shelter is needed.12 Unlike Dunant’s text, this excerpt does not claim to have been written by a single person. It is the product of an undefined number of anonymous humanitarian experts. Though the way in which it designates the target of humanitarian aid is different, its overall objective is the same as that of Un Souvenir de Solferino: Encouraging the reader to support humanitarian action. UNHCR is one of the largest agencies for humanitarian assistance; it has a mandate to protect and assist refugees. It has gained a high level of public recognition and received the Nobel Peace Prize twice.13 As can be seen in the excerpt, UNHCR lists objectified problems according to domains of intervention (malnutrition, mortality, nutrition,

4

Introduction

education, health, drinking water, shelter, etc.). It mobilizes categories of beneficiaries (young children, pregnant and nursing women, urban refugees), uses standard definitions (“acute malnutrition,” “mortality,” “non-food items”), and quantified indicators (prevalence of malnutrition, mortality rates). Unlike Un Souvenir de Solferino, UNHCR’s text is not presented as the result of subjective experience. Of course, subjective descriptions of suffering still play an important role in the humanitarian gaze. It has almost become an academic routine to criticize contemporary politics for its constant mobilization of moral sentiments and to analyze the frequent use of metaphors, pictures, and narratives triggering compassion, empathy, or pity.14 But the compassionate view of distant suffering is increasingly supported by another type of information with an objectivist ambition. Dunant described what he had seen and felt on a particular battlefield. In contrast, UNHCR is working simultaneously in 130 countries, addressing the suffering of refugees across borders and within the most diverse social and cultural settings. In order to justify the “impartiality” of its actions, it relies on standard definitions, quantification, and systematic assessment procedures. Aid workers are well aware that they are exercising power when they construct refugee camps, select the target groups for aid projects, deliver goods and services, organize consultations, etc. Indeed, humanitarian agencies act like governments at a distance. However, they know that they have to justify their actions, as their legitimacy cannot be proven through elections or referenda. Aid agencies must therefore make considerable efforts to legitimize their presence and their decisions in the allocation of resources. “We cannot prevent disasters,” agencies explain, “but we can try to deliver relief aid in an impartial way.” Aid agencies argue that a better assessment of people’s needs is a precondition for aid that is more just and, eventually, for a world that is fairer. However, as I will argue in the following pages, this argument hides a deep contradiction: The more aid agencies have acted on larger scales, the more they have reduced and simplified their definition of needs.

Humanitarian “impartiality” as a view from nowhere The argument presented here is not that humanitarian quantification is new – the argument is that quantification currently plays a key role in the legitimation of humanitarian aid, to the point that numbers are believed to be the most efficient guardians of humanitarian impartiality. Humanitarian statistics are not new. While Henri Dunant was giving a qualitative account of the battle near Solferino, Jean Charles Chenu, a physician in the French army, was painstakingly counting the dead and injured soldiers of Solferino, producing a detailed, statistical account of the war.15 As will be seen in Chapter 1, state administrations and universities produced many statistics on demography, health, poverty, hunger, war casualties, asylum seekers, and natural disasters throughout the nineteenth century – a practice that was systematized during the first half of the twentieth century. The two world wars were times of intense production for statistics – on body density, logistics, stocks, displaced persons, resources, etc.16

Introduction

5

However, during the twentieth century, decisive shifts took place in the role played by humanitarian numbers – their producers, their scale, and their use for justifying action. International organizations and non-governmental organizations are playing an increasing role in the production of data. These organizations not only aggregate data provided by states, they also provide their own expertise, guidelines, staff, and norms to help states produce them. In many cases, international organizations and NGOs produce data independently. The scale of their statistical ambition has changed. Until the 1940s, international statistics on poverty, hunger, or migration did not include the world’s colonized population (roughly a third of the global population). Statistics on colonized subjects were carefully singled out: It did not occur to Dunant’s contemporaries to compare the basic needs of European citizens with those of African subjects. Now, UN datasets aim at producing universal comparisons. Finally, humanitarian statistics now enjoy an aura of legitimacy of which Dunant and Chenu’s generation could never have dreamed. The current hype for quantitative humanitarianism, for big data fueled by digital technologies, should call for an urgent reexamination of its past.17 A good indicator of the changing role of quantification in humanitarian aid is the shift in the definition of “humanitarian impartiality.” All major actors now agree that humanitarian aid should be “impartial,” and that “aid priorities [shall be] calculated on the basis of need alone.”18 While most literature on humanitarian principles traces the origin of “impartiality” back to Henri Dunant and the foundation of the Red Cross, virtually none mentions the radical shift in the definition during the second half of the twentieth century. For Dunant, impartiality and neutrality meant that humanitarian actors should not take sides – in his case, by favoring either the French, Austrian, or Sardinian soldiers – but provide relief to them all. He argued that the humanitarian’s point of view was external to that of the conflicting parties. However, this had nothing to do with quantification. In the prevailing nineteenth-century European discourse on charity, this position of externality was justified by reference to the monotheistic, far-removed God, who was independent of mortal passions. The early twentieth-century Red Cross movement justified its humanitarian impartiality by analogy to the position of a judge or physician: Both were thought to be impartial because of their training and professional ethics. It was only after the Second World War that a juridical and medical ethic of impartiality began to be increasingly backed and supported, if not gradually replaced, by the concept of statistical objectivity. Impartiality, in today’s interpretation of humanitarian principles, is the necessity of helping people “according to their needs,” a definition that is increasingly being interpreted as kind of mathematical rules of distribution. Thus, needs have not only become the metric, but also the moral compass of humanitarian aid: Impartiality is no longer defined as God’s point of view, or that of a judge or medical doctor, but as the point of view of the algorithm.19 Much is now expected from humanitarian quantification: It is supposed to ensure the impartiality of relief and legitimize humanitarian action vis-à-vis other modes of action (political, economic, etc.), as well as ensuring the cohesion of the

6

Introduction

humanitarian field.20 This is a highly competitive field: Dozens of UN agencies, hundreds of international NGOs, and thousands of local NGOs compete for humanitarian funding and public attention. Aid agencies have different target populations (refugees, victims of natural catastrophes, people injured in wars, children, etc.), different traditions, and different objectives. Needs assessment has, however, become the new doxa of humanitarian aid: The quantification, hierarchization, and prioritization of needs is increasingly considered able to ensure cooperation and consensus within the “humanitarian community” – this might be too large a task for these fragile numbers. To borrow from the approach of science historian Lorraine Daston, humanitarian agencies speak from an “aperspectival” point of view: They do not speak from a specific place, they take a point of view from everywhere and therefore “from nowhere.”21 They build on an ontology of humanity. The notion of needs aligns a moral impetus with juridical categories, statistical tools, technical devices, manufactured items, and expert practices. It allows international aid organizations to compare different individual destinies, while at the same time articulating them according to the horizon of a common humanity.

Universal vital minimum as the lowest common denominator of humanity Another argument of this book is that humanitarian quantification not only ensures worldwide comparison, but also sets specific norms. A common assumption is that humanitarian needs assessment puts quantification first and decisionmaking second (ideally, decisions are taken on the basis of quantification). As will be seen here, the quantification of needs actually requires crucial decisions to be made before the needs assessment has been begun. For instance, as Chapter 3 will show, one cannot assess acute malnutrition in different communities without having first established a common yardstick to enable the comparison. This book, therefore, does not separate the history of statistics from the history of the yardstick, i.e. the standards and thresholds that humanitarian agencies have used to define what they variously describe as “survival,” “elementary,” “emergency,” “fundamental,” “primary,” “urgent,” “essential,” “acute,” or “basic” needs. Therefore, this book is also about the thin line that separates, in the view of those experts, the bare minimum from the rest. Aid agencies argue that their perimeter of action is global, because of the universality of needs. Of course, the idea of a common humanity that transcends national or cultural boundaries is old.22 Similarly, the attempt to establish a commensurability of bodies through quantification dates back at least two centuries.23 Humanitarian agencies have however recently merged these two endeavors: The idea of humanity as a single and common community (expressed, for instance, in the United Nations’ Universal Declaration of Human Rights), and the commensurability of all human suffering (expressed through indicators and standard definitions) have become two sides of the same coin. The category of “people in need” is the result of this fusion.

Introduction

7

The history of humanitarian aid is a paradigmatic example of a more general “rise in globality.”24 Humanitarian actors are not alone in seeing the whole planet as a pertinent scale of intervention. The twentieth century has witnessed the birth of a “global population,” a “global economy,” and a “global environment,” as well as a “juridical humanity.”25 The globe as a whole is now seen as the natural horizon of humanitarianism.26 Humanitarian aid is not only an ambition to help a large number of people but, potentially, to help every single person in need on the planet. The UNHCR Handbook for Emergencies, for instance, speaks of “worldwide” action, while the Sphere Humanitarian Charter and Minimum Standards in Disaster Response creates nothing less than “universal minimum standards” that apply anywhere in the world.27 But this rise in globality has been marked by a contradiction: The more universal the comparison of needs has become, the narrower it has become. Thus the definition propagated by the UNHCR Handbook for Emergencies declares that in situations of distress: “Everyone in the population, irrespective of age or sex, should receive exactly the same general ration (i.e. same quantity and type of foods).”28 According to UNHCR, for a standard population, humanitarian organizations should provide at least: 2,100 kcal of food (including 350 to 400 grams of staple cereal, 20 to 40 grams of an energy-rich food like oil or fat, and 50 grams of a protein-rich food), 15 to 20 liters of clean water (to drink, cook, and wash) per person and per day and 3.5 square meters of sheltered space (tents, or other structures), one latrine seat per 20 people, one wheelbarrow per 500 people, one 100-liter refuse bin per 50 people, etc.29 This definition of needs is in accordance with that of other large humanitarian agencies30 such as the definition given by the Sphere Project (see Chapter 4). However, it is more than an ethereal list of standards listed and printed in obscure handbooks. The indicators and thresholds that it suggests also have a material dimension: The list determines the entire dispositive material of aid intervention, and the tools and instruments provided by humanitarian agencies, including tents, cooking utensils, and medical devices that are industrially produced according to these standards, thus shaping the practices of aid workers and the lives of recipients. The notion of “basic needs” (along with how embedded it is in materiality and technology) is the keystone of what scholars increasingly call the “humanitarian government” of the world i.e., to borrow Michel Agier’s definition, the “globalized apparatus” made of “a set of organizations, networks, agents, and financial means distributed across different countries and crisscrossing the world as they herald a universal cause, the only and exclusive raison d’être of humanitarian projects.”31 Herein lies the paradox: The more the definition of “needs” has been claimed to be applicable to all, the more it has been simplified, in an eternal search for the lowest common denominator of humanity. The more humanitarian action became global, the more its notion of needs shrank. According to the viewpoint expressed by UNHCR and other agencies, the tastes, politics, and interests of different societies depend on where they live. Their basic needs, however, do not. “What do we really require to survive?” humanitarians ask. What is the minimum, the bottom line below which less is nothing and more is optional? What is negotiable, and what is not?

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The following chapters explore how humanitarian experts have come to answer these questions over the last decades. Our current definition of needs is, this book argues, the result of power struggles between aid agencies (and, in a second instance, the result of power struggles between those agencies and other actors of aid, including donors, states, aid recipients, etc.). While agencies solve their problems, either through the victory of one position over the other, or through ad hoc compromises, their decisions lead to the creation of new social categories, the adoption of new concepts, the codification of norms, the production of industrialized items, or the adoption of standard procedures. Thus, the whole apparatus of aid transports black-boxed assumptions that historical research may unpack.32 Practice theories (especially actor–network theory and pragmatic sociology) constitute an important conceptual resource here. The important points are that actors contribute to defining the scale of their actions, and that their actions are not solely symbolic – it is not only about how the actors represent the world, but how they perform it:33 The notion of needs is not only a representation of a real world that would exist outside of it, but a tool that has physical repercussions on the individual recipients’ life chances. Specific attention to categories and material artifacts therefore enables us to rediscover possibilities that despite once having been dismissed, may help to reopen new horizons.

Writing about humanitarian aid: The good, the bad, and the historical34 The literature on humanitarian aid is polarized. Some authors never tire of celebrating humanitarianism’s moral virtuousness, while others have had an easy job of enumerating the bloopers of failed relief projects.35 Aid glorification and aid bashing may be entertaining (both definitely have their readers), but they are not always helpful for understanding the past and thinking about the future. The academic literature sometimes succeeds in going beyond this polarization but, as far as historical knowledge is concerned, this is apparently still not an easy task.36 Many authors share Ban Ki-Moon’s optimism about “evidence based humanitarianism.” In their view, statistics have increased the visibility, efficiency, and transparency of international aid. Management, information technology, and big data analysis tools are believed to contribute to better accountability of relief. When considering the past, these authors consider that the growth in humanitarian expertise was a reaction to a steadily growing humanitarian problem (a growing number of catastrophes and wars). In this light, universal standards appear as a sign of the “professionalization” of humanitarian aid. The codification of humanitarian aid is thus seen as evidence that emergency relief is becoming more efficient and more just. Even these optimist authors often emphasize the difficulties of professionalization in the sector. These difficulties are mostly seen as persisting in spite of the growing bureaucratization, standardization, and specialization of humanitarian agencies. The construction of humanitarian knowledge is generally understood to be in congruence with a long history of humanitarian progress, having roots

Introduction

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in eighteenth-century humanism, the Enlightenment, and the nineteenth-century abolition of the slave trade. Christian and humanistic moral values such as empathy, altruism, philanthropy, and charity are described as the motors of humanitarianism. For Michael Barnett, for instance, humanitarian aid is the result of a “revolution in moral sentiments”37 and for Michael Ignatieff, there was a “revolution of moral concern”38 during the second half of the twentieth century. Seen in this perspective, the professionalization of aid is a consequence of a moral transformation – a quasi-metaphysical perspective that David Rieff has therefore labeled “neo-Hegelian.”39 This perspective, however, has a strong teleological bias: It regards the geographical expansion of international aid as an unproblematic and quasi-natural necessity.40 It assumes that humanitarian globalization has simply followed a steady increase in the need for aid. In recent decades, the number of forcibly displaced persons has increased rapidly, amounting to 51.2 million in 2014.41 Accordingly, the totality of humanitarian operations’ budgets has multiplied by 10 in the last 20 years.42 In this line of thought, the rise in global humanitarian aid has been propelled by the growing number of disaster victims.43 This literature, however, fails to understand how aid agencies have defined the problem that they wanted to tackle. The conventional narrative considers the problems addressed by relief aid (diseases, hunger, etc.) as universal per se. According to this view, international NGOs and UN agencies simply waited for their material and technological capacity to grow in order to expand across the globe. Globalization is presented as a powerful force that was impossible for humanitarian actors to resist. The conventional historiography of humanitarianism considers globalization to be a mysterious driving force beyond the scope of its study. This explanation results in a strange tautology: Globalization is presented as a cause of humanitarian globalization.44 A growing number of critical studies have recently been published that disagree with this conventional narrative.45 These studies consider humanitarian aid to be a set of discourses and practices which are part of the globalization processes. They consider that aid is a part of global governmentality, in Michel Foucault’s sense of the term, deploying a kind of biopolitical domination that targets territories, bodies, and populations, and thereby shapes people’s needs. From this perspective, needs are neither natural nor ahistorical. Critical anthropologists show that, notwithstanding the allure of its simplicity and straightforwardness, humanitarianism does in fact shape its object of intervention. Beyond the apparent “moral clarity” of humanitarianism’s approach to “real problems” and the “life and death” matters it addresses,46 there is actually a complex power/knowledge relationship at play.47 This critical perspective has also led to a reexamination of the use of statistics in development aid. Morton Jerven’s work on the problems of GDP as an indicator of growth has (re)launched a debate about “statistical fictions” in Africa.48 Several authors have criticized the idea of a “data revolution,” while denouncing a “statistical myth,” a “mirage of technology,” and “data hubris.”49 Studies have indicated the negative effects of quantification. Some fear a decline of face-to-face interactions in favor of remote

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control, a phenomenon that has been labelled “cyber humanitarianism”50 or “digital humanitarianism.”51 The quantification of aid also pressures aid agencies into a harsh competition to produce quantifiable results. Statistics thus may contribute to depoliticize crisis situations, this literature argues. However, this critical (and often neo-Foucauldian) perspective relies heavily on anthropology and political sciences, and less often on history. Thus, some critics bear witness to a static analysis that reduces humanitarian power to an oversimplified essence, be it “neocolonial,” “neoliberal,” or “biopolitical” in nature.52 The notion that frequent “humanitarian” intervention in the global South participates in a “humanitarian government” is useful. However, we should avoid overestimating the coherence and strength of the humanitarian system. In the same way, we should avoid reducing science and techniques to a mere rationale of power. While the neo-Hegelian perspective is overwhelmingly enthusiastic about the technicization of aid, some neo-Foucauldian perspectives consider technicity simply as evidence of domination. For example, the author Jean-Pierre Godding implies that while humanitarian aid is becoming increasingly focused on cold statistics, it is forgetting about human beings: The UNHCR considers [. . .] refugees more as statistical units, numbers in an administration, perhaps as animals in a zoo. Most important are the centiliters of water, the grams of corn or of firewood necessary for their survival.53 However, this perspective tends to overestimate the solidity of the power structure under scrutiny, and it lacks awareness of historical contingencies. If we portray the globalization of humanitarianism as nothing but an avatar of the wider process of globalization – ultimately rooted in economic relations or biopolitics – we lose sight of humanitarian aid’s specific, active contribution to the process.54 While conventional accounts consider globalization to be a general cause of social change that lies beyond the scope of its study, critical anthropology portrays humanitarian aid as a mere symptom of a more powerful, hidden global structure. In both cases, the task of addressing globalization is left to others. The work done by humanitarian workers and experts to globalize aid is not considered an object of analysis in its own right. This is the area to which the historical analysis presented here aims to contribute. For optimists, technical knowledge makes humanitarianism more efficient, and thus more valuable. In contrast, for their critics, technicity is dehumanizing humanitarian aid and making it worthless. But in both cases, the sphere of objects and the sphere of ideas are clearly distinguishable: Humanitarian action is shaped by morality and materiality, but the two hardly seem to interact. The approach taken here is different. This book looks at how the epistemic community of humanitarian experts articulate morality and materiality as being mutually entwined.55 This approach is inspired by the global history of humanitarian aid,56 as well as the historical sociology of social problems.57 Before going further, let us consider why the Central African region has become one of the privileged sites for humanitarian knowledge.

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Central Africa and the last frontier of humanity It is only recently that Africa has come to be seen as the continent of poverty, hunger, and war. In the late 1940s, in the aftermath of the war, Central Europe was more frequently associated with humanitarian crises than Central Africa: Mass displacement, malnutrition, and epidemics were European realities.58 However, the humanitarian focus shifted during the 1980s and 1990s: The Central African region is now seen as the ultimate frontier of humanitarian universalism.59 The red zones on the UN agencies’ maps of absolute poverty, the Human Development Index, the Gender Related Development Index, the Gender Empowerment Measure, and many others, are frequently to be found south of the Sahara. Why does Africa play such an important role in the world’s humanitarian government? A common argument is that Africa has been more prone to humanitarian crises than other parts of the world and has therefore attracted more humanitarian interventions. Wars have occurred in Africa more often than elsewhere.60 Therefore, the continent has accounted for a large part of the world’s refugee population;61 in 2014, it still accounted for one-fourth of the world’s forcibly displaced persons.62 Similar arguments have been made about famine, poverty, and natural disasters. Some authors also establish a link between aid relief and the decline of the postcolonial state (sometimes described as an “underdeveloped,” “weak,” or “failed” state). A variant of this argument is that international and non-governmental organizations have contributed to the weakening of the postcolonial state since the 1980s.63 Another possible explanation for Africa’s place in the humanitarian agencies’ globalist imagination is linked to the historicity of the postcolonial state. Modern states are often described in sociological theory as institutions of knowledge. The production and storage of knowledge about populations (archives, files, cadasters, registers, censuses, identity documents, maps, statistics, etc.) is a key feature of modern European states. In Foucault’s terminology, the state is intent upon generating “governmentality,” power over its population’s well-being.64 However, recent works have shown that in Africa, modern statehood often arised without a monopolization of knowledge about the population – some states may function, at least in part, without relying on governmentality – Keith Breckenridge speaks of “power without knowledge.”65 Colonial states in Africa were often unable to provide even the most basic data on the colonized population. The French colonial administration produced little data on poverty, hunger, diseases, or colonial subject migration.66 In some cases, colonial states did not even want to enumerate or identify large proportions of the population.67 This was not only because the states lacked the resources but also because, in many cases, they simply had “no will to know.”68 This is one of the most striking results of current sociological research on the state; the cost and energy associated with governmentality were, at least in the view of many colonial governors and their postcolonial successors, not worth it. The sources of power did not lie within the population but at the doors of the state, in the monopoly of external resources – at the “gates” of the state, to use Frederick Cooper’s description.69

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According to this line of thought, heads of states have willingly refrained from investing in governmental bureaucracies. Instead, they have deliberately “discharged” or delegated70 these tasks to others, including international organizations or NGOs. As Greg Mann showed, postcolonial leaders did not wait until the neoliberal reforms of the 1980s to delegate bureaucratic tasks to NGOs – they started soon after their countries’ independence, in the 1960s, when the postcolonial state was perceived to be a strong and ambitious institution.71 Thus, there is a continuity between the colonial lack of interest in rural populations and the relative scarcity of official statistical data on demography, health, or economics.72 The politics of austerity during the era of the World Bank’s structural adjustment programs in the 1980s and 1990s actually worsened the already-weak efficiency of state bureaucracies. Thus, the international government of Africa is rooted in the long history of the state on the continent.73 As soon as the African states became independent, international organizations and foreign institutions furnished funds, tools, and expertise for the production of statistical data. The World Bank and the UN contributed to GDP calculations, household consumption surveys, and censuses. International institutions’ interest in knowledge on African societies increased during the food and refugee crises of the 1970s and the 1980s, and rose further in the 1990s and 2000s, when some regions, identified by donor countries as “ungoverned places,” were seen as potential threats to Western states.74 Africa became one of the aid agencies’ favorite places for intervention; it went on to receive the largest amount of aid, in terms of the financial share of global humanitarian contributions.75 Thus, Central Africa has long been imagined as one of the last frontiers of humanitarian universalism.

Sources and structure of the book I started research on this topic in 2014, shortly after the United Nations and the Inter-Agency Standing Committee classified the crisis in Central Africa as a Level 3 Emergency situation (the most severe type of emergency in this classification). The civil war in the Central African Republic had produced approximately 1 million displaced persons and refugees, thus having a major impact on all neighboring countries.76 The largest group of refugees fled to Cameroon,77 where I observed the work of aid agencies in the Cameroonian borderland in November and December 2014. I started by identifying some salient elements of what can be called a humanitarian infrastructure of commensurability (concepts, classifications, artifacts, and standards) and used those elements as entry points into history. Returning to Cameroon in 2015 and 2016, I looked more closely at the use of technology in needs assessments led by UN agencies.78 As well as interviews with aid workers, I analyzed articles and reports (grey literature) written by humanitarian experts. I used material from the Geneva-based archives of UNHCR, the Sphere Project, and Médecins Sans Frontières (Doctors Without Borders, MSF). Some of the most interesting aspects of the debate were found reading the handwritten notes from meeting protocols and email correspondence among aid experts.

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The first chapter in this book analyzes concepts of “needs” in history. Contrary to common assumptions, the use of “needs” in humanitarian assistance is relatively new. Looking at the genealogy of the notion, the chapter argues that its success at the end of the twentieth century lay in its malleability. “Needs” have been shaped by different and sometimes competing fields of knowledge such as political economy, health care, and international law. While organizations may draw on one (or several) different definition of needs, the ambiguities of the notion allow for consent that is sometimes based on working misunderstandings. The second chapter moves from concept to classification. Crucial material issues (the quantity of food one receives, the size and quality of the tent one lives in, or the walking distance to the water tap one may use) depend upon the category of people-in-need one belongs to. This chapter investigates the origins of categories used by UNHCR to classify refugees. There are juridical categories (refugee, internally displaced person, returnee, etc.) as well as other social categories (vulnerable groups, disabled, separated minors, etc.). Looking at 50 years of refugee classification in Central Africa, the chapter argues that the notion of “needs” has shifted from a narrow legal category to a composite notion, including medical vulnerability. The third chapter adds a materialist dimension to the argument of the book. It explores a tool for the determination of acute malnutrition – MUAC (mid-upper arm circumference) tape. MUAC tape has become a signature tool in humanitarian aid: It is used to screen children, to map emergencies, and to prioritize interventions. This tool allows for exploration of the questions of triage, the medicalization of the definition of needs, the role of statistics in humanitarian controversies, and the iconic role of hunger in the moral economy of aid. Thus, this measuring tool is emblematic of a range of industrialized items used by the humanitarian apparatus (tents, food rations, kitchen sets, etc.) that entail a solidified definition of human needs and shape everyday humanitarian practices.

Figure 0.1 Lolo refugee camps in East Cameroon, 2014. Source: ©Glasman

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Figure 0.2 Sphere Archive in Geneva. Source: ©Glasman

The fourth chapter investigates the standardization of good humanitarian practice by large aid agencies since the 1980s. While some refined their own “humanitarian principles,” others produced handbooks in which they listed the dos and don’ts of their profession. UNHCR, UNICEF, Oxfam, CARE, and MSF produced such handbooks, but none have been more controversial and more influential than the aforementioned Sphere Handbook. The Sphere Project attempted to produce a handbook of all handbooks, a definition of survival needs oriented toward an ISO-norms-like understanding of aid work. While the first four chapters consider the concepts, categories, artifacts, and standards in a successive way, the last pair of chapters returns to Cameroon to explore how aid workers put the different pieces of the puzzle together. These

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Figure 0.3 UNHCR headquarters in Geneva. Source: Courtesy of UNHCR

chapters start with the production of a key figure produced by humanitarian agencies, the estimation of a number of “people in need.” Chapter 5 looks at the emergence of a knowledge of crisis in Cameroon, and the registration of refugees by UNHCR. Chapter 6 looks at the construction of the number of malnourished children by UNICEF, and at the mapping of “vulnerability” in Cameroon. Both chapters analyze needs assessment as a tool to pacify the competition between humanitarian agencies. Technology, it is argued, does not play the role that one expects: Even when digital technologies are included in the process, needs assessment still relies heavily on low tech. Moreover, high tech does not necessarely means higher transparency. The conclusion discusses the notion of minimal humanity, and engages with some possible paths to rethink needs assessment. I argue that our current infrastructure of commensurability is minimalist – both in the sense that it is narrow in what it compares, and that it sets a low bar for satisfaction.79 Thus, a global bookkeeping of human needs has only limited ability to inform a critique of power. Technological solutionism will not solve the contempt for local institutions. A defense of a true universalism that goes beyond a flat globalism implies a redeployment of our infrastructure of commensurability.

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Figure 0.4 Map of Central African L3 Emergency, 2014. Source: UNHCR, Central African Republic Regional Refugee Response Plan, Jan–Dec. 2015, p. 6.

Notes 1 United Nations Security Council. Meetings conducted by the Security Council, 7897th Meeting, New York, 10 March 2017, 3 p.m. www.un.org/en/ga/search/view_doc. asp?symbol=S/PV.7897 (Accessed 2018-01-31). 2 Ibid. 3 BBC News. UN: World facing greatest humanitarian crisis since 1945, 11 March 2017. https://www.bbc.com/news/world-africa-39238808; CNN. UN: World facing greatest humanitarian crisis since 1945. https://edition.cnn.com/videos/tv/2017/07/04/ united-nations-warns-of-mass-starvation-the-lead-farai-sevenzo.cnn; Al Jazeera. Famine ‘largest humanitarian crisis in history of UN.’ 2017-03-12; Al Jazeera. https://www. aljazeera.com/news/2017/03/famine-united-nations-170310234132946.html; South

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China Morning Post. UN says world faces largest humanitarian crisis since 1945. 2017-03-11; 20 million people could starve. South China Morning. Post, 2017-03-11. https://www.scmp.com/news/world/africa/article/2078072/un-says-world-faceslargest-humanitarian-crisis-1945-20-million (Accessed 2018-02-13). For an early critique of O’Brien’s figures, see Caramel, Laurence. Brauman, Rony. Crise alimentaire: Les chiffres des nations unies sont discutables. Le Monde, 2017-12-15. www.lemonde.fr/afrique/article/2017/12/15/rony-brauman-les-chiffres-des-nationsunies-sont-discutables_5230536_3212.html (Accessed 2019-04-01). United Nations General Assembly/Economic and Social Council. Report of the SecretaryGeneral: Strengthening of the coordination of emergency humanitarian assistance of the United Nations. A/67/89-E/2012/77, 2012-05-25. (Accessed 2018-10-30). See Chapter 1 for the history of the notion of impartiality. The notion of “rationality” is borrowed from Michel Foucault (Foucault, Michel. Foucault étudie la raison d’État. In Dits et écrits II. Foucault, Michel. Paris: 1979: 801–805). The rationality of needology studied here is “global” in both senses of the term: It addresses the human as a whole, and claims to have a worldwide reach. I use “historical knowledge” here in the sense of Jean-Claude Passeron, that is not as a single academic discipline but as a form of knowledge that is contextual and relational and can be found in disciplines such as history, sociology, anthropology, ethnography, etc. (Passeron, Jean-Claude. Le raisonnement sociologique: L’espace non-poppérien du raisonnement naturel. Paris: Nathan, 1991). Office for the Coordination of Humanitarian Affairs (OCHA). Global Humanitarian Overview. Geneva: OCHA, Decembre 2015: 4. Dunant, Henri. Un Souvenir de Solférino. Genèva: International Committee of the Red Cross, 1986: [first edition 1862] 32–33. In the nineteenth century, as Thomas Laqueur has shown, humanitarianism depended on the development of new narrative forms that created empathy through narrative details. Among these new narrative forms: Realistic novels, enquiries, and medical case histories, See Laqueur, Thomas. Bodies, details, and the humanitarian narrative. In The new cultural history, Hunt, Lynn, and Biersack, Aletta et al. (eds.). Berkeley: University of California Press, 1989: 176–204. On the notion of “distant suffering,” see Boltanski, Luc. Distant suffering: Morality, media and politics. Cambridge: Cambridge University Press, 2008. UNHCR. Global needs assessment: Pilot report October 2008: Refugee realities – meeting the needs of refugees and other people of concern globally. 2008: 5. www. refworld.org/pdfid/48ef42352.pdf (Accessed 2018-10-24). In 1954 and 1981. For theoretical elaborations on this point, see Boltanski, 2008 and Fassin, Didier. La raison humanitaire: Une histoire morale du temps présent. Paris: Gallimard, 2010; For convincing case studies: Wilson, Richard Ashby, and Brown, Richard D. (ed.) Humanitarianism and suffering: The mobilization of empathy. Cambridge: Cambridge University Press, 2009; Curtis, Heather. Depicting distant suffering: Evangelicals and the politics of pictorial humanitarianism in the age of American empire. Material Religion 8, no. 2 (2012): 153–182; Kurasawa, Fuyuki. The making of humanitarian visual icons: On the 1921–1923 Russian famine as a foundational event. In Iconic Power. New York: Palgrave Macmillan, 2012: 67–84; Fehrenbach, Heide and Rodogno, Davide. A horrific photo of a drowned Syrian child: Humanitarian photography and NGO media strategies in historical perspective. International Review of the Red Cross 97, no. 900 (2015): 1121–1155. Chenu, Jean Charles. De la mortalité dans l’armée et des moyens d’économiser la vie humaine: Extraits des statistiques médico-chirurgicales des campagnes de Crimée en 1854–1856 et d’Italie en 1859. Paris: Hachette, 1870. On Chenu’s work, see Fredj, Claire. Compter les morts

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21 22 23 24 25

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Introduction de Crimée: Un tournant sur l’identité professionnelle des médecins de l’armée française (1865–1882). Histoire, économie & société 29, no. 3 (2010): 95–108. See Chapter 1 on this. Also: Read, Róisín, Taithe, Bertrand, and Mac Ginty, Roger. Data hubris? Humanitarian information systems and the mirage of technology. Third World Quarterly 37, no. 8 (2016): 1314–1331. See also: Jorland, Gérard, Opinel, Annick, and Weisz, George (eds.). Body counts: Medical quantification in historical and sociological perspectives. Montreal: McGill-Queen’s University Press, 2015; Salvatici, Silvia. ‘Help the People to help themselves’: UNRRA relief workers and European displaced persons. Journal of Refugee Studies 25, no. 3 (2012): 428–451. See the first report of this group: The Secretary-General’s Independent Expert Advisory Group on a Data Revolution for Sustainable Development (IEAG). A World that counts: Mobilising the data revolution for sustainable development. New York: United Nations, November 2014. All international quasi-legal instruments defining humanitarian aid state that aid shall be provided “on the basis of need alone,” “according to need,” or “in proportion to need.” Among others: United Nations (UN). Strengthening of the coordination of humanitarian emergency assistance of the UN. In United Nation General Assembly Resolution 46/182 of 1991, 78th Plenary Meeting [A/RES/46/182], 1991. www. un.org/documents/ga/res/46/a46r182.htm (Accessed 2018-10-24); Steering Committee of Humanitarian Response, The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief, SCHR 1994. See Chapter 1 for a discussion of the different notions of impartiality. On humanitarianism as a “field,” see Krause, Monika. The good project: Humanitarian relief NGOs and the fragmentation of reason. Chicago: University of Chicago Press, 2014. On the notion of “doxa,” see Bourdieu, Pierre. Espace social et genèse des “classes.” Actes de la recherche en sciences sociales 52, no. 1 (1984): 3–14. Daston, Lorraine. Objectivity and the escape from perspective. Social Studies of Science 22, no. 4 (1992): 597–618. Stuurman, Siep. The invention of humanity: Equality and cultural difference in world history. Cambridge MA: Harvard University Press, 2017. Foucault, Michel. Naissance de la clinique. Paris: Presses Universitaires de France, 1963; Lachenal, Guillaume, Lefève, Céline, and Nguyen, Vinh-Kim (eds.). La médecine du tri. Histoire, éthique, anthropologie. Paris: Presses Universitaires de France, 2014. An expression used by the historian Christophe Bonneuil in allusion to the “rise in generality” coined by Boltanski and Thévenot: Boltanski, Luc and Thévenot, Laurent. De la justification. Les économies de la grandeur. Paris: Gallimard, 1991. Grevsmühl, Sebastian Vincent. La Terre vue d’en haut: L’invention de l’environnement global. Paris: Seuil, 2014; Connelly, Matthew James. Fatal misconception: The struggle to control world population. Cambridge, MA: Harvard University Press, 2009; Chassé, Daniel Speich. Die Erfindung des Bruttosozialprodukts: Globale Ungleichheit. In Wissensgeschichte der Ökonomie. Göttingen: Vandenhoeck & Ruprecht, 2013: 212; Le Bris, Catherine. Esquisse de l’humanité juridique. L’humanité juridique, une sphère infinie dont le centre est partout, la circonférence nulle part. Revue interdisciplinaire d’études juridiques 69, no. 2 (2012): 1–50. This is the “universal appeal” of humanitarian aid; Redfield uses the term “global medicine.” This global ambition is embedded in the founding documents of humanitarian organizations, their names and acronyms, and their public awareness campaigns. The terminology of globality (“worldwide,” “universal,” “global,” “international,” “planet,” etc.) is also omnipresent in the guidelines and handbooks – and even logos – of humanitarian organizations (Médecins sans Frontières [Doctors without Borders], Global Nutrition Cluster, World Health Organization, etc.) Redfield, Peter. Life in crisis: The ethical journey of doctors without borders. Berkeley: University of California Press, 2013.

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27 The Sphere Project. Humanitarian charter and minimum standards in disaster response, Geneva: The Sphere Project, 2004: 2. 28 UNHCR. Handbook for emergencies, 2nd ed. Geneva: UNHCR, 2000: 192. 29 UNHCR, 2000: 373. 30 For instance, Oxfam’s Handbook of Development and Relief, Médecins sans Frontières’ Public health engineering in emergency situations, UNICEF’s Assisting in emergencies: A resource handbook for UNICEF field staff, the World Health Organization’s (WHO) Emergency Health Kit, the UN Disaster Relief Organization’s Shelter after Disaster, and many more. Pratt, Brian, and Boyden, Jo. The field directors’ handbook: An Oxfam manual for development workers. Oxford: Oxford University Press, 1985; Médecins Sans Frontières. Refugee health: An approach to emergency situations. London: Palgrave Macmillan, 1997; UNICEF. Emergency field handbook: A guide for UNICEF staff. Geneva: UNICEF, 2005; Ville de Goyet, Claude de, Seaman, John, and Geijer, Udo. The management of nutritional emergencies in large populations. Geneva: WHO, 1978. 31 Agier, Michel. “Humanity as an identity and its political effects (a note on camps and humanitarian government).” Humanity: An International Journal of Human Rights, Humanitarianism, and Development 1.1 (2010): 29–45. Here p. 32. One can find a comparable definition of the humanitarian government in Fassin, 2010: 8–9, and slightly different versions of a “new humanitarian order,” an “international humanitarian order,” and a “new humanitarianism in global governance,” in: Mamdani, Mahmood. Savior and survivors: Darfur, politics and the war on terror. Cape Town: Three Rivers Press, 2010; Barnett, Michael. The international humanitarian order. London: Routledge, 2009; Duffield, Mark. Global governance and the new war: The merging of development and security. London: Zed Books, 2001. See also the notion of “nongovernmentality” emphasizing the role of NGOs in Mann, Gregory. From empires to NGOs in the West African Sahel: The road to nongovernmentality. Cambridge: Cambridge University Press, 2015. 32 Agier 2010. And Agamben, Giorgio. What is an apparatus? And other essays. Palo Alto: Stanford University Press, 2009. 33 For a short presentation of actor-network theory, see Latour, Bruno. Changer de société, refaire de la sociologie. Paris: La découverte, 2006. 34 I borrowed this title from Frederick Cooper: Cooper, Frederick. Writing the history of development. Journal of Modern European History 8, no. 1 (2010): 5–23. 35 For an example of the latter: Polman, Linda. The crisis caravan: What’s wrong with humanitarian aid? New York: Metropolitan Books, 2010. 36 For historiographical surveys, see Barnett, Michael. Empire of humanity: A history of humanitarianism. Ithaca: Cornell University Press, 2011; Davey, Eleanor, Borton, John, and Foley, Matthew. A history of the humanitarian system: Western origins and foundations. HPG Working Paper. London: Overseas Development Institute, 2013; Paulmann, Johannes. Conjunctures in the history of international humanitarian aid during the twentieth century. Humanity Summer 215–238 (2013); Davis, Adam J. and Taithe, Bertrand. From the purse and the heart: Exploring charity, humanitarianism and human rights in France. French Historical Studies 34, no. 3 (2011): 413–432; O’Sullivan, Kevin. Humanitarian encounters: Biafra, NGOs and imagining the Third World in Britain and Ireland: 1967–70. Journal of Genocide Research 16, no. 2–3 (2014): 299–315; Maul, Daniel Roger. The Rise of a humanitarian superpower: American NGOs and international relief: 1917–1945. In Internationalism, imperialism and the formation of the contemporary world. Cham: Palgrave Macmillan, 2018: 127–146; Glasman, Joël and Framke, Maria. Humanitarismus. WerkstattGeschichte 67 (2015): 3–12. 37 Barnett, 2011: 49. 38 Ignatieff, Michael and Welsh, Jennifer M. The lesser Evil: Political ethics in an age of terror. Princeton: Princeton University Press, 2004. 39 Rieff, David. A bed for the night: Humanitarianism in crisis. London: Vintage Books, 2002.

20

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40 Moorehead, Caroline. Dunant’s dream: War, Switzerland and the history of the Red Cross. New York: Carroll & Graf, 1998; Forsythe, David P. The humanitarians: The international committee of the Red Cross. New York: Cambridge University Press, 2005; Barnett, 2011. 41 UNHCR. Global trends report for 2013. Geneva: UNHCR, 2014. 42 ALNAP (Active Learning Network for Accountability and Performance). The state of the humanitarian system, London: ALNAP, 2012. 43 Crisp, Jeff and Jacobsen, Karen. Refugee camps reconsidered. Forced Migration Review 3, no. 1 (1998): 27−30; Black, Richard. Fifty years of refugee studies: From theory to policy. International Migration Review 35, no. 1 (2001): 57–78; Barnett, 2011; Davey, Borton, and Foley, 2013; Gatrell, Peter. The making of the modern refugee. Oxford: Oxford University Press, 2013. 44 A case in point is Barnett’s otherwise inspiring book (Barnett, 2011). 45 Duffield, Mark. Development, security and unending war: Governing the world of peoples. Cambridge: Polity Press, 2007; Agier, Michel. Gérer les indésirables. Des camps de réfugiés au gouvernement humanitaire. Paris: Flammarion, 2008; Fassin, 2010; Redfield, 2013. 46 Redfield, 2013: 32. 47 Agier, 2008; Duffield, 2007. 48 Jerven, Morten. Poor numbers: How we are misled by African development statistics and what to do about it. Ithaca, NY: Cornell University Press, 2013; Bédécarrats, Florent, Cling, JeanPierre, and Roubaud, François. Révolution des données et enjeux de la statistique en Afrique. Introduction thématique. Afrique contemporaine 2, no. 258 (2016): 9–23; Gabas, Jean-Jacques, Ribier, Vincent, and Vernières, Michel. Introduction thématique: La mesure du développement: Comment sciences et politique se conjuguent. Revue TiersMonde 1, no. 213 (2013): 7–22. 49 Read, Taithe, and Mac Ginty, 2016. 50 Duffield, Mark. Disaster-resilience in the network age: Access-denial and the rise of cyberhumanitarianism. DIIS Working Paper 23. Copenhagen: Danish Institute for International Studies, 2013. 51 Burns, Ryan. Moments of closure in the knowledge politics of digital humanitarianism. Geoforum 53 (2014): 51–62; Burns, Ryan. Rethinking big data in digital humanitarianism: Practices, epistemologies, and social relation. GeoJournal 80 (2015): 477–490. 52 Harrell-Bond, Barbara E. Imposing aid: Emergency assistance to refugees. Oxford: Oxford University Press, 1986; Hyndman, Jennifer. Managing displacement: Refugees and the politics of humanitarianism. Minneapolis: Minnesota University Press, 2000; Agier, 2008; Scalettaris, Guilia. La fabrique du gouvernement international des réfugiés. Bureaugraphie du HCR dans la crise afghane. PhD diss., Paris: EHESS, 2013; Hammerstad, Anne. The rise and decline of a global security actor: UNHCR, Refugee protection and security. Oxford: Oxford University Press, 2014. 53 Godding, Jean-Pierre. Réfugiés rwandais au Zaïre: Sommes-nous encore des hommes? Documents des groupes de réflexion dans les camps? Paris: Editions L’Harmattan, 1997. 54 A similar argument is made in Geissler, Paul W., Rottenburg, Richard, and Zenker, Julia (eds). Rethinking biomedicine and governance in Africa: Contributions from anthropology. Bielefeld: Transcript Verlag, 2012. 55 Haas, Peter M. Introduction: Epistemic communities and international policy coordination. International Organization 46, no. 1 (1992): 1–35. See also: Redfield, 2013: 12; Davey, 2013. 56 Taithe, Bertrand. The Cradle of the new humanitarian system? International work and European volunteers at the Cambodian border camps: 1979–1993. Contemporary European History 25, no. 2 (2016): 335–358; Davey, Eleanor. Idealism beyond borders: The French revolutionary left and the rise of humanitarianism: 1954–1988. Cambridge: Cambridge University Press, 2015; Mann, 2015; O’Sullivan, Kevin. Ireland, Africa and the end of empire: Small state identity in the Cold War: 1955–75. Manchester: Manchester University Press, 2012.

Introduction

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57 Bonnecase, Vincent. La pauvreté au Sahel. Du savoir colonial à la mesure internationale. Paris: Karthala, 2011; Fassin, Didier. Les scènes locales de l’hygiénisme contemporain: La lutte contre le saturnisme infantile: Une bio-politiques à la française. In Les hygiénistes, Enjeux, modèles et pratiques (XVIIIe-XXe siècles), Bourdelais, Patrice (ed.). Paris: Belin, 2001: 447–465; Young, Allan. The harmony of illusions: Inventing post-traumatic stress disorder. Princeton, NJ: Princeton University Press, 1995. 58 See Chapter 1 on this point. 59 The “Central African region” mentionned here is not the geographical region, but the hyperreal Central Africa of humanitarian imagination (similar to the hyperreal Europe of Chakabarty’s Provincializing Europe [Chakrabarty, Dipesh. Provincializing Europe: Postcolonial thought and historical difference. Princeton and Oxford: Princeton University Press, 2000]. In the terminology of UNHCR, “Central Africa” refers to a loose ensemble of tropical states which includes Burundi, Cameroon, the Central African Republic, Congo, Equatorial Guinea, Gabon, the Democratic Republic of the Congo, and Rwanda. However, the boundaries of this region are loose; some official documents, for instance, include Angola or Uganda, as well as South Sudan, and the same region is sometimes termed “Central Africa and the Great Lakes Region.” In social sciences, the term “Central Africa” also allows for several definitions. For a useful definition, see Guichaoua, Andre (ed.). Exilés, réfugiés, déplacés en Afrique centrale et orientale. Paris: Karthala, 2004: 21. 60 Since 1945, one-third of the world’s wars have been fought in Africa. See: Chojnacki, Sven and Reisch, Gregor. Perspectives on war: Collecting, comparing and disaggregating data on violent conflicts. Sicherheit und Frieden 26, no. 4 (2008): 233−245. 61 Holborn, Louise W. Refugees. A problem of our time: The work of the United Nations high Commissioner for refugees, 1951–1972. Metuchen: Scarecrow Press, 1975; Loescher, Gil. The UNHCR and World politics: A Perilous path. Refugee Survey Quarterly 20, no. 3 (2001). 62 UNHCR, 2014. 63 For a critique of this argument, see Mann, 2015. 64 Foucault, Michel. Sécurité, territoire et population: Cours au College de France: 1977–1978. Paris: Gallimard and Seuil, 2004: 4–32. 65 Breckenridge, Keith. Power without knowledge: Three nineteenth century colonialisms in South Africa. Journal of Natal and Zulu History 26, no. 1 (2008): 3–31. 66 See Chapter 1. 67 Weitzberg, Keren. Unaccountable census: Colonial enumeration and its implications for the Somali people of Kenya. The Journal of African History 56, no. 3 (2015): 409–428. 68 Breckenridge, Keith. No will to know: The rise and fall of African civil registration in twentieth-century South Africa. Proceedings of the British Academy 182 (2012): 357–382; Breckenridge, Keith. Biometric state: The global politics of identification and surveillance in South Africa: 1850 to Present. Cambridge: Cambridge University Press, 2014. 69 That is, the “gatekeeper state” described by Frederick Cooper or the “State of extraversion” described by Jean-Francois Bayart. Bayart, Jean-Francois and Ellis, Stephen. Africa in the world: A history of extraversion. African Affairs no. 99 (2000): 217–267; Cooper, Frederick. Africa since 1940: The past of the present. Cambridge: Cambridge University Press, 2002; Breckenridge, 2012: 357–382; Breckenridge, 2014. 70 Hibou, Béatrice (ed.). La privatisation des Etats. Paris: Karthala, 1999. 71 Gregory Mann presents this idea: Mann, 2015. 72 Jerven, 2014: 177–199. 73 Bayart, 2000: 217–267; Cooper, 2002. 74 According to the terminology of donors for certain geographic zones in the margins (notably in the north of Nigeria and in Cameroon under Boko Haram). See Foreign and Commonwealth Office. The link between ‘ungoverned spaces’ and terrorism: Myth or reality? London: Foreign and Commonwealth Office, August 2014.

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75 In 2010, almost half of global humanitarian contributions went to sub-Saharan Africa (ALNAP, 2012: 37). 76 UNHCR. Global focus: UNHCR operations worldwide, operation: Central African Republic: 2014 year-end report. UNHCR, 2014: 2. http://reporting.unhcr.org/sites/default/files/pdfsummaries/GR2014-CentralAfricanRepublic-eng.pdf (Accessed 2019-04-02). 77 UNHCR. Central African Republic regional Refugee response plan. Geneva: UNHCR, January–December 2015 12. 78 I conducted 54 semi-structured interviews with aid experts, mostly in Geneva and in Cameroon (Yaoundé, Bertoua, and in the small refugee camps of Lolo, Mbilé, and Timangolo). I conducted additional interviews with Central African refugees and Cameroonian officials. 79 To my knowledge, Liisa Malkki was the first to use the notion of “minimal humanity,” which she uses (as a synonym for “bare” or “naked” humanity) to designate a mode of representation of refugees that does not strictly dehumanize, but “humanize in a particular mode.” Malkki, Liisa, Speechless Emissaries: Refugees, Humanitarianism, and Dehistoricization, in: Cultural Anthropology, Vol 11, 3, 1996, 377-404. Here p. 390. For a discussion on “minimal biopolitics,” see Redfield, 2013: 18–22.

References Agamben, Giorgio. What is an apparatus? And other essays. Stanford: Stanford University Press, 2009. Agier, Michel. Gérer les indésirables. Des camps de réfugiés au gouvernement humanitaire. Paris: Flammarion, 2008. ALNAP (Active Learning Network for Accountability and Performance). The state of the humanitarian system, London: ALNAP, 2012. Anderson, Mary B. Do no Harm: How aid can support peace-or war. Colorado: Lynne Rienner Publishers, 1999. Barnett, Michael. Empire of humanity: A history of humanitarianism. Ithaca: Cornell University Press, 2011. Barnett, Michael. The international humanitarian order. London: Routledge, 2009. Bayart, Jean-Francois, and Ellis, Stephen. Africa in the world: A history of extraversion. African Affairs no. 99 (2000): 217–267. Bédécarrats, Florent, Cling, Jean-Pierre, and Roubaud, François. Révolution des données et enjeux de la statistique en Afrique. Introduction thématique. Afrique Contemporaine 2, no. 258 (2016): 9–23. Black, Richard. Fifty years of refugee studies: From theory to policy. International Migration Review 35, no. 1 (2001): 57–78. Boltanski, Luc. Distant suffering: Morality, media and politics. Cambridge: Cambridge University Press, 2008. Boltanski, Luc, and Thévenot, Laurent. De la justification. Les économies de la grandeur. Paris: Gallimard, 1991. Bonnecase, Vincent. La pauvreté au Sahel. Du savoir colonial à la mesure internationale. Paris: Karthala, 2011. Bourdieu, Pierre. Espace social et genèse des ‘classes’. Actes de la recherche en sciences sociales 52, no. 1 (1984): 3–14. Bourdieu, Pierre. Sur l’Etat. Cours au Collège de France: 1989–1992. Paris: Seuil, 2012. Breckenridge, Keith. Biometric state: The global politics of identification and surveillance in South Africa: 1850 to present. Cambridge: Cambridge University Press, 2014.

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Breckenridge, Keith. No will to know: The rise and fall of African civil registration in twentieth-century South Africa. Proceedings of the British Academy 182 (2012): 357–382. Breckenridge, Keith. Power without knowledge: Three nineteenth century colonialisms in South Africa. Journal of Natal and Zulu History 26, no. 1 (2008): 3–31. Burns, Ryan. Moments of closure in the knowledge politics of digital humanitarianism. Geoforum 53 (2014): 51–62. Burns, Ryan. Rethinking big data in digital humanitarianism: Practices, epistemologies, and social relation. GeoJournal 80 (2015): 477–490. Chakrabarty, Dipesh. Provincializing Europe: Postcolonial thought and historical difference. Princeton and Oxford: Princeton University Press, 2000. Chassé, Daniel Speich. Die Erfindung des Bruttosozialprodukts: Globale Ungleichheit. In Wissensgeschichte der Ökonomie, 212. Göttingen: Vandenhoeck & Ruprecht, 2013. Chenu, Jean Charles. De la mortalité dans l’armée et des moyens d’économiser la vie humaine: Extraits des statistiques médico-chirurgicales des campagnes de Crimée en 1854–1856 et d’Italie en 1859. Paris: Hachette, 1870. Chojnacki, Sven, and Reisch, Gregor. Perspectives on war: Collecting, comparing and disaggregating data on violent conflicts. Sicherheit und Frieden 26, no. 4 (2008): 233–245. Connelly, Matthew James. Fatal misconception: The struggle to control world population. Cambridge, MA: Harvard University Press, 2009. Cooper, Frederick. Africa since 1940: The past of the present. Cambridge: Cambridge University Press, 2002. Cooper, Frederick. Writing the history of development. Journal of Modern European History 8, no. 1 (2010): 5–23. Crisp, Jeff, and Jacobsen, Karen. Refugee camps reconsidered. Forced Migration Review 3, no. 1 (1998): 27–30. Curtis, Heather. Depicting distant suffering: Evangelicals and the politics of pictorial humanitarianism in the age of American empire. Material Religion 8, no. 2 (2012): 153–182. Daston, Lorrraine. Objectivity and the escape from perspective. Social Studies of Science 22, no. 4 (1992): 597–618. Davey, Eleanor. Idealism beyond borders: The French revolutionary left and the rise of humanitarianism: 1954–1988. Cambridge: Cambridge University Press, 2015. Davey, Eleanor, Borton, John, and Foley, Matthew. A history of the humanitarian system: Western origins and foundations. HPG Working Paper. London: Overseas Development Institute, 2013. Davis, Adam J., and Taithe, Bertrand. From the purse and the heart: Exploring charity, humanitarianism and human rights in France. French Historical Studies 34, no. 3 (2011): 413–432. Duffield, Mark. Development, security and unending war: Governing the world of peoples. Cambridge: Polity Press, 2007. Duffield, Mark. Disaster-resilience in the network age: Access-denial and the rise of cyberhumanitarianism. DIIS Working Paper 23. Copenhagen: Danish Institute for International Studies, 2013. Duffield, Mark. Global governance and the new war: The merging of development and security. London: Zed Books, 2001. Dunant, Henri. Un Souvenir de Solférino. Genèva: International Committee of the Red Cross, 1986 [first edition 1862]. Fassin, Didier. La raison humanitaire: Une histoire morale du temps présent. Paris: Gallimard, 2010.

24

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Fassin, Didier. Les scènes locales de l’hygiénisme contemporain: La lutte contre le saturnisme infantile: Une bio-politiques à la française. In Les hygiénistes, Enjeux, modèles et pratiques (XVIIIe-XXe siècles), Bourdelais, Patrice (ed.), 447–465. Paris: Belin, 2001. Fehrenbach, Heide, and Rodogno, Davide. A horrific photo of a drowned Syrian child: Humanitarian photography and NGO media strategies in historical perspective. International Review of the Red Cross 97, no. 900 (2015): 1121–1155. Foreign and Commonwealth Office. The link between ‘ungoverned spaces’ and terrorism: Myth or reality? UK: Foreign and Commonwealth Office, London: August 2014. Forsythe, David P. The humanitarians: The international committee of the Red Cross. New York: Cambridge University Press, 2005. Foucault, Michel. Foucault étudie la raison d’État. In Dits et écrits II, Foucault, Michel (ed.), 801–805. Paris: Gallimard, 1979. Foucault, Michel. Naissance de la clinique. Paris: Presses Universitaires de France, 1963. Foucault, Michel. Sécurité, territoire et population: Cours au College de France: 1977–1978. Paris: Gallimard and Seuil, 2004. Fredj, Claire. Compter les morts de Crimée: Un tournant sur l’identité professionnelle des médecins de l’armée française (1865–1882). Histoire, économie & société 29, no. 3 (2010): 95–108. Gabas, Jean-Jacques, Ribier, Vincent, and Vernières, Michel. Introduction thématique: La mesure du développement: Comment sciences et politique se conjuguent. Revue TiersMonde 1, no. 213 (2013): 7–22. Gatrell, Peter. The making of the modern refugee. Oxford: Oxford University Press, 2013. Geissler, Paul W., Rottenburg, Richard, and Zenker, Julia (eds.). Rethinking biomedicine and governance in Africa: Contributions from Anthropology. Bielefeld: Transcript Verlag, 2012. Glasman, Joël, and Framke, Maria. Humanitarismus. WerkstattGeschichte 67 (2015). Godding, Jean-Pierre. Réfugiés rwandais au Zaïre: Sommes-nous encore des hommes?: Documents des groupes de réflexion dans les camps? Paris: Editions L’Harmattan, 1997. Grevsmühl, Sebastian Vincent. La Terre vue d’en haut: L’invention de l’environnement global. Paris: Seuil, 2014. Guichaoua, Andre (ed.). Exilés, réfugiés, déplacés en Afrique centrale et orientale. Paris: Karthala Editions, 2004. Haas, Peter M. Introduction: Epistemic communities and international policy coordination. International Organization 46, no. 1 (1992): 1–35. Hammerstad, Anne. The rise and decline of a global security actor: UNHCR, refugee protection and security. Oxford: Oxford University Press, 2014. Harrell-Bond, Barbara E. Imposing aid: Emergency assistance to refugees. Oxford: Oxford University Press, 1986. Herten, Lasse. A wie Auschwitz, B wie Biafra: Der Bürgerkrieg in Nigeria (1967–1970) und die Universalisierung des Holocaust. Zeithistorische Forschungen 3 (2011). Hibou, Béatrice (ed.). La privatisation des Etats. Paris: Karthala, 1999. Holborn, Louise W. Refugees. A problem of our time: The work of the United Nations high Commissioner for refugees, 1951–1972. Metuchen: Scarecrow Press, 1975. Hyndman, Jennifer. Managing displacement: Refugees and the politics of humanitarianism. Minneapolis: Minnesota University Press, 2000. Ignatieff, Michael, and Welsh, Jennifer M. The lesser Evil: Political ethics in an age of terror. Princeton: Princeton University Press, 2004. Jerven, Morten. Poor numbers: How we are misled by African development statistics and what to do about it. Ithaca, NY: Cornell University Press, 2013.

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Jorland, Gérard, Opinel, Annick, and Weisz, George (eds.). Body counts: Medical quantification in historical and sociological perspectives. Montreal: McGill-Queen’s University Press, 2015. Krause, Monika. The good project: Humanitarian relief NGOs and the fragmentation of reason. Chicago: University of Chicago Press, 2014. Kurasawa, Fuyuki. The making of humanitarian visual icons: On the 1921–1923 Russian famine as foundational event. In Iconic power, 67–84. New York: Palgrave Macmillan, 2012. Lachenal, Guillaume, Lefève, Céline, and Nguyen, Vinh-Kim (eds.). La médecine du tri. Histoire, éthique, anthropologie. Paris: Presses Universitaires de France, 2014. Laqueur, Thomas. Bodies, details, and the humanitarian narrative. In The new cultural history, Hunt, Lynn, and Biersack, Aletta et al. (eds.), 176–204. Berkeley: University of California Press, 1989. Latour, Bruno. Changer de société, refaire de la sociologie. Paris: La découverte, 2006. Le Bris, Cahterine. Esquisse de l’humanité juridique. L’humanité juridique, une sphère infinie dont le centre est partout, la circonférence nulle part. Revue interdisciplinaire d’études juridiques 69, no. 2 (2012): 1–50. Loescher, Gil. The UNHCR and world politics: A perilous path. Refugee Survey Quarterly 20, no. 3 (2001). Malkki, Liisa, Speechless emissaries: Refugees, humanitarianism, and dehistoricization. Cultural Anthropology 11, no. 3 (1996), 377-404. Mamdani, Mahmood. Savior and survivors: Darfur, politics and the war on terror. Cape Town: Three Rivers Press, 2010. Mann, Gregory. From empires to NGOs in the West African Sahel: The road to nongovernmentality. Cambridge: Cambridge University Press, 2015. Maul, Daniel Roger. The Rise of a humanitarian superpower: American NGOs and international relief: 1917–1945. In Internationalism, imperialism and the formation of the contemporary world, 127–146. Cham: Palgrave Macmillan, 2018. Médecins Sans Frontières. Refugee health: An approach to emergency situations. London: Palgrave Macmillan, 1997. Moorehead, Caroline. Dunant’s dream: War, Switzerland and the history of the Red Cross. New York: Carroll & Graf, 1998. Office for the Coordination of Humanitarian Affairs (OCHA). Global Humanitarian Overview. Geneva/ New York: OCHA, December 2015. O’Sullivan, Kevin. Humanitarian encounters: Biafra, NGOs and imagining the Third World in Britain and Ireland: 1967–70. Journal of Genocide Research 16, no. 2–3 (2014): 299–315. O’Sullivan, Kevin. Ireland, Africa and the end of empire: Small state identity in the Cold War: 1955– 75. Manchester: Manchester University Press, 2012. Passeron, Jean-Claude. Le raisonnement sociologique: L’espace non-poppérien du raisonnement naturel. Paris: Nathan, 1991. Paulmann, Johannes. Conjunctures in the history of international humanitarian aid during the twentieth century. Humanity Summer 215–238 (2013). Pierce, Steven. Looking like a state: Colonialism and the discourse of corruption in northern Nigeria. Comparative Studies in Society and History 48, no. 4 (2006): 887–914. Polman, Linda. The crisis caravan: What’s wrong with humanitarian aid? New York: Metropolitan Books, 2010. Pratt, Brian, and Boyden, Jo. The field directors’ handbook: An Oxfam manual for development workers. Oxford: Oxford University Press, 1985.

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Read, Róisín, Taithe, Bertrand, and Mac Ginty, Roger. Data hubris? Humanitarian information systems and the mirage of technology. Third World Quarterly 37, no. 8 (2016): 1314–1331. Redfield, Peter. Life in crisis: The ethical journey of doctors without borders. Berkeley: University of California Press, 2013. Rieff, David. A bed for the night: Humanitarianism in crisis. London: Vintage Books, 2002. Salvatici, Silvia. ‘Help the people to help themselves’: UNRRA relief workers and European displaced persons. Journal of Refugee Studies 25, no. 3 (2012): 428–451. Scalettaris, Guilia. La fabrique du gouvernement international des réfugiés. Bureaugraphie du HCR dans la crise afghane. PhD diss., Paris: EHESS, 2013. The Secretary-General’s Independent Expert Advisory Group on a Data Revolution for Sustainable Development (IEAG). A world that counts: Mobilising the data revolution for sustainable development. New York: United Nations, November 2014. Slaughter, Joseph R., Wilson, Ashby Richard, and Brown, Richard D. Humanitarianism and suffering: The mobilization of empathy. Cambridge: Cambridge University Press, 2009. Sphere Project. Humanitarian charter and minimum standards in disaster response, Geneva: Sphere Project, 2004. Sphere Project. The Sphere Handbook, 3rd ed. Geneva: Sphere Project, 2011. Steering Committee of Humanitarian Response, The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief, SCHR 1994. Stuurman, Siep. The invention of humanity: Equality and cultural difference in world history. Cambridge, MA: Harvard University Press, 2017. Taithe, Bertrand. The Cradle of the new humanitarian system? International work and European volunteers at the Cambodian border camps: 1979–1993. Contemporary European History 25, no. 2 (2016): 335–358. Terry, Fiona. Condemned to repeat? The paradox of humanitarian action. Ithaca: Cornell University Press, 2002. Twomey, Christina, and May, Andrew J. Australian responses to the Indian Famine 1876– 78: Sympathy, photography and the British Empire. Australian Historical Studies 43, no. 2 (2012): 233–252. UNHCR. Central African Republic regional Refugee response plan. UNHCR, January–December Geneva: UNHCR, 2015. UNHCR. Global focus: UNHCR operations worldwide, operation: Central African Republic: 2014 year-end report. UNHCR, 2014. http://reporting.unhcr.org/sites/default/files/pdfsummaries/GR2014-CentralAfricanRepublic-eng.pdf (Accessed 2019-04-02). UNHCR. Global needs assessment: Pilot report October 2008: Refugee realities-meeting the needs of refugees and other people of concern globally, 2008. www.refworld.org/ pdfid/48ef42352.pdf (Accessed 2018-10-24). UNHCR. Global trends report for 2013. Geneva: UNHCR, 2014. UNHCR. Handbook for emergencies, 2nd ed. Geneva: UNHCR, 2000. UNICEF. Emergency field handbook: A guide for UNICEF staff. Geneva: UNICEF, 2005. United Nation General Assembly Resolution 46/182 of 1991, 78th Plenary Meeting [A/ RES/46/182], 1991. www.un.org/documents/ga/res/46/a46r182.htm (Accessed 2018-10-24). Ville de Goyet, Claude de, Seaman, John, and Geijer, Udo. The management of nutritional emergencies in large populations. Geneva: WHO, 1978. Weber, Max. Économie et Société. Paris: Plon, 1971.

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Weitzberg, Keren. Unaccountable census: Colonial enumeration and its implications for the Somali people of Kenya. The Journal of African History 56, no. 3 (2015): 409–428. Wheeler, Nicholas J. Saving strangers: Humanitarian interventions in international society. Oxford and New York: Oxford University Press, 2000. Young, Allan. The harmony of illusions: Inventing post-traumatic stress disorder. Princeton, NJ: Princeton University Press, 1995.

1

Concepts Elements of a genealogy of needology

“Impartiality” is now recognized as a paramount principle of humanitarian aid – not only by NGOs, but also by UN agencies and governments.1 The academic literature, as well as the official documentation of these organizations, traces the notion of impartiality back to its original formulation in humanitarian law in the 1864 Geneva Convention and to the work of Henri Dunant.2 However, this official version misses an important shift in the definition of “impartiality.” For Dunant and the Convention, impartiality was not a rule of distribution – it was a clause of non-discrimination. It was much later that “impartiality” came to be understood as rule of mathematic distribution of good and services. It was Jean Pictet, in the 1940s, who inscribed the idea of “proportionality” in the definition of “impartiality”: Aid relief would have to be distributed “according to needs.” During the last decades of the twentieth century, the definition of impartiality became increasingly associated with the quantification of needs. As the Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs endorsed by the Steering Committee for Humanitarian Response states: “Aid priorities are calculated on the basis of need alone.”3 Any good humanitarian project, it is now argued, should start with a quantitative estimation of suffering – the famous “needs assessment.”4 How did needology – the global bookkeeping of suffering – become the doxa of the humanitarian field? This chapter starts with an analysis of “impartiality” within international humanitarian law and focuses on the contribution of Jean Pictet. As a Geneva-based ICRC jurist, Pictet drew on the heritage of international humanitarian law and human rights law, reinterpreting two others Genevans – Henri Dunant and Jean Jacques Rousseau. But the inflection that Jean Pictet gave to the definition of impartiality, and the subsequent formulation of the “according to needs” principle, was preceded by a general shift in the perception of suffering that occurred between the 1870s and the Second World War. During the threequarters of a century that separated Dunant from Pictet, the perception of needs within industrialized societies changed almost totally. It was a decisive period for the conceptualization of needs – on one side, people increasingly talked about “needs”; on the other side, within a few decades, the quantification of suffering became one of the favorite activities of state bureaucracies and scientists. While Pictet worked on humanitarian principles, everyone was talking about needs and

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their quantification – when Dunant was working on the Geneva Convention, almost no one did. In the last quarter of the nineteenth century, two fields of knowledge increasingly addressed the question of sufficiency: One was political economy. In this period, the European bourgeoisie was preoccupied with questions such as political order and social cohesion. How could states avoid social protests and maintain order? What was the minimum provision that people should receive to live and work? Those questions fueled an interest in poverty and working-class consumption. Another field of knowledge, health care, the definition of biological needs and the quantification of bodily consumption (for instance the quantification of food rations), witnessed increasing attention at the end of the nineteenth century. Both traditions of thoughts – political economy and health – diffused a new understanding of needs as individual and quantifiable category. During the two world wars, the quantification of the needs of soldiers and civil populations became a military and strategic matter. Notions like “triage” (i.e. the classification of patients in order of priority) spread throughout military medicine and emergency relief. Questions of minimal provision and sufficiency became a matter of national interest in a global competition among capitalism, fascism, and Bolshevism. Thus, in the 1940s, everyone was talking about needs. One highly influential theory, Abraham Maslow’s famous “hierarchy of needs,” was formulated at the same moment as Pictet’s legal codification. By the end of the Second World War, the idea that needs were quantificable, hiearchizable, and prioritizable had become common sense. The very notion of “needs” had migrated from the field of expert knowledge to everyday language (in the same manner as other words such as “class,” “GDP,” “crisis,” “depression,” or “stress,” etc.).5 While everyone was now measuring needs, it was not about the needs of everyone. Needs could be compared and quantified, but they were not universal. The last sections of this chapter address the question of colonial differentialism and the late universalization of needs. In the colonial territories, the quantification of needs only targeted a handful of categories of persons: Soldiers, workers, settlers, etc. After the Second World War, African intellectuals, politicians, and labor unionists increasingly fought against the colonial division of needs in two distinct classes – one for Europeans, one for “native” populations. Moreover it was only in the 1970s, long after the decolonial wave of the 1960s, that international organizations made “basic needs” a key tool for the global commensuration of social distress.

Needs as a legal category: Impartiality, proportionality, entitlement The principle of “impartiality” is mostly attributed to Henri Dunant and the authors of the 1864 Geneva Convention.6 But there is often confusion in this narrative between the idea of impartiality as it was used in the nineteenth century and the idea as it is used today. The 1864 Geneva Convention did include a clause that one could describe as an “impartiality clause,” but it did not mention

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Figure 1.1 The use of “needs” and “suffering” in digitized printed sources (1830–2000). This image shows the use of the word “needs” and “suffering” over the last century and a half, according to Ngram Viewer. This tool is far from perfect.7 However, it allows a quick exploration of a large corpus. The word “needs” is used more often today than it was in the early nineteenth century. The word “suffering,” conversely, was used twice as much as “needs” in the early nineteenth century, and was used four or five times less frequently by the end of the twentieth century. All humans “suffer,” and all humans have “needs.” However, these terms imply different regimes of action. The language of suffering is fueled by emotion and compassion – the language of needs is fueled by comparison and counting. The language of suffering functions in the “regime of Agapè” described by Luc Boltanksi: a regime of action that calls for direct action but avoids the commensuration of individuals. On the top of this traditional language of compassion, a language on needs has been added, implying comparison, counting, and hierarchization.

a proportionality of needs. For Henri Dunant, there was no question of quantity. Dunant described suffering and aid, but he did not bother to render them equivalent. The mode of description he used made calculation obsolete. He described pains that were immeasurable: They could be seen (“The wounds, aggravated by heat and dust and lack of water and care, have become more painful”), heard (“one hears the groans, the muffled sighs full of anguish and suffering, and ragged voices that cry out for aid”), and smelled (“fetid exhalations taint the air”).8 Dunant talked about “serious wounds” and “sores,” he evoked “a left shoulder shattered by a cannonball,” and he describes “agonies” and “suffering” triggered by bullets and gangrene. One recognizes, in Dunant’s story, victims – on one side, “the unfortunates,” the “poor soldiers,” the “sick,” and on the other side “aid,” “French surgeons,” people “moved by compassion.” One witnesses “generous attention,” “necessary amputations,” “relief,” but nowhere in Dunant’s text is there a question of proportion. Dunant listed services and items (“wooden planks,” “straw,” “canvas to protect the injured from the sun,” “chicken broth,” “wine,” “biscuits,” “bandages,”) but nowhere did he count them. The “impartiality” clause of the 1864 Geneva Convention was merely a non-discrimination clause:9 “injured or sick soldiers will be retrieved and cared for, whatever nation they belong to,” Article 6 stated. That meant: Care for your friend as well as for your enemy. It did not entail much more than that.10

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In 1906 and 1929, international conventions extended the principle of aid impartiality to other categories of war victims – no longer only injured soldiers, but also sick civilians, the interned, the deported, evacuated persons, the homeless, the populations of occupied regions, and refugees.11 The International Committee of the Red Cross (ICRC) frequently debated the principles of humanitarian aid. In subsequent texts published by members of the Red Cross movement (1921, 1928, 1952), new “principles” were introduced, others were abandoned, but the idea of impartiality was always preserved – always in its negative acceptance of non-discrimination.12 Jean Pictet, a jurist at ICRC, began to work on humanitarian law during the Second World War. After the war, the then Director of General Affairs of the ICRC Pictet wrote his thesis on the “doctrine of the Red Cross.” He outlined seven fundamental principles of humanitarian aid: Humanity, equality, proportionality, impartiality, neutrality, independence, and universality. He fully reworked the principle of “impartiality” by adding to it the principle of the proportionality of aid.13 Why did Pictet feel the need to rewrite the Red Cross’s principles? After the war, his organization, the ICRC, was harshly criticized for its ambiguous role during the war – and its failure to protect the victims of fascism. One of the most direct attacks, however, came from within the Red Cross movement. The ICRC, together with the National Red Cross Societies and the League of Red Cross Societies, formed the Red Cross movement. But in the aftermath of the war, the League tried to expand its authority at the expense of the ICRC. Traditionally, the ICRC had the moral high ground: It was seen as the “guardian of principles.” However in 1946, the General Assembly of the National Societies of the Red Cross assembled in Oxford published its own humanitarian principles.14 It was clearly an attempt by the Governors of the League to circumvene the ICRC’s authority. Pictet’s thesis was the main weapon of the Committee’s counter-attack. He formulated the principles in a way that could justify the moral authority of the Committee within both the humanitarian field and the Red Cross movement. One of his major innovations was the reformulation of “impartiality.” It was an old idea within the Red Cross movement: “The Red Cross will act without favor or prejudice towards or against anyone.”15 But now, under Pictet’s interpretation, it took on new authority and a new legitimacy: It was not only about persons and organizations, but about knowledge as well. Impartiality required a “depersonalization” of charitable action.16 Impartiality was now justified by objectivity: Impartiality implied “a precise and complete examination of the elements of the problem and an exact appreciation of the values in question,” Pictet wrote, and “[it] thus proceeds from objectivity, which consists [of] determination according to facts alone.”17 Two notions were key to define impartiality: “equality” and “proportionality.”18 “Equality” corresponded to the traditional definition of impartiality: “the Red Cross is ready to provide assistance equally and without any discrimination.”19 Non-discrimination was already found in the 1864 Geneva Convention, and it

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was refined after the Second World War by other criteria of affiliation rather than simply by nationality. The 1949 Geneva Conventions thus prohibited all discrimination “which would be based on sex, race, nationality, religion, political opinions, or all analogous criteria.”20 But Pictet’s “equality” went further. It was not just a negative criterion. The principle of equality eliminated all distinctions that prevail outside of the humanitarian world.21 At the same time, however, it enabled humanitarian organizations to create their own criteria of distinction: This is where “proportionality” comes in:22 “Available aid will be distributed according to the relative importance of individual needs and following their order of urgency.”23 Pictet introduced into international law an idea that, until then, had remained implicit.24 It worked as a syllogism: (a) man must be given relief commensurate to his suffering; (b) resources dedicated to aid are insufficient in the world to alleviate all of its distress; (c) thence derives the necessity to call upon a rule for their allocation.25 In this argument, Pictet combined different concepts. The principles of “humanity” (the Red Cross targets human suffering) and “equality” (for equal distress, rendered services should be equal) had already been established in the doctrine of the Red Cross. The idea of the insufficiency of aid and necessary rationing resulted from Pictet and the Red Cross’s experience during the Second World War. His logical conclusion, the rule of allocation, first developed at the 1949 Geneva Conventions, allowed humanitarian organizations to classify victims. The Conventions established “permitted distinctions” based on vulnerability: “Those that are based on suffering, distress, or the natural weakness of the protected persons,” for example, women, children, or the elderly, but also “captives used to a tropical climate who find themselves in a cold country” or prisoners having suffered “a long captivity.”26 According to the Conventions, these categories of persons should receive particular attention. The Conventions also specified that there could be “a priority in the order of caregiving” (ibid.).27 Additional motivation was found in military medicine, in the practice of “triage.” In army medical corps, doctors cared “first [for] men to whom a delay would be fatal,” Pictet explained.28 While Pictet saw “non-discrimination” and “equality” as two notions firmly entrenched in universal moral traditions,29 he saw “proportionality” as a novelty. “Proportionality” required a deeper form of justification. How could one justify the Red Cross’s ability to make distinction between humans? For the Red Cross, there are distinctions that are licit and even necessary to use among individuals: these are those which are based on suffering, distress, or the natural weakness, and on those alone.30 Pictet distinguished “quantitative inequality” (“aid will thus be proportionate to the distress of each”) from “temporal inequality” (“the order in which it will be

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rendered will result from its degree of urgency”).31 Pictet referred here to the military logic of “triage” of the wounded.32 The history of the Red Cross, born on the battlefields of Europe, chronologically and geographically coincided with the diffusion of military medicine. However, Pictet also appealed to different logics of prioritization of needs – including rationing and medical care in times of scarcity.33 Pictet eventually rooted proportionality in the widely shared experience of scarcity in postwar Europe, in common sense – and even in the proportionality of taxation.34 There is a close link, in Pictet’s thought, between post-war globalization and proportionality. In his work, knowledge is key to defining long-distant solidarity that transcends racial and national boundaries. For the sake of attaining solidarity at the scale of humanity, one must be freed from solidarities of proximity, or, as Pictet wrote, “affinities.” Humanitarian solidarity was to be distanced from the solidarities of nations (which privileged “nationals”), solidarity of religions (which privileged “co-worshippers”), professional communities (which targeted “colleagues in the same field”), or political groups (which targeted “their sympathizers”).35 The symmetrical opposite of humanitarian solidarity was familial solidarity: “With mutual familial aid, each one worries about those he considers as the closest to [him], as dependent on [him]. Is that not the first sense of the word closest?”36 Yet humanitarian solidarity is that which addresses the unknown. It transcends ordinary charity. Humanitarianism thus requires a strong principle for the rehabilitation of solidarity.37 It is clear from Pictet’s work that he considered “impartiality” as a key tool to counter the Red Cross’s League’s and National Societies’s ambitions. The National Societies of the Red Cross and the Red Crescent acted on national scales, which did not allow them to be purely humanitarian: “the National Societies of the Red Cross help above all those of their own nationality, which is normal, given the national character of these institutions.” The ICRC had the higher moral ground: It could allocate “aid measured solely by the extent of distress.”38 Thanks to the idea of proportionality, the ICRC found itself structurally more faithful to the principles of the Red Cross than the National Societies. The proportionality of needs could justify the ICRC’s unique position within the Red Cross movement. The Red Cross movement used Pictet’s principles to justify its specific position within the humanitarian system – just as the ICRC used Pictet’s principles to justify its positions within the Red Cross movement. Pictet’s writing gave the ICRC a weapon to retake a hegemonic position, visà-vis the League, on the question of principles, and to establish its position at the center of the humanitarian field.39 In 1961, the Council of Delegates approved Pictet’s interpretations. In 1965 the 20th International Conference of the Red Cross officially endorsed the principles – and they were also adopted by the governments of all the parties of the Geneva Convention. The resolutions relating to the fundamental principles were now obligatory and constraining for the organizations of the Red Cross Movement.40 In this version, the principle of

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proportionality was subsumed under by the principle of impartiality – and the necessity of a form of knowledge that objectifies needs was entrenched: The observation of the principle of proportionality supposes a deep knowledge of the miseries of the world. Efficient aid demands as much intelligence as discernment. Charity implies understanding. One should even be omniscient to be able to apply the principle in all its rigor.41 While the human suffering described by Dunant was local, personified, incarnated, incommensurable, and visible, suffering described by Pictet was comparable, shared, universal, and partly hidden. It was now up to humanitarian organizations to “discover” hidden suffering.42 The “fundamental principles” of Pictet are largely found in the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief, co-signed by 140 organizations, which defined the principle of “impartiality” thus: Aid is given regardless of the race, creed or nationality of the recipients and without adverse distinction of any kind. Aid priorities are calculated on the basis of need alone.43 Countless legal or quasi-legal documents refer to this principle, in particular the General Assembly Resolutions44 of the United Nations and The Humanitarian Charter shared by numerous non-governmental organizations.45 Unlike the principles of “neutrality” or “independence,” for example, the principle of impartiality is consensual and rarely debated.46 Some lawyers today consider it “an integral part of international law.”47 In order to understand how Pictet’s formulation of proportionality could become so successful, i.e. how a concept that was originally conceived as a tool for the defense of the ICRC’s reputation could become mainstream humantiarianism, one has to understand that by the time Pictet published his thesis, the quantification of needs had become common practice in industrialized nations. Two fields of knowledge especially had turned “needs” into an object of scientific inquiry and bureaucratic quantification between the end of the nineteenth century and the 1940s: Political economy and health care.

Needs as a problem of political economy: Power, population, and contestation In the last quarter of the nineteenth century, the quantification of people’s needs suddenly became a central matter for academic and administrative knowledge alike. The quantification of workers’ consumption particularly became a fashionable topic of bureaucratic inquiries. There had been some inquiries into household budgets before,48 but nothing like what would happen between 1850 and 1930:49 1,500 studies on household budgets were produced, mostly in North America and Western Europe.50 Economists, bureaucrats, and statisticians met in international conferences to compare statistics and set some rules for quantification and comparison. Standardized guides on household consumption were established.51

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The notion of “needs” itself obviously had a much older origin within political economy. According to Foucault’s seminal texts on biopolitics, the question of populations’ “well-being” emerged as a matter of concern for administrative sciences during the seventeenth century.52 Following the battles of the Thirty Years’ War, epidemics and famines resulted in a population drop in Central Europe, and a whole range of publications advised princes to spare their subjects’ lives and to start caring about their well-being.53 Cameralism (Kameralwissenschaften) tried to teach princes that “the prosperity of the country or the welfare of its subjects is inseparably bound up with the interest of their leader.”54 This doctrine, formulated by professors, senior officials, and those who drafted administrative regulations, soon became a university discipline,55 bringing together the topics of economics (science of domestic management), policing (maintenance of order and the administration of the economic life), and public financing. The wellbeing of populations had now become an object of knowledge and government.56 The concept of “needs” (Bedürfnisse), a word that designated at once a state of lack and the goods capable of satisfying this lack, was key to Cameralism.57 To maintain control, a ruler should identify the needs of each social rank and the overseeing of their satisfaction.58 Needs were seen as a source of danger, as well as a potential source of wealth. Unfulfilled needs could give rise to diseases, criminality, or riots that ultimately weakened the power of the prince. But needs were also a driver of economic activity – a source of economic growth and political power.59 Needs was already entrenched as a notion of political philosophy during the Enlightenment. In his On the Origins of Inequality (1755), Jean-Jacques Rousseau famously argued that each man had a right “to everything he needs.”60 Thomas Paine and the Marquis de Condorcet integrated the notion of relief for the poor into moral philosophy, while for Kant, “needs” allowed critique of the absolutist state: The sovereign who failed to heed the needs of his subjects fails in his responsibility.61 Karl Marx, in turn, used the notion of needs as a critique of capitalism: Capitalism created new needs without being capable of satisfying them, which provokes alienation.62 Socialism would be a society in which resources would be distributed not according to social rank, fortune, or status, but as a function of each person’s needs: “from each according to his abilities, to each according to his needs.”63 At the beginning of the nineteenth century, Karl Rau recasted cameral economics and made the notion of needs the touchstone of his new science: Economics was now defined as the study of human needs and their satisfaction.64 The final goal of economics? The complete satisfaction of needs (die vollständige Befriedigung der Bedürfnisse).65 For Karl Rau however, “needs” were defined in a more individual manner than in the old cameralism.66 They were no longer the needs of rank (Stand) but of persons. The study of needs was crucial, for its understanding permitted the conceptualization of all other notions of economics – value, use, price, etc.67 By the middle of the nineteenth century, the notion of needs had become central within economy. Even a liberal economist like Frédéric Bastiat wrote that “political economy [has] for an object the man considered from the point of view of his needs and the means by which he fullfills them.”68 While the notion of “needs” was already firmly established by the middle of the nineteenth century, bureaucrats and scientists lacked a statistical apparatus

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to compare the needs of different populations. This changed rapidly during the last quarter of the century. Social protests triggered a new interest in the needs of the working class. Europe experienced an economic crisis and a series of urban revolts. The anxiety of the bourgeoisie regarding socialism grew, and state bureaucracies increasingly sought to prevent revolts by protecting workers from the consequences of capitalism’s crises. At the core of statistical knowledge on people’s needs was the “social question”: That is, the question of social peace and the reproduction of the labor force.69 Statistical surveys served to weigh the cost indices of consumption to avoid the brutal devaluation of workers’ salaries and social unrest. Social reformers produced numerous surveys on the living conditions of the urban poor: The challenge was to categorize narrowly the populations of the inferior classes in order to target social interventions.70 It was about distinguishing “the good poor – recoverable – and the bad – irretrievable.”71 Social classes were largely incommensurable. Bourgeois and working-class consumption patterns were not to be compared (and it did not occur to the researchers to be interested in the budgets of affluent and bourgeois families72). At the turn of the century, sociologists and economists could draw on the statistical material produced by state bureaucracies to compare needs over time and space. A decisive step towards the study of poverty was taken by British sociologist Seebohm Rowntree. In his 1901 study of urban poverty in York, he introduced a minimum threshold of satisfaction. He defined this “threshold”73 as the minimum that a “normal” family needed to survive during a week. Rowntree called on nutritionists to estimate the caloric and nutritional intake necessary to avoid sickness or weight loss.74 From this estimate, he calculated the minimum sum of consumables (food, clothing, and lodging), of which he then estimated the prices, according to market prices. He then calculated that 28% of the population of York lived under the poverty threshold, the “poverty line.” This definition of poverty was determined by the sum of money necessary for the “maintenance of physical efficiency,” a minimal definition that permits the comparison of areas of the city as well as the comparison of poverty over time.75 While Maurice Halbwachs’ thesis focused on workers’ “hierarchies of needs,” at the dawn of the First World War. A work largely inspired by Rowntree, he could rely on two large studies on the, one by the Imperial Office of Statistics and the other by a metallurgical syndicate.76 Halbwachs’ statistical comparison however included a constructivist critique of the notion of “needs”: He indicated that it was in fact impossible to classify needs in order of importance, because man does not consume “food” or “clothes” but always particular products – meat, bread, spices, sugar – prepared and served in a particular way – at the table, on plates, on a tablecloth – and according to particular routines – as a family, in a group, etc.: “our needs are the work of society,” he explained.77 Nevertheless, his statistical analysis relied on a classification of “needs” in four groups: Food, clothing, shelter, and other expenses. Rowntree’s definition of poverty inspired numerous similar studies in Europe and North America, as well as international comparisons.78 Rowntree himself duplicated his study in York in 1936 and 1951. He expanded his list of minimal

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goods (adding goods not strictly necessary for survival: Newspapers, books, radio, beer, tobacco, vacation, gifts), but conserved an absolute definition of poverty.79 While Rowntree’s style of poverty studies diffused widely between the two world wars, it did not yet concern the colonial territories, a point to which we will turn later. In North America and Western Europe, the “poverty line” was harshly criticized after the Second World War. The absolute poverty line distinguished no more than a minimal fraction of the population and stopped being a useful object of intervention. Consumption surveys ceased being limited to workers and the poor, instead concerning the whole population: Economists became less interested in absolute needs than in inequalities.80 In 1962, Peter Townsend attacked the minimalist definition of poverty founded on the idea of needs that are essentially physiological.81 In countries of the global North, studies talked more and more about “relative poverty” – about poverty as exclusion (or as a proportion in relation to average income) – whereas in countries of the global South, the definition of a poverty line would come to be very much in use. Before we turn to the tipping point of the Second World War and the diffusion of needs quantification to the global South, let us have a look at another tradition of knowledge, namely health studies.

Needs as a health problem: Ontologization, prioritization, hierachization When Jean Pictet reworked the principle of “humanitarian impartiality,” the notion that needs could be quantified had been well established by political economy and bureaucratic surveys. Another inspiration for Pictet was certainly the broad set of ideas related to needs in public health that developed in various settings prior to the Second World War. A tradition that Pictet explicitly mentioned was the tradition of military medicine that had coined the term “triage.” How could a physician know which patient should be treated in priority? The medical term of “triage” (also sometimes called “rationing” and “allocation”) referred to this problem of resource distribution: A “process by which a doctor classifies patients in order of priority.”82 The notion of “triage” is now widespread in emergency medicine. For instance, the World Medical Assocation recommends classifying patients in emergency situations into at least four classes: “Red/immediate” are those whose lives are in immediate danger; “yellow/delayed” are those who need urgent but not immediate medical care; “green/minimal” are those who require only minor treatment; and “black/expectant” are those who cannot be saved. Historians mostly trace its invention back to the chief surgeon of Napoleon’s army, who imposed a principle of “rational management of the evaluation of first aid for the wounded.”83 The technique of triage spanned the nineteenth century, and progressively became a technique for the conservation of military personnel. The world wars were a crucial moment for its diffusion. It was, on one side, about saving life, and, on the other, about maximizing the efficient use of armed forces’ medical resources.84 This mode of commensuration of the bodies was well known to Pictet.85

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Another important source of inspiration was probably the tradition of bodily consumption measurements that emerged during the nineteenth century.86 Bodily consumption measurements emerged in medical overseeing in closed settings, such as schools, barracks, hospitals, and prisons. What kind of health provision and food rations did pupils, patients, soldiers, and prisoners need? In the middle of the nineteenth century, French physicians introduced scale balances to measure food intake, quantify diets, and estimate their respective nutritive values.87 At the end of the nineteenth century, nutrition studies emerged as a new science, at the cross road of physiology, medicine, and chemistry. Wilbur O. Atwater revisited Lavoisier’s theory of the calorie while sealing one of his students in a “calorimeter” – a device once used to measure the combustive efficiency of explosives and engines. Atwater measured the quantity of bread, beans, steak, milk, and potatoes that his student took, and quantified his labor output, i.e. the heat that he produced while doing physical exercise (weight lifting) and intellectual tasks (studying a physics text).88 By the end of the nineteenth century, this thermodynamic theory of nutrition had become common knowledge among European and American nutritionists. They established tables linking calorie counts to specific foods and specific tasks. Thus, they invented “caloric bookkeeping” that enabled them to compare individual bodies and food without reference to taste, ethnic tradition, or social context.89 Caloric accounting became fashionable in the first half of the twentieth century, and fueled the development of a broad network of nutritionists, laboratories, and interest groups. By the 1930s, the League of Nations was able to make international comparisons on the “problem of nutrition,”90 although, as we will see later, this international comparison largely excluded the colonies. Techniques such as emergency triage, caloric accounting, and household budget surveys all allowed for a commensuration of needs beyond social and territorial borders. However, it was Abraham Maslow’s “hiearchy of needs” that would become one of the main vehicles for the ontologization of needs.91 In fact, Malsow articulated a biological conception of needs with a definition of personhood. The New York psychologist found nothing less than a “theory of human motivation”92 that synthetized major psychological, psychiatric, and psychosocial theories of the inter-war period.93 At times, Maslow presented his hierarchy of needs as a brand-new theory of human nature. At other times, he spoke of a mere “framework” for research.94 Maslow recognized that his thesis was not the result of an empirical survey and that he lacked an empirical foundation.95 “We,” he wrote, “know so little about the facts.”96 Nevertheless, Maslow’s hierarchy of needs would become one of the most influential models of needs of the twentieth century. Maslow classified needs in five groups.97 The base of the pyramid represents physiological needs which are prioritized (hunger, thirst, fatigue, etc.), while the upper levels represent, in order of importance, the need for security (need for resources, physical integrity), the need for love (affection, friendship), the need for esteem (respect, self-esteem), and the need for self-realization (creativity, thirst for knowledge). Not only could needs be classified, they could be ranked. The relative satisfaction of one class of needs permitted the next higher level of need

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Figure 1.2 Maslow’s hierarchy of needs has often been presented as a pyramid.98

to be expressed. A man who is hungry is obsessed with food, but once that need is satisfied, it is the need for security that takes over, until that need is relatively satisfied, and so on.99 Maslow qualified this situation of “pure hunger drive,” during which all behavior is oriented toward the satisfaction of a physiological need. A man struck with hunger tends to make this need the principal foundation of all his actions—nothing else has importance for him: For our chronically and extremely hungry man, Utopia can be defined very simply as a place where there is plenty of food. He tends to think that, if he is guaranteed food for the rest of his life, he will be perfectly happy and will never want anything more. Life itself tends to be defined in terms of eating.100 Maslow thus posed, at the very origins of action, an ontology of human nature. But to uncover human needs necessitates an intellectual inquiry, because the situation of extreme hunger is rare. Normally, needs are all more or less satisfied, so that all the needs are prone to expression, but in varying degrees.101 Most members of our society are partially satisfied and partially unsatisfied – so that their needs do not emerge in any obvious way. Generally, needs are hidden. Maslow’s master stroke was to integrate, in one single ontological model, preoccupations that were at play across very different literature and scientific methodologies. The unity of the whole was given by the unity of the human organism.102 Needs thus made up part of a whole, and Maslow could thus treat the thirst for artistic creation with the same terminology with which he designates hunger (“hunger,” “starvation”). This new concept of “needs” allowed Maslow to refer to heterogeneous phenomena with the same terms: His descriptions of “physiological” needs relied on

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laboratory experiments carried out on white rats and chimpanzees;103 his description of “security” needs relied on experiments on anxiety in young children; his description of “love” needs relied on clinical studies; his description of the need for “esteem” relied on studies of trauma victims; his description of the highest needs, needs for “self-accomplishment,” relied on illustrious examples of poets, painters, and athletes. The idea of needs connected this long series of cases – white rats, chimpanzees, young children, trauma victims, and poets. Maslow articulated a whole series of ideas (“basic needs,” “drives,” “wants,” “desires,” “goals”) borrowed from very diverse sets of literature—from zoology to American Romanesque writing.104 The genius of his system resides in the fact that he never gave an exhaustive list of needs: Maslow offered a method of arrangement that allows the reader to continue the list for oneself. For Maslow, needs could be arranged in a hierarchy,105 but they could not be enumerated.106 His attention to hierarchy distinguishes his work from Freud’s theory of drives (Triebe). Freud’s drives (life drives and the death drives) were anarchic, in tension with one another. Maslow’s needs were neatly ordered: They occurred nicely one after the other. Maslow offered a more accessible, less esoteric, and less erudite model than Freud. He wrote in a simpler style, renounced jargon, and cited Greek mythology less often than ordinary experience. Maslow’s model gave a reassuring image of Western society. According to Freud, the drives (buried, though one may keep them in the depths of the id) do not naturally differ according to social class. An artist can sublimate his drives and make a work of art, but nothing distinguishes, in principle, the libido of an acclaimed poet from that of a psychiatric patient. The libido ignores class differences. In Maslow’s model, on the other hand, the hierarchy of needs was doubled in a hierarchy of social classes. The moral construction of the text rested on a stratified vision of society. Inferior needs – like the need for security – were observed only in the sick and those on the economic and social margins.107 The highest-ordered needs – like that of self-accomplishment – were best observable in the cultural bourgeoisie.108 Maslow thus gave, as a counterpoint to his psychological model, a vision of the moral order of society. He portrayed a tidy society, certainly with room for improvement, but well structured. He aimed less to describe mental pathologies than to draw up the typical profile of that which he called the “average American citizen.”109 Finally, he generalized his typical profile of American society and the adult American male member of the middle class, to a universal model valid across gender, age, and culture: No claim is made that it is ultimate or universal for all cultures. The claim is made only that it is relatively more ultimate, more universal, more basic, than the superficial conscious desires from culture to culture, and makes a somewhat closer approach to common-human characteristics. Basic needs are more common-human than superficial desires or behaviors.110 In the same way that he reduced the whole of American society to fit the model of the middle classes, Maslow reduced the world to fit the American model, and

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human nature to that of the average American.111 But this vision of social organization was also a vision of the organization of scientific disciplines. Maslow articulates information issued from different disciplines, constructing a continuity not only of the content of these disciplines, but also their methods: Biology and medicine, which studied the base of the pyramid of needs, were epistemologically first; social psychology and literature studied the top of the pyramid and were epistemologically last, that is, at once the noblest and the least essential. “Physiological” needs were studied quantitatively, while “self-accomplishment” needs were studied qualitatively. The “hierarchy of needs” became one of the most often cited concepts in American psychology; and Maslow has been named one of the ten most influential psychologists of the twentieth century.112 His model spread during the 1960s and 1970s,113 both in the literature of management (knowing the needs of employees meant better organizing their work and increasing their returns114) and in the literature of marketing (knowing the needs of consumers makes it possible to direct their choices).115 Maslow became a “cult author” of the business world.116 In today’s humanitarian sector, reference to Maslow’s model is ambivalent. While implicit references to his model are frequent, explicit quotes are less so. Some organizational and humanitarian experts make extensive use of Maslow, however.117 Others critique his eurocentrism and his focalization on white American middle-class subjects.118 On one occasion, however, the Oxford moral philosopher Hugo Slim, a very influential voice in the humanitarian field (and now the Head of Policy of the International Committee of the Red Cross), proposed shaping all humanitarian architecture according to Maslow’s model.119 Hugo Slim sees in Maslow’s hierarchy of needs a model for the division of labor of international humanitarian aid, each type of need being assigned to a type of international organization: The “need for security and protection” is the duty of UNHCR, the “need” for food aid and basic health care is the responsibility of WHO and FAO, etc. As we will see in the last chapter of this book, the “cluster model” used by OCHA is not far from this theory. For now, it is worth noting that when Maslow and Pictet were working on their respective definitions of needs, discussion of needs had been made omnipresent by the experience of the two World Wars.

Needs at war: The Second World War, food aid, and the birth of the welfare state When Jean Pictet started his career as a lawyer, scarcity, disease, and forced displacement were not seen as African problems, they were European realities. The war had killed 50 million, destroyed millions of homes and industries, and put millions on the street.120 Poverty, emergencies, and epidemics – as well as relief aid – were seen as European questions. The Second World War, however, had not taken European leaders unprepared. The First World War had already put “needs” on the agenda: It was about whose soldiers and whose civil population would best “endure” the war and maintain the highest “morale.”121 In 1917, Europe had experienced a wave of strikes,

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mutineries, riots, and revolution that remained a lesson for political and military strategists. Food provision, rationing, and health logistics could make a victor – or a collapsing state. After the First World War, the notion that a government should be able to fullfill its population’s basic needs became the cornerstone of European politics.122 Thus, at the end of the Second World War, it was evident that the question of needs would be central for post-war politics. The fascist welfare state had eventually collapsed on the battlefield and at home, but its popularity was a warning for the victorious capitalist and Soviet powers.123 For the Western powers, it was clear that “welfare” would play a central role in the upcoming ideological battle. The Soviet Union came out of the war as victor against the Nazis, with strong moral capital on the international stage. The new welfare state was born out of a “reformism of fear”124 in face of the internal pressure from organized labor, and the external menace of Soviet communism. In 1942, the Beveridge Report had already broke ground for the renewal of social provisions based on new minimum standards. A general consensus emerged on the duty of the state to fullfill certain social services – a consensus that would have been unthinkable in Dunant’s times: Reformists, socialists, communists, social Catholics, and trade unionists all pushed for welfare provisions. Obviously, not everyone agreed on what “welfare” meant. For some, it was sufficiency (i.e. a vital minimum for workers). For others, it was about equality (i.e. a general fight against inequality).125 The first position implied merely a “floor of protection against the worst outcomes by affording basic provision,” while the second implied “a ceiling on wealth and a constraint on material hierarchy.”126 Both visions, however, implied at least minimal social provisions. Countries as different as France, the USSR, and India now promoted social goals in their constitutions. Entitlements to sufficient provision thus became “a constitutional orthodoxy under both capitalism and communism.”127 It was, however, not only about “national welfare.” It was also about the needs of foreign populations. War had fueled new thinking on relief aid. After the First World War, Herbert Hoover had explained to President Wilson that food aid to Central Europe was instrumental to “preserv[ing] these countries from Bolshevism and rank anarchy.”128 Twenty years later, in his State of the Union speech of 1941, Franklin Delano Roosevelt had made the “freedom from want” a war aim. Together with the European government-in-exiles, the British government started planning for relief and reconstruction only a few months after the beginning of the war.129 War was not only to be fought through battle, occupation, and blockade, but through relief, food aid, and refugee camps.130 “If we continue to starve the Greeks,” a US administrator explained, “we shall undermine the resistance of an ally.”131 Food aid became a weapon against communism. The US occupation governor in postwar Germany explained that failing to fullfill the basic need of Europeans would “pave the way to a communist Europe.”132 The promotion of “better standards of life” and “social progress” were written into the preamble of the Charter of the United Nations (1945) and “social rights” were inscribed in the Universal Declaration of Human Rights (1948): The right to health, to work, to various forms of social provision, even the right to rest and

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leisure. The newly founded World Health Organization promoted a “right to a standard of living adequate for the health and well being” while the International Labour Organization established universal “Minimum Standards of Social Security” (including medical care, social security for disability and sickness, unemployment, old age, employment injury, and family support).133 United Nations humanitarian agencies have been shaped by this context. The first United Nations agency that coordinated relief on a large scale, fought against malaria, and provided health care, food, and basic services for millions of “displaced persons” (DPs) was the United Nations Relief and Rehabilitation Administration (UNRRA, 1943–1946) in Western and Central Europe. In 1944, there were around 60 million displaced persons: Demobilized soldiers, former slave laborers, prisoners of war, liberated concentration camp inmates, civilians fleeing before foreign armies, etc. UNRRA established a wide system of camps stretching from northern Germany to southern Italy.134 As Liisa Malkki rightly points out, the problem of refugees was first and foremore conceived as a military and strategic question.135 Even though UNRRA was nominally comprised of 44 countries, in Europe, it worked under the authority of the Supreme Headquarters of the Allied Expeditionary Forces (SHAEF). At the heart of the question of relief, there was a worry for questions of “contagion” – contagion of political ideologies (fascism and communism) as well as diseases (cholera, dysentery, typhoid fever, etc.).

The colonial divide: Racial differentialism and the refusal of knowledge When quantification became the rule, colonial territories were the exception. In the middle of the twentieth century, international organizations could publish comparative statistics on poverty, migration, or calorie consumption for almost all Western nations, while on the colonial population (at least one-third of the world’s population), they barely had anything to offer. The French colonial administration did not produce any regular statistics on poverty for its African territories.136 The International Labour Organization, which published statistics on migration, could incorporate neither the British nor the French colonial territories in its tables.137 In the 1930s, when the British administration organized an “African Survey” to ensure a scientific knowledge for the ruling colonial administration, it included long descriptions of African languages, cultures, regions, and customs – but only very limited quantitative data.138 Colonial domination, Keith Breckenridge explains, was largely a “power without knowledge.” Colonial administrators did not just lack basic knowledge about the needs of the populations they were administrating, they had simply “no will to know.”139 Colonial administrators were often incapable or unwilling to furnish precise information on what people consumed and on their standards of living.140 They could publicize the number of clinics, schools, railway stations, kilometers of railways, the number of vaccinated persons, that is the “performance” of colonial services, but not the needs of populations. In the eyes of colonial officials, poverty, hunger, and vagrancy impacted Africans in an undifferentiated manner: As

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a “race,” as a mass, but not as groups or individuals. The colonial administration therefore worked with very general categories (“African,” “indigenous,” “peasant,” “worker,” etc.), but there were only rare attempts to identify specific needs, vulnerable groups, etc. As Vincent Bonnecase shows, colonial knowledge relied mainly on descriptions, not on quantification. In 1936, while the French governor of West Africa was required by his minister to give information on the social situation of his administrees, he had barely any statistics to offer: He just described the “precarious life” of the “indigenous population” in general terms. “The native fights hard for his daily bread, against [the] climate, against locusts,” he wrote. “He is poorly clothed, even during the cold nights.”141 While poverty studies à la Rowntree were already well established in Europe, they did not take place in the colonies before the late 1940s. Calorie counting is a case in point. In Western Europe, the estimation of food intake and viability was a matter of public health and, soon enough, of general government. Since Rowntree’s study of 1901, it became common to measure caloric consumption as an estimation of household budgets and overall poverty. But in the colonies, the quantification of calories was introduced mostly as a question of workforce management. After the First World War, the shortage of labor force, both in “quantity” and “quality,” was seen as the primary obstacle to colonial development. Administrators subscribing to the mise en valeur of the colonies turned their efforts into the “fortification of the African races.” Malnutrition was “discovered” by colonial administration primarily as a problem for labor and colonial development.142 Thus colonial bureaucrats experimented with different “ration types” (made out of millet, corn, rice in the Sahel zone, and cassava, yams, and plantains in the forest zone) – they estimated the amount of calories, fats, protein, and vitamins needed by different groups of workers. In French Equatorial Africa, the Inspector General of Health Services established an ideal ration for African workers, while a French private company calculated a standardized ration containing an ideal proportion of “nitrogen, amino nitrogen, mineral salts and sodium chloride” for each individual.143 These experiences prefigured the invention of “ready to use therapeutic foods” that would be developed for developing countries in the 1990s.144 In any case, the notion of caloric consumption entered the colonies through the angle of workforce mobilization – not through an interest in the general quantification of a population’s living standards. The question of “needs” was framed by the colonial and racial divide. When the League of Nations published its report on the “problem of nutrition” in the 1930s, it aimed at international comparisons.145 League experts gathered nutritional information on 25 countries and established an often-quoted international standard of 2,500 kcal per day for a laboring adult.146 However this survey included only one African country, South Africa, and distinguished between the needs of “whites” and “Bantus.”147 British nutritionists in colonial India did not only distinguish the nutritional requirements of “whites” and “natives,” but also between different “Indian races,” for instance “martial” and “sedentary races.”148

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An official report of the US administration studying worldwide daily requirements unsurprisingly put the needs of the “native laborer” of the Congo at the bottom (2,812 kcal) and the American athlete at the top (4,510 kcal).149 After the Second World War, however, international organizations attempted to enter the colonies to assess the living standards of colonial populations. In 1949, the first international conference on food and nutrition in sub-Saharan Africa was held in Dschang in Cameroon. The FAO considered all the world as being in a “food crisis.” “But this ‘entire world’ now also included Africa,” Bonnecase explains.150 In 1952, the Economic and Social Council of the United Nations (ECOSOC) published its first report on the “social situation across the world” including information of nutritional ration for the Belgian Congo (1,930 kcal), Tanganyika (1,980), and French West Africa (2,070).151 In the 1950s, “welfare” had made a sudden entrance into colonial politics. European colonial Empires underwent a “crisis of legitimacy” that obliged them to rethink needs:152 First, a wave of social protest challenged colonial domination: Workers’ strikes in Dakar, on the railways of French West Africa, in the port of Mombasa, in Nigeria, and other places.153 Second, a new ideology of “development” was founded, following the British “Development and Welfare Act” of 1940, and the French FIDES of 1946 (Fonds d’investissement pour le développement économique et social). Finally, the UN demanded statistics from the colonial powers: The UN Charter, adopted in San Francisco in June 1945 (Chapter XI, article 73) required the colonial powers to submit information on the populations’ standards of living.154 In 1952, the UN “Preliminary report on the world social situation, with special reference to standards of living” set itself the goal of defining “indices, fully quantitative, on needs whose existence is universally recognized.”155 France and the United Kingdom had to accept the idea that “there was a minimum standard of living below which no-one should fall.”156 The definition of a “vital minimum,” however, remained differentialist. This became obvious in the calculation of the minimal wage. In 1950, the French Minister of Labor asked a group of trade union leaders, employers, and experts to establish a standard for minimum wages, and define a budget type, a monthly budget for the lowest paid French workers.157 This minimum wage commission struggled regarding the minimum needs. Employers, trade unionists, and scientific experts in each group used different figures from nutrition studies to argue for a lower or higher minimum wage. However it was not only about calorie and protein requirements, but also on the list of items that this “minimum” should include: Leisure, vacations, newspapers, wine, coffee, tobacco, etc. (the SMIG commission excluded tobacco, but endorsed the human person’s need for wine, counting 17 liters of wine monthly (nearly a bottle a day) for each French wage earner).158 This definition, however, only applied for the French metropolitan worker – and European workers in the colonies. For colonial subjects, colonial officials negotiated another “vital minimum” to calculate the minimal needs of African workers which would then allow definition of their minimum wage.159 These “minimal costs” of African workers included ten categories of spending: Combustibles,

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lighting, cooking and sleeping equipment, clothing, rent, hygiene and pharmacy, interment, entertainment, and taxes.160 But African trade unionists did not accept that African living standards should be distinct from European ones. They claimed “equal pay for equal work” and struggled for African workers’ salaries and indemnities to be aligned to Europeans’.161 Papa Jean Ka, leader of the Dakar commercial workers’ union, was not ready to accept the colonial administration’s argument of a low African “vital minimum” defined by “scientific” methods. He protested “European methods of calculation” and refused the idea of an African way of life – an assumption unquestioned in the separate calculation of minimum wages.162 As Frederick Cooper argues, France and Great Britain withdrew from empire when they understood that they could not reduce the demand for equality of treatment, which they were not ready to provide.

“Two innocent words”: The rise of “basic needs” in international aid In the 1960s, “development” still meant primarily “economic growth.” Ten years later, this would now mean “meeting basic needs.” The president of the World Bank mentioned “the most essential human needs” in 1972. Within a couple of years, everyone – USAID, the Third World Forum, the International Labour Organization, and several more – spoke of “basic human needs,” “essential needs,” “core needs,” “minimum needs,” or “fundamental needs.”163 In the 1960s, the accent was put on the “trickle-down effect”: Industrial development would ultimately result in a decline of poverty.164 The World Bank lent money at low interest rates to countries that were not in a position to borrow money at the market rate and expected the rest to just happen. In the 1950s and 1960s, the Bank financed mostly infrastructure projects: Bridges, roads, ports, or hydraulic dams. But the bank had to reconsider its plans. At the end of the 1960s in fact, the critics of the world economic order had become more vocal. Political leaders in Africa, Latin America, and Asia made the fight against poverty a national priority.165 Tanzanian president Julius Nyerere had promised “freedom from hunger, sickness and poverty,” while Ghana’s president Kwame N’krumah had declared that his “first object [was] to abolish [. . .] poverty, ignorance and disease.”166 For them, however, welfare was not only about minimal provision or sufficiency, it was about development, as well as about a change in the international order. Many argued for stronger intervention of the state to reduce inequality, an intervention that could include the limitation of wealth accumulation. Julius Nyerere’s vision was one of mass equality at a certain level of sufficiency, not risky luxury that seemed unethical: “We have to work towards a position where each person realizes that his rights in society (above the basic needs of every human being) must come second to the overriding need of human dignity for all.”167 Postcolonial leaders however did not stop their call for political voluntarism within the borders of the nation states. The Non-Aligned Movement initiated a broader critique of

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inequality at a world scale. Within the United Nations Conference on Trade and Development (UNCTAD) and the New International Economic Order (NIEO, 1974), they made the case for global equality and redistribution.168 Thus, the new international emphasis on “basic needs” was, at best, a late reaction to an old demand. At worse, as some argued then, it was a planned reaction of the World Bank against NIEO demands, a tool to circumvent the postcolonial leaders’ claim for global equality. By the late 1970s, several voices argued that the “basic needs strategy” was a hypocritical substitute for growth, modernization, and industrialization, a way of keeping the Third World dominated. While industrialization had brought wealth and power to the North, the NIEO countries argued that the North attempted to prevent developing countries from following the same path. “Basic needs” were thought to slow down growth in the Third World, while containing contestation through minimal provision. In the most critical analyses, “basic needs” were presented as a kind of neo-colonialism, an instrument to enlarge the First World’s market in the Third World (one could imagine transnational corporations making “basic needs packages” containing food, textiles, drugs, and some education material invading a local market with or without the agreement of national authorities). This strategy would legitimize external intervention; the introduction of basic needs criteria could lend itself to the violation of national sovereignty and of the autonomous setting of development priority. While the NIEO argued that poverty was the result of exploitation by the rich countries and the international system, the World Bank implied that it was a result of bad national governance and inefficient administration.169 For NIEO proponents, McNamara’s new approach to development was meant to divert the public opinion’s attention from the New International Economic Order – a way to sidetrack the real issue of international economic justice. In fact, “acceptance of global inequality,” the historian Samuel Moyn writes, “was the beginning of wisdom”: The inauguration of a “subsistence ethic for an unequal word.”170 One of the lead economists of the World Bank, Mahbub ul Haq, called for the abandonment of the pursuit of elusive present-day Western standards as “the gap will continue to widen and the rich nations will continue to become richer,” Haq explained. Thus, the focus on global sufficiency was the best remaining hope.171 “Unlike ‘closing the gap,’ ” McNamara explained, “reducing poverty is a realistic objective, indeed an indispensable one.”172 For NIEO, development was about global power relations, dependence, and inequality. In the language of the World Bank, this became a moral obligation of providing sufficient minimum and preventing political disorder. Shortterm realistic targets were preferred to egalitarian horizons. This use of basic needs as a palliative to NIEO demands was obvious for some contemporary observers. Human rights lawyer Vijaya Lakshmi Pandit explained that “the basic needs strategy has been used as an excuse to imply that the only problem of developing countries is providing a minimum necessary for subsistence.”173 Thus, a “commitment to sufficiency” was a “consolation prize” in response to claims of global equality.174

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Figure 1.3 The use of “basic needs” in digitized printed sources (1910–2008).175 Source: Google Books Ngram Viewer

In its “First Things First” report, the World Bank’s economists seemed to reactivate the debate of cameralists and liberal economists from 150 years earlier: To prosper, should one bet on work and profit, or, conversely, on consumption and the satisfaction of fundamental needs? Faced with the conventional approach, which allowed for an increase in productivity and growth to lead to an increase in revenue and consumption (“trickle-down”), McNamara’s team relied on the primary satisfaction of basic needs, the only thing capable of maintaining the work force and development (“trickle-up”).176 A former US Secretary of Defense at the time of the Vietnam War, Robert McNamara was more about political authority than about economic orthodoxy. It is not about equality, the World Bank explained: Increased revenues are not always a sign of good economic health as they are not always well-disbursed, instead they are sometimes used for conspicuous spending rather than for the satisfaction of physiological needs. Also, approaching the issue through the question of revenues neglects certain categories of populations – the sick, the injured, the elderly, or children – who do not necessarily profit from increased revenues. Thus, one must reverse the order of priorities, and start with basic needs before getting involved in labor. In any case, even the “quality of the labor force” is essentially dependent on the preliminary satisfaction of fundamental needs.177 McNamara’s team thus invited its reader to abandon the fight against inequality: Meeting basic needs is more important than reducing inequality for three reasons. First, equality as such is probably not an objective of great importance to most people other than utilitarian philosophers and ideologues. Second, this lack of concern is justified, because meeting basic human needs is morally a more important objective than reducing inequality. Third, reducing inequality is a highly complex, abstract objective, open to many different interpretations and therefore operationally ambiguous.178

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Many, including voices within the World Bank, were highly critical of the new concept: It was a “hair curling reform,” “a superfluous new idea,” “a slogan,” and a “mistake.”179 “Basic needs” was seen as a bad “trade-off ”: The children of today trade an immediate improvement in their living conditions against later augmentation of their income (loss of earning potential). But for McNamara’s protegees, “Basic needs” were simply two “innocent, five-letter words.”180 They offered a “pragmatic response” to the problem of world poverty: It was politically easier to call upon the generosity of Western public opinion to satisfy fundamental needs rather than to finance infrastructure projects. “Food aid is politically easier than finance.”181 Consequently, the focus on extreme poverty could enhance the image of the World Bank, focusing on spots with a strong “moral and political appeal.”182 “Basic needs” offered a new paradigm for universal quantification. As the Director-General of the ILO put it, it was the “dethronement of Gross National Product (GNP)” as a unique indicator of development.183 GNP and GDP were not the only indicators of development anymore. It the coming decades, it would be flanked by a whole new series of indicators targeting societies through the prism of their “basic needs” – the poverty line (by the World Bank), the Human Development Index (HDI) by the United Nations Development Programme, the Gender Related Development Index, Gender Empowerment Measure, Human Poverty Index, etc. Human needs were now universally commensurable. It allowed the ILO to describe the “reference man” who could serve as a standard: He consumed 3,000 kcal and 17 grams of protein per day: He is between 20 and 39 years of age and weighs 65 kg. He is healthy, that is free from disease and physically fit for active work. On each working day he is employed for eight hours in an occupation that usually involves moderate activity. When not at work, he spends eight hours in bed, four to six hours sitting or moving around in only very little activity, and two hours walking, in active recreation or in [. . .] household duties.184 The new numerical universalism of aid was linked to a governmental project on the subject of the “Third World”: The labor force was supposed to be significantly improved by the decrease in malnutrition, sickness, and the progression of education. The demographics should be improved by the reduction of infant mortality, the education of women, and care in the case of sickness or old age, which leads to a “lower fertility rate.”185 Finally, citizens of the South should be taught to better consumption patterns: They should learn to eliminate their consumption expenses that were not aimed at the satisfaction of fundamental needs, whereas their middle classes should reduce their conspicuous consumption.186 Eventually, the World Bank had succeeded in putting “poverty” and “needs” at the forefront of international aid. The concept gave rise to a whole new series of global social indicators, but also entrenched the ideology of sufficiency at the expense of equality. The 1970s opened a new period for the individualization of the basis of well-being.

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Conclusion Dunant did not define humanitarian impartiality in the language of the hierarchy of needs. Pictet did. Between Dunant and Pictet, various institutions and scientists had produced vast bodies of statistics, concepts, and theories of needs. Sometimes for scientific purposes, sometimes for bureaucratic, political, or military reasons. Karl Rau made needs the foundation of economics, Atwater calculated caloric consumption, Rowntree defined a poverty line based on minimal needs, Maslow built a hierarchy of needs at the center of his theory of motivation, and Beveridge made the provision of minimum standards a duty of the welfare state. All of them shared the conviction that basic needs were key to human behavior, and that they constituted an object of knowledge. Needs – unlike suffering – were hidden. They had to be uncovered, by theory and by empirical research. One of the reasons for the success of the notion of needs was its malleability. This may be why elementary needs were so easily able to become, starting in the 1970s, the new doxa of the humanitarian field: The language of needs gives humanitarian agencies a common language while enabling different diagnoses. Needs assessment enables both consent and competition within the field: All agencies can, with some legitimity, argue that they are acting “according to the needs” of the beneficiaries, while producing very different analyses of what those needs actually are. The malleability of the notion results from the different layers of history that it subsumes, as well as from the different spheres of knowledge that it has been shaped by. The “basic needs” of political economy are neither those of health care nor those of international law. Agencies and NGOs engaged in humanitarian aid can thus cherry pick the definition of needs that best fits their own objectives: Those focusing on “development” may refer to poverty or unemployment, those focusing on “health” might refer to nutrition and diseases, while those focusing on “protection” might refer to human rights law, each tradition offering, in turn, a variety of definitions of “needs.” A key part of thinking about needs has been the conceptualization of their articulation. How do needs relate to one another? Household budgets, “triage,” and “social rights” were different answers to this question. During the Second World War, Maslow theorized a “hierarchy” of needs that would become very influential. As emergency relief is concerned, however, it was Pictet’s definition of “proportionality” that enjoyed the greatest success. After the Second World War, the notion of a “vital minimum” was both accepted and contested. The anticolonial fight against a differentialist definition of what was to include in the “living wage” played a significant role in the decolonization process. In the 1970s, international organization such as the World Bank introduced a new conception of “basic needs” that was both universalist and minimalist: It allowed for broad comparisons on a world scale while circumventing the question of global power relations and inequalities. When the UN institutions for the coordination of emergency aid were founded (Emergency Relief Coordinator and OCHA) in the early 1990s, they could rely on broad consent of UN agencies

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and NGOs that needs were universally measurable, commensurable, and prioritizable. Even though it came from a place far away from emergency aid, the introduction of “basic needs” in the 1970s enabled the constitution of the new doxa, already transforming the dream of a welfare world into the global accounting of individual entitlement to sufficiency. According to Samuel Moy, this codification of “social rights” as international norms had only very little impact and “low visibility,” and played a marginal role in the political language of the post-war decades because these international norms were way below the concurrent promises of emerging welfare states.187 While many called for distributive equality and dreamed of a “welfare world,” the Universal Declaration only guaranteed a bare social minimum. Thus, the Declaration “failed to capture a strong contemporary impulse to social equality” and was at best a “modicum of basic individual entitlements” that could not contribute to frame the welfare agenda of states.188

Notes 1 For NGOs, see the long list of signatories of “The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief ” (Steering Committee of Humanitarian Response, SCHR 1994). For the United Nations’ understanding of impartiality, see Resolution 46/182 of the 1991 General Assembly of the United Nations (A/RES/46/182), establishing an international aid coordination body (the future OCHA) (a resolution that recalls the principle of impartiality). For an example of governmental definitions of humanitarian principles, see France/ Ministère de l’Europe et des affaires étrangères. Stratégie humanitaire de la République Francaise 2018–2022. Paris, 2018; Deutscher Bundestag. Bericht der Bundesregierung über die deutsche humanitäre Hilfe im Ausland 2014 bis 2017. Drucksache 19/5720, 2018–11– 12, Berlin: Bundestag 2018. 2 See later in this chapter for the Geneva Convention. 3 Steering Committee of Humanitarian Response, The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief, SCHR 1994. 4 This is the quantification of “people in need” as the first step of the “project cycle,” which included five steps. On this point, this Chapter 6. For a critical overview of needs assessment practices, see Darcy, James and Hofmann, Charles-Antoine. According to need? Needs assessment and decision-making in the humanitarian sector: ODI. Humanitarian Policy Group Report 15 (ODI, 2003): 1–80. 5 Young, 1995; Jurk, Charlotte. Der niedergeschlagene Mensch: Depression- Geschichte und gesellschaftliche Bedeutung einer Diagnose. Münster: Verlag Westfälisches Dampfboot, 2008; Haller, Lea, Höhler, Sabine, and Stoff, Heiko, Stress – Konjunkturen eines Konzepts, Zeithistorische Forschungen 11, no. 3 (2014): 359–381; Chassé, 2013. 6 In 1864, five years after the battle of Solferino, a diplomatic conference called in Geneva and convening delegates from 16 countries signed the “Geneva Convention for the Amelioration of the Condition of the Wounded in Armies in the Field.” 7 This image is the result of a count, by Google Ngram Viewer, of how often the words “needs,” and “suffering” occur in digitized sources available in the corpus (out of the total corpus of 30 million books of Google Books, the corpus of Ngram includes 8.1 million, of which ca. 4.5 million are in English). The graph represents the results in proportion of the total number of words (‘unigram’) for a specific year. For instance, the word “needs” represents ca. 0.002% of the total number of words digitized for the year 1800 in the corpus. Ngram Viewer allows for a distinction between verbs

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Concepts: Elements of a genealogy of needology (_VERB_) and nouns (_NOUN_). The corpus of Ngram includes books such as fiction and non-fiction books, booklets, legal books, etc. but does not include documents that are difficult to scan, for instance, it excludes maps, posters, and newspaper articles. Dunant, 1862: 31 and 47. In the example of Henri Dunant’s description of suffering at Solferino, one recognizes the description of the “state of love” or “Agapè” described by Luc Boltanski. In this regime of action, there is no place for equivalences and quantification; see Boltanski, Luc and Porter, Catherine. Love and justice as competences: Three essays on the sociology of action. Cambridge: Polity Press, 2012: [original: 1990] 110–113. “On the basis of need alone,” “according to need,” or “in proportion of need,” according to the most-used formulations. The revision of the Geneva Convention of 1906, then the Geneva Convention relative to the treatment of prisoners of war in 1929. At the turn of the twentieth century, at least 20 different “principles” co-existed (Palmieri, Daniel. Les principes fondamentaux de la Croix-Rouge: Une histoire politique. 6 juillet 2015: 4. www.icrc.org/fr/document/les-principes-fondamentaux-de-la-croix-rougeune-histoire-politique [Accessed 2017-10]). An idea that was the subject of discussions with his thesis director Max Huber during the war. The minutes of the ICRC indicate that the question of “proportionality” of aid was addressed by the organization for the first time in 1942 (the coordinating commission: Meeting of 6 March 1942, at 10 a.m.: Max Huber suggested that a coordination commission examine the problem of the proportionality of aid given to prisoners of war). I thank Daniel Palmieri, archivist of the ICRC, for this information. Palmieri, 2015. Pictet, Jean. Les principes de la Croix-Rouge (III). Revue Internationale De La Croix-Rouge 37, no. 442 (1955): 633–640. Here p. 633. Pictet, 1955 [III]: 638. Pictet, 1955 [III]: 635. Pictet’s “proportionality principle” should not be confused with the proportionality principle known today in international human rights (sometimes under the name “Martens Clause,” introduced in The Hague Convention of 1899), which deals with the proportionality of military attacks. Pictet, Jean. Les principes de la Croix-Rouge (II). Revue Internationale De La Croix-Rouge 37, no. 441 (1955): 559. Pictet, 1955 [II]: 561. “The principle of equality prohibits, in particular, all objective distinction between individuals.” Ibid. Pictet, 1955 [II]: 561. Pictet, 1955 [II]: 568. Pictet recognized that the proportionality principle was implied in the doctrine of the Red Cross (Pictet, 1955 [II]: 569). He attributed to Max Huber, his thesis advisor, an outline of codification: Huber, Max. Principes d’action et fondements de l’œuvre du Comité international de la Croix-Rouge 1939–1946. Revue Internationale De La CroixRouge 29, no. 337 (1948): 10. Pictet, 1955 [II]: 568. Pictet, 1955 [II]: 570. Article 12 of the first Convention of 1949 establishes this point. Pictet, 1955 [II]: 570. See later in the chapter for the notion of “triage.” To justify the principles of equality and non-discrimination, Pictet cited (a) the “general law”: Citizens are equal before the Law; (b) the UN Charter and the Universal Declaration of Human Rights, that forbid discriminations; (c) the “medical deontology” codified in the Declaration of Geneva established by the World Medical Association; and (d) “different moral systems,” notably Christian, with the commandment

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“love your enemy” and the parable of the Good Samaritan. (Pictet, 1955 [II]: 560–563). Pictet, 1955 [II]: 569. He would return to this point in his commentary on the fundamental principles of the Red Cross in 1979 (Pictet, 1979). Pictet, 1955 [II]: 569. Pictet recognized a limit to the proportionality principle: The necessity of concentrating aid. If one has a single dose of serum for two sick people, one does not divide it between them, because neither will be cured. Assistance must be “effective.” It is thus not always desirable to “divide aid” (Pictet, 1955 [II]: 573). Another source of inspiration for Pictet was the priority of care in medicine, priority that could be linked to social or cultural values (Pictet, 1955 [II]: 564). In a subsequent commentary, Jean Pictet cited Sir John Kennedy, vice-president of the British Red Cross, declaring in 1946: “there is only one rule for the Red Cross: The greatest help to the greatest need” (Pictet, Jean. The fundamental Principles of the Red Cross. International Review of the Red Cross 19, no. 210 (1979): 130–149). Equity does not demand that everyone pays the same tax. Pictet, 1979. Pictet, 1955 [II]: 571. Pictet, 1955 [II]: 571. A specific role in the advent of a new humanity was thus conferred to humanitarian organizations – and to the Red Cross in particular – because suffering was at the center of the definition of the human. That which constituted the foundation of humanity, and the universality of the Red Cross, was the universality of human suffering. It was “the fight between suffering and death” that constitutes the principle of humanity (Pictet, 1955 [I]: 496), not just in the sense of philanthropy, but equally in the sense of a human community. As Catherine Le Bris shows, the notion of humanity was taken up by international law after the Second World War, as a reaction to suffering. “Humanity” entered into law at the moment of the realization of its mortality. The demographic bloodbath, genocide, and the atomic bomb brought about a “humanism of humility” that recognized the mortality of the human species (Le Bris, 2012: 4). The idea of humanity was thus indexed to the idea of suffering. According to the UN’s San Francisco Charter, people were assigned the task of “sav[ing] succeeding generations from the scourge of war, which twice in our life-time has brought untold sorrow to mankind” (cited in Le Bris, 2012: 5). Pictet, 1955 [II]: 571. Pictet voluntarily recalled, in his writings, that the structure of the Red Cross allowed the ICRC to be as close as possible to humanitarian principles. Pictet, 1979. The notion of impartiality was also strategic because, in the Geneva Conventions, the rights and special responsibilities were conferred upon “impartial humanitarian organizations” (article 9 of the Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. Geneva, 1949.). In his comments on the Geneva Convention, Pictet explained this idea of impartiality: “he is guided in his choice by the apparent gravity of the wounds, making no distinction between friends, allies and enemies. The ideal would be to be able to base the distribution of relief entirely on the actual needs” (Pictet, 1952: 109). Pictet, 1955 [II]: 573. [My emphasis] As Haug agreed in his analysis of the impartiality principle: For Haug, only “factual” and “objective” criteria could justify an unequal distribution of aid. Haug, Hans. Humanité pour tous. Le mouvement international de la Croix-Rouge et du Croissant-Rouge. Bern and Stuttgart: Institut Henry-Dunant and Haupt, 1996: 460. Pictet, 1955 [II]: 573. Steering Committee of Humanitarian Response, The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief, SCHR 1994. The Code of Conduct was supported by the Red Cross Movement and a large collection

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Concepts: Elements of a genealogy of needology of NGOs (Caritas Internationalis, Catholic Relief Services, International Save the Children Alliance, the World Lutheran Federation, Oxfam, etc.). The definition of impartiality was inspired by the “fundamental principles” adopted by the Red Cross in 1965. OCHA defined impartiality in a way explicitly inspired by the Fundamental Principles of the Red Cross: “Humanitarian action must be carried out on the basis of need alone, giving priority to the most urgent cases of distress and making no distinctions on the basis of nationality, race, gender, religious belief, class or political opinions” (OCHA on Message: Humanitarian Principles 2011). On the Sphere Project, see Chapter 4. The Sphere Humanitarian Charter notably indicated in point 6: “Any such assistance must be provided according to the principle of impartiality, which requires that it be provided solely on the basis of need and in proportion to need,” whereas, among four great principles of protection, the second point indicates the objective: “Ensure people’s access to impartial assistance – in proportion to need and without discrimination. People can access humanitarian assistance according to need and without adverse discrimination.” Sphere Project. Humanitarian charter and minimum standards in humanitarian response, 3rd ed. Geneva: The Sphere Project, 2011. Pechayre, Marion. Impartialité et pratiques de triage en milieu humanitaire. Le cas de médecins sans frontières au Pakistan. Les Cahiers du Centre Georges Canguilhem 1, no. 6 (2014): 125–142, here p. 125. Haug, 1996: 448. The principle of impartiality is found, in a different formulation, in the Geneva Conventions of 1949, which conferred it a particular weight in international humanitarian law (Mackintosh, Kate, The principles of humanitarian action in international humanitarian law, HPG Report 5, Overseas Development Institute, 2000: 13). The principle of “impartiality” figures in the Fundamental Principles of the Red Cross adopted – by the represented nations as well – during the international conferences of the Red Cross in 1965 and 1986. The idea of a household budget was older than the nineteenth century, however. Some noble and bourgeois families had produced family budgets for their own private purposes in the seventeenth century. At the end of the eighteenth century, some inquiries were conducted in Great Britain in a sporadic fashion on the budgets of peasant and working-class families: 136 families studied by David Davies in 1795, 86 families studied by Frederick Eden in 1797, etc. See Fischer, Hendrik K. Konsum im Kaiserreich: Eine statistisch-analytische Untersuchung privater Haushalte im wilhelminischen Deutschland. Berlin: Akademie Verlag GmbH, 2011: 67–78. Le Play, Frédéric. Les ouvriers européens, Vol. 6. Tours, 1855 (2nd ed.: 1877–1879); Ducpetiaux, Edouard. Budgets économiques des classes ouvrières en Belgique. Brussels: M. Hayez, 1855; Engel, Ernst. Die Produktions- und Consumtionsverhältnisse des Königreiches Sachsen. Zeitschrift des Statistischen Büreaus des Königlich Sächsischen Ministeriums des Innern 3, no. 8/9 (1857 [reprinted 1895]). Ernst Engel is known for his “law” that indicates that the poorer a family is, the more it spends for food in proportion to the total outlay. In the middle of the nineteenth century, the inquiries by household were monographic: Le Play and his disciples choose families that they consider “typical.” Of which 75 are from Great Britain, 100 from France, and more than 200 from Germany. Fischer, 2011: 76. Uwe Spiekermann has another tally but confirms the rapid growth of this kind of inquiry: Spiekermann, Uwe. Household budgets as sources of food history: A methodological overview. In Current research into eating practices: Contribution of social sciences, Vol. 10, Feichtinger, Elfriede and Köhler, Barbara (eds.). Frankfurt a.M.: AGEV, 1995: 88–90. A document reproduced in the “Bulletin de l’Institut international de statistique.” Fischer, 2011: 75. Foucault, Michel. Sécurité, territoire, population. Cours au Collège de France: 1977-1978. Paris: Gallimard/Le Seuil, 2004; Foucault, Michel. Naissance de la biopolitique. Cours au collège de France: 1978-1979. Paris: Gallimard/Le Seuil, 2004.

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53 Reinert, Erik S. A brief introduction to Veit Ludwig von Seckendorff (1626-1692). European Journal of Law and Economics 19, no. 3 (2005): 221-230. 54 Quoted in Hull, Isabel. Sexuality, State and Civil Society in Germany: 1700-1815. Cornell University Press, 1997: p. 158. 55 Frederick William I of Prussia created the first chairs of cameral sciences in Halle and Frankfurt/Oder (1727). Other chairs were introduced in German and Austrian universities (Leipzig, Iena, Göttingen, Vienna, Prague, Innsbruck, and Klagenfurt). See Tribe, Keith. Governing economy. The reformation of German economic discourse, 1750-1840. Cambridge: Cambridge University Press, 1988; Laborier, Pascale. La ‘bonne police’: Sciences camérales et pouvoir absolutiste dans les Etats allemands. Politix: Revue des sciences sociales du politique 12, no. 48 (1999): 7-35; Garner, Guillaume. Territoire et espace dans la théorie économique en Allemagne: 1750-1820. Revue d’histoire moderne et contemporaine 2, no. 48 (2001): 25-50; Garner, Guillaume. État, économie et territoire en Allemagne: L’espace dans le caméralisme et l’économie politique 1740-1820. Paris: Éditions de l’EHESS, 2005. The aim of cameralism was to construct an economic theory and to train administrators to apply it. 56 A well-policed nation is easier to govern: The sovereign shall protect the population from famines, catastrophes, and plagues. 57 Garner, 2005: p. 108. 58 Justi, Johann Heinrich Gottlob von. Staatswirtschafts oder systematische Abhandlung aller ökonomischen und Kameralwissenschaften, die zur Regierung eines Landes erfordert werden. Leipzig: Bernhard Christoph Breitkopf, 2nd ed., 1758 [1st ed.: 1755]; Sonnenfels, Joseph von. Grundsätze der Polizey—Handlungs- und Finanzwissenschaft 2. Vienna: 3rd ed., 1771-1778. [1st ed.: 1765-1771]. See Garner, 2001 and Garner, 2005. 59 Bielefeld, Baron de. Institutions politiques, ouvrage où l’on traite de la société civile: Des loix, de la police, des finances, du commerces, des forces d’un etat; et en général de tout ce qui a rapport au gouvernement. Duchesne, 1762: p. 57, quoted in Laborier, 1999: p. 18. 60 Moyn, Samuel. Not enough: Human rights in an unequal world. Cambridge, MA: Harvard University Press, 2018: p. 20. 61 Garner, 2001: p. 39. 62 Heller, Agnes. The theory of need in Marx. Science and Society 43, no 3 (1979): 349–355. 63 German: “Jeder nach seinen Fähigkeiten, jedem nach seinen Bedürfnissen!” Marx, Karl, Kritik des Gothaer Programms, Berlin: Verlag Neuer Weg 1946 [1875]: 21. 64 Historians of German political economics agree on this point: See Garner, 2001; Tribe, 1988: 149-182; and: Bowler, Richard. Mediating Creative Nature and Human Needs in Early German Political Economy. History of Political Economy 40, no. 4 (2008): 633-669. For Garner, the notion of “needs” was central to this economic discourse, because it reconciled two approaches: One ethical approach, and one individualist approach (Garner, 2001: p. 45). German national economics took a different path from those of the British liberal economics of Adam Smith (founded on the laws of work, “ponocracy”) and of French economics (founded on the laws of nature, “physiocracy”). 65 Rau, Karl Heinrich. Grundriss der Kameralwissenschaft oder Wirthschaftslehre für encyklopädische Vorlesungen. K. Groos: 1823: p. 17, §35. 66 For a similar definition of the national economy, see Jakob, Ludwig Heinrich von. Grundsätze der National-Oekonomie, oder Theorie des National-Reichthums, 3rd ed. Halle: Friedrich Ruff, 1825: 46-47. 67 Tribe, 1988: p. 191. 68 A liberal economist like Bastiat could thus list needs that have “a real importance” (une importance réelle) and prioritize them: Breathing, food, clothing, housing, conservation and recovery of health, locomotion, safety, education, entertainment, a sense of the beautiful. (Bastiat, Frédéric. Œuvres complètes de Frédéric Bastiat: Sophismes économiques. Petits pamphlets II. Guillaumin, 1863: 62-92). The text of Chapter 3, “Des besoins et des hommes” (“Of needs and men”) was published for the first time in 1849.

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69 With Lucien March in France, Ernst Engel in Germany, Caroll Wright in the United States, and Kiaer in Norway. Desrosières, Alain. Gouverner par les nombres. L’argument statistique II, Paris: Presses de l’Ecole des Mines. 2008: p. 13. 70 Social type, a description, an explanation, and a proposal of tiered action were associated. (Desrosières, 2008: p. 18). 71 Desrosières, 2008: p. 16. According to the typology proposed by Alain Desrosières, the “classic liberal state” at the end of the eighteenth century is distinguished from the “providential state” at the end of the nineteenth not just by a general objective (to ensure market transparency to facilitate exchange and concurrence in the first case; to protect salaries from the consequences of capitalism in the second case), but also by a statistical instrumentation (the study of agricultural prices being characteristic of the liberal state, the study of the spending of working-class households being characteristic of the providential state). (Desrosières, 2008: 9-14). 72 Desrosières, 2008: p. 20. 73 Rowntree, Benjamin S. Poverty: A study of town life. London: Palgrave Macmillan, 1901. 74 On nutrition studies, see later in the chapter. 75 Lollivier, Stéfan. La pauvreté: Définitions et mesures. Regard croisés sur l’économie 2/4, (2008): 21-29; Lepenies, Philipp. Armut: Ursachen, Formen, Auswege. CH Beck, 2017. 76 Halbwachs, Maurice. La classe ouvrière et les niveaux de vie. Recherches sur la hiérarchie des besoins dans les sociétés industrielles contemporaines. PhD diss., Paris: Faculté des Lettres de l’Université de Paris, 1912. Halbwachs showed that needs were divided in “four essential categories,” all the while specifying that this classification was not natural but rather the “work of society” (Halbwachs, 1912: p. 19). 77 Halbwachs, 1912: 6-42, here p. 42.  78 Lollivier, 2008. 79 Rowntree, Benjamin S. Progress and poverty: A second social survey of York. London: Longmans, Green and Co, 1941; Rowntree, Benjamin S. and Lavers, George Russell. Poverty and the welfare State: A third social survey of York dealing only with economic questions. London: Longmans, Green and Co., 1951. 80 The method of representative, then random samples therefore replaced monographs. Desrosières attributes a precursory role to the Norwegian Anders Kiaer, who proposed representative samples on the whole population to the International Statistical Institute in 1895. See Desrosières, 2008. 81 “One mistake has been to narrow attention largely to the preservation of physical efficiency, whatever that may mean, and by implication to assume that the physical efficiency of individuals can be divorced from their psychological well-being and the organization and structure of society. Another has been to draw up a list of basic necessities, translate them into a certain income, and call this ‘subsistence.’ All students of poverty . . . have tended to write as if their subsistence standards consisted of a list of absolute necessities which could be applied irrespective of time and place.” Townsend, Peter. The meaning of poverty. British Journal of Sociology 13, no. 3 (1962): 201–227, here pp. 218–219. Cited in Lepenies, 2013: 9. 82 Lachenal et al., 2014: p. 2. 83 Ibid. 84 Lachenal et al., 2014: p. 5. 85 Foucault, Michel. Naissance de la clinique, Paris: Presses Universitaires de France, 1963. Quote by Lachenal et al., 2014. 86 For historical accounts of early quantification of demography and health, see Rusnock, Andrea. Vital Account. Quantifying Health and Population in Eighteenth-Century England and France. Cambridge: Cambridge University Press, 2002. On the emergence of mortality statistics in the seventeenth century, see Le Bras, Hervé. Naissance de la mortalité. L’origine politique de la démographie et de la statistique. Paris: Gallimard/le Seuil, 2000. 87 Simmons, Dana. Vital Minimum: Need, science, and politics in modern France. University of Chicago Press, 2015: 33-39.

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88 Cullather, Nick. The foreign policy of the calorie. The American Historical Review 112, no. 2 (2007): 337-364. 89 Ibid. 90 Barona, Josep L. The problem of nutrition: Experimental science, public health and economy in Europe 1914-1945. Brussels/New York: Peter Lang, 2010. 91 Although the representation as a pyramid was not Maslow’s, but didactic explanation of Maslow’s idea by his German colleague Werner Cornell. 92 Maslow subscribed to a tradition of motivational studies (from movere, to move); that is, studies of the origin of human conduct: What compels individuals to act? 93 He tried to reconcile the varied works of the functionalist theory (James and Dewey), with holism and the Gestalt theory (of Wertheimer and Goldstein) as well as dynamic psychology (which he associates with Freud and Adler). 94 Maslow, Abraham H. A theory of human motivation. Psychological Review 50, no. 4 (1943): p. 371. 95 He talked about “questions raised” and of “a very serious lack of sound data.” Maslow 1943: p. 371 and p. 383. 96 Maslow, 1943: p. 385. The empirical weakness of the hierarchy of needs did not escape his peers: “The theory is widely accepted, but there is little research evidence to support it. (. . .) It has almost become a tradition for writers to point out the discrepancy between the popularity of the theory and the lack of clear and consistent empirical evidence to support it.” See Wahba, Mahmoud A. and Bridwell, Lawrence G. Maslow reconsidered: A review of research on the need hierarchy theory. Organizational Behavior and Human Performance 15, no. 2 (1976): 212-240, here p. 212. Indeed, Maslow was not very preoccupied with confirming the empirical bases of his theory, and numerous studies have contradicted his hypotheses, without affecting the theory’s development. 97 “There are at least five sets of goals, which we may call basic needs. These are briefly physiological, safety, love, esteem, and self-actualization.  .  . . These basic goals are related to each other, being arranged in a hierarchy of prepotency” (Maslow, 1943: p. 394). 98 This picture is from Kenrick, Douglas T., Griskevicius, Vladas, Neuberg, Steven L., and Schaller, Mark. Renovating the pyramids of needs: Contemporary extensions built upon ancient foundations. Perspectives on Psychological Science 5, no. 3 (2010): 292–314. 99 “For the man who is extremely and dangerously hungry, no other interests exist but food. He dreams food, he remembers food, he thinks about food, he emotes only about food, he perceives only food and he wants only food” (Maslow, 1943: p. 374). 100 Maslow, 1943: p. 374. 101 “The average member of our society is most often partially satisfied and partially unsatisfied in all of his wants” (Maslow, 1943: p. 395). “In actual fact, most members of our society who are normal, are partially satisfied in all their basic needs and partially unsatisfied in all their basic needs at the same time. A more realistic description of the hierarchy would be in terms of decreasing percentages of satisfaction as we go up the hierarchy of prepotency. For instance, if I may assign arbitrary figures for the sake of illustration, it is as if the average citizen is satisfied perhaps 85 per cent in his physiological needs, 70 per cent in his safety needs, 50 per cent in his love needs, 40 per cent in his self-esteem needs, and 10 per cent in his self-actualization needs” (Maslow, 1943: 388-389). 102 “The integrated wholeness of the organism must be one of the foundation stones of motivation theory” (Maslow, 1943: p. 370). 103 As well as on medical works on homeostasis (the body’s natural tendency to maintain a constant state of blood flow). 104 The ambiguity maintained by Maslow on the contours of the idea of “need” was noted by Wahba and Bridwell: “The most problematic aspect of Maslow’s theory,

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Concepts: Elements of a genealogy of needology however, is that dealing with the concept of need itself. It is not clear what is meant by the concept of need. Does need have a psychological and/or physiological base? Does a need come to existence because of deficiency only or does need always exist even if it is gratified? How can we identify, isolate and measure different needs?” (Wahba and Bridwell, 1976: p. 234). “Human needs arrange themselves in hierarchies of pre-potency. That is to say, the appearance of one need usually rests on the prior satisfaction of another, more prepotent need” (Maslow, 1943: p. 370). “Thus it seems impossible as well as useless to make any list of fundamental physiological needs for they can come to almost any number one might wish, depending on the degree of specificity of description” (Maslow, 1943: p. 372). “If we wish to see these needs directly and clearly we must turn to neurotic or nearneurotic individuals, and to the economic and social underdogs” (Maslow, 1943: p. 379). The musician, the artist, the poet, the inventor – even if the “ideal mother” and the “athlete” made a short appearance (Maslow, 1943: 382–383). (“the average American citizen” [374], “the average child in our society” [378], “the healthy, normal, fortunate adult” [378], “average citizen” [388], “the average person” [388], “the average member of our society” [395], etc.) Maslow specified that the hierarchy of needs could find itself inverted in people who were situated furthest from the American average, (a) those who, having had all their needs satisfied from childhood, were particularly “strong” and capable as an adult of channeling a superior need (for example the defense of a value) before a physiological need or at the price of a risk to their security and (b) those who, since they had been used to food deprivation since childhood, were accustomed to hunger and could control it. Maslow, 1943: p. 390. In a corrosive article, the psychologist Joseph Henrich and his colleagues showed how American psychology was constructed on an empirical foundation essentially based on experiments on North American subjects from the middle- or upper-classes, and in particular on studies effected on first-year psychology students, who were the captive population for laboratory experiments. According to them, American psychologists considered their models to be universal, even though the North American population represented less than 5% of the world population, and even though the students from the first and second years represented less than 0.2% thereof. It is therefore on the “weirdest” (“weird” also being an acronym for “Western, Educated, Industrialized, Rich, and Democratic”) of subjects that these theories, which have universal pretensions, have been constructed (Henrich, Joseph, Heine, Steven J., and Norenzayan, Ara. The weirdest people in the world? Behavioral and Brain Sciences 33, no. 2–3 (2010): 61–135). Haggbloom, Steven J., et al. The 100 most eminent psychologists of the 20th century. Review of General Psychology 6, no. 2 (2002): 139–152. On the continuation of Maslow’s ideas in psychology, see Alderfer, Clayton P. An empirical test of a new theory of human needs. Organizational Behaviour and Human Performance 4, no. 2 (1969): 142–175; Tay, Louis, and Diener, Ed. Needs and subjective well-being around the world. Journal of Personality and Social Psychology 101, no. 2 (2011): 354-365. The Economist review considers Maslow a management “guru.” His “hierarchy of needs” figures in the pantheon of management ideas (Hindle, Tom. Guide to Management Ideas and Gurus. London: The Economist in Association with Profile Books LTD, 2008: p. 101 and pp. 267–268). Some of Maslow’s ideas have been cherished in marketing theories, especially the idea that one can sell a good that might seem superfluous if this good is linked, on a deeper level, to a basic need. One example given by Maslow – that of the ice cream cone – prefigured the script of many advertisements: “A desire for an ice cream cone might

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actually be an indirect expression of a desire for love. If it is, then this desire for the ice cream cone becomes an extremely important motivation. If, however the ice cream is simply something to cool the mouth with, or a casual appetitive reaction, then the desire is relatively unimportant. Everyday conscious desires are to be regarded as symptoms, as surface indicators of more basic needs” (Maslow, 1943: 392-393). Boltanski, Luc, and Chiapello, Eve. Le nouvel esprit du capitalisme 10. Paris: Gallimard, 1999: p. 109. According to Boltanksi and Chiapello, a new problem occurred in the 1960s for enterprises: Salaries and benefits alone could not suffice to motivate highly qualified staff. Thus, Maslow’s theory of motivation was attractive and he became a “fetish author” of capitalist management. The “need for security” for instance became “one of the central arguments of the defense of capitalism” in the 1960s and 1970s (Boltanski and Chiapello, 1999: 148–154). Among countless examples of very free adaptations of Maslow’s model: World Health Organization (WHO), Reed, Bob, et al. Technical notes on drinking water, sanitation and hygiene in emergencies. Geneva: WHO, 2011; see also Wemmers, Jo-Anne M., and Manirabona, Amissi. Defining victims: A proposed typology for victims of war crimes and their need for reparation. Criminological Approaches to International Criminal Law, Bantekas, Illias and Mylonaki, Emmanouela (eds.), 316–337, here 329. University of Cambridge, 2014. Veenema, Tener Goodwin (ed.). Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards. New York: Springer, 2013: 80–81 and 289–291. The American NGO “Relief International” made its logo from a representation of the classification of needs. This position is also presented in humanitarianism: Certain authors insist on the situated character of priorities and the ethnocentric character of the whole “hierarchy of needs.” Beristain, Carlos Martín. Humanitarian aid work: A critical approach. Philadelphia: Pennsylvania University Press, 2006: p. 6: “Our priorities are often different from theirs,” explains Beristain: “whether informing the families of fatalities is more urgent than restoring ration cards.” For Aptekar, mental health is as important as “basic needs” in Ethiopia, notwithstanding the “ethnocentric scale of values derived by Abraham Maslow.” Aptekar, Lewis. Cultural problems for Western counselors working with Ethiopian refugees. In Counselling Refugees: A Psychosocial Approach to Innovative Multicultural Intervention, Bemak, Fred, Chi-Ying Chung, Rita, and Pedersen, Paul B. (eds.), 208–221, here 211. Westport: Greenwood Press, 2003. Slim, Hugo. Politicizing humanitarian action according to need. In Presentation to the 2nd International Meeting on Good Humanitarian Donorship, Geneva: Centre for Humanitarian Dialogue, 21–22 Oct. 2004. See later in the chapter for the role of UNRRA for relief in Central Europe. Watson, Alexander. Enduring the Great War: Combat, morale and collapse in the German and British Armies: 1914–1918. Cambridge: Cambridge University Press, 2008. Weinreb, Alice Autumn. Modern hungers: Food and power in twentieth-century Germany. Oxford: Oxford University Press, 2017; Trentmann, Frank. Coping with shortage: The problem of food security and global visions of coordination: c. 1890s-1950. In Food and conflict in Europe in the age of the two World Wars, Trentmann, Frank and Just, Flemmin (eds). London: Palgrave Macmillan, 2006: 13–48; Collingham, Lizzie. Taste of war: World War II and the battle for food. New York: Penguin, 2012. Moyn, 2018: 48. Rosanvallon, Pierre. La société des égaux. Paris: Seuil, 2011: 289. On the history of the welfare state, see Kuhnle, Stein and Sander, Anne. The emergence of the western welfare state. In The Oxford handbook of the welfare state, 2010: 61–80; Ewald, François. Histoire de l’Etat providence: Les origines de la solidarité. Paris: Grasset, 1996. On the difference between sufficiency (how well an individual is doing in relation to some minimum provision) and equality (how far individuals are from one another in the portion of the good things they receive), see Moyn, 2018: 3. Moyn, 2018: 13.

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127 Moyn, 2018: 46. 128 Hoover led the Committee for Relief of Belgium. Quoted in Cullather, 2007: 350. On the history of relief in Belgium, see Becker, Annette. Les cicatrices rouges. Paris: Fayard, 2010. 129 On governments-in-exile, see Eichenberg, Julia. Macht auf der Flucht. Europäische Regierungen in London 1940–1944. Zeithistorische Forschungen – Studies in Contemporary History 3 (2018): 452–473. 130 Relief organizations were established in London (the Council of British Societies for Relief Abroad (COBSRA)) and Washington (Office of Foreign Relief and Rehabilitation Operations (OFRRO)). 131 Collingham, 2012. 132 Quoted in Cullather, 2007: 363. 133 ILO. Social Security (Minimum Standards) Convention no. 102. ILO, 1952. 134 Reinisch, Jessica. Auntie UNRRA at the crossroads. Past & Present 218, no. 8 (2013): 70–97; Reinisch, Jessica and White, Elizabeth (eds.). The disentanglement of populations: Migration, expulsion and displacement in postwar Europe: 1944–49. London: Palgrave Macmillan, 2011; Reinisch, Jessica. Internationalism in relief: The birth (and death) of UNRRA. Past and Present 210, no. 6 (2011): 258–289; Mazower, Mark, Reinisch, Jessica, and Feldman, David. Post-war reconstruction in Europe: International perspectives 1945– 1949. Oxford: Oxford University Press, 2011. 135 Malkki, Liisa H. Refugees and exile: From ‘refugee studies’ to the national order of things. Annual Review of Anthropology 24, no. 1 (1995): 495−523. 136 Bonnecase, 2011. 137 See ILO. Migration movements throughout the World. International Labour Review 4 (1923): 515–540. And the ongoing PhD of Stricker, Yann. Migration zwischen Imperium und Nation: Herstellung von internationalem statistischem Wissen in einer kolonialen Welt 1919– 1962, Ongoing PhD diss., Universität Luzern. 138 Hailey, Baron. An African survey: A study of problems arisings in Africa South of the Sahara. London: Palgrave Macmillan, 1938. On this: Tilley, Helen. Africa as a living laboratory: Empire, development and the problem of scientific knowledge 1870–1950. Chicago: University of Chicago Press, 2011. 139 Breckenridge, 2012; Breckenridge, 2008. 140 Weitzberg, 2015. 141 Quoted in Bonnecase, Vincent. Généalogie d’une évidence statistique: De la ‘réussite économique’ du colonialisme tardif à la ‘faillite’ des états africains (v. 1930–v.1980). Revue d’histoire moderne et contemporaine 4 (2015): 33–63. 142 There is a growing literature on this: Hunt, Nancy Rose. ‘Le Bebe en Brousse’: European women, African birth spacing and colonial intervention in breast feeding in the Belgian Congo. The International Journal of African Historical Studies 21, no. 3 (1988): 401–432; Brantley, Cynthia. Feeding families: African realities and British ideas of nutrition and development in early colonial Africa. Portsmouth: Heinemann, 2002; Bonnecase, Vincent. Avoir faim en Afrique occidentale française: Investigations et représentations coloniales (1920–1960). Revue d’histoire des sciences humaines 2 (2009): 151–174; Worboys, Michael. The discovery of colonial malnutrition between the wars. In Imperial medicine and indigenous societies. Manchester: Manchester University Press, 2017. 143 On this: Bonnecase, Vincent. When numbers represented poverty: The changing meaning of the food ration in French colonial Africa. The Journal of African History 59, no. 3 (2018): 463–481, here p. 467. 144 Something which Bonnecase describes accurately. See Bonnecase, 2018: 468. On ready to use therapeutic foods, see: Carémel, Jean-Francois. Mesurer la malnutrition infantile au Niger. Entre révolution thérapeutique et transformations de la métrique des corps. Ethnologie française 45, no. 1 (2015): 95–107. See also Scott-Smith, Tom. Sticky technologies: Plumpy’Nut®, emergency feeding and the viscosity of humanitarian design. Social Studies of Science 48, no. 1 (2018): 3–24.

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145 Barona, Josep L. and Vilar, Joseph L. The problem of nutrition: Experimental science, public health and economy in Europe 1914–1945. Brussels: Peter Lang, 2010. 146 League of Nations. The problem of nutrition, vol. 3: Nutrition in various countries. Geneva: League of Nations, 1936; League Health Organization. Report on the physiological base of nutrition. Geneva: LHO, 1935; International Labour Office. Workers’ nutrition and social policy. Geneva: ILO, 1935. 147 League of Nations, 1936; International Labour Office, 1935. 148 Arnold, David. The ‘discovery’ of malnutrition and diet in colonial India. The Indian Economic & Social History Review 31, no. 1 (1994): 1–26. See also: Brantley, 2002. 149 Cullather, 2007: 345. 150 Bonnecase, 2018: 474. 151 United Nations Economic and Social Counsel (ECOSOC). Preliminary report on the world social situation, with special reference to standards of living. New York: United Nations, 1952: 56. Cited in Bonnecase, Vincent. When numbers represented poverty: The changing meaning of the food ration in French colonial Africa. The Journal of African History 59, no. 3 (2018): 463–481, here p. 464. 152 Bonnecase, Vincent. Généalogie d’une évidence statistique: De la ‘réussite économique’ du colonialisme tardif à la ‘faillite’ des États africains (v. 1930–v. 1980). Revue d’histoire moderne contemporaine 4 (2015): 33–63. 153 Cooper, Frederick. Decolonization and African Society: The Labor Question in French and British Africa. Cambridge: Cambridge University Press, 1996. 154 According to Article 73 of the UN Charter, adopted in San Francisco in June 1945, the member states “which have or assume responsibilities for the administration of territories whose peoples have not yet attained a full measure of self-government . . . accept as a sacred trust the obligation to promote to the utmost . . . the well-being of the inhabitants . . . and to this end . . . to transmit regularly to the Secretary-General . . . statistical and other information of a technical nature relating to economic, social, and educational conditions in the territories for which they are respectively responsible” (United Nations. Charter of the United Nations: Chapter 9, Article 73. UN, June 1945). Cited in Bonnecase, 2015. 155 United Nations Economic and Social Counsel, 1952: 56. Cited in Bonnecase, 2015: 43. 156 Cooper, 1996: 469. 157 Simmons, Dana. Wages and the politics of life in postwar France. The Journal of Modern History 81, no. 3 (2009): 579–606. The minimum wage “Salaire Minimum interprofessionnel garanti (SMIG)” concerned 65% of French workers in 1951. From 1951 to 1970, the minimum wage in France was indexed to a definition of “vital minimum.” In 1970, President Pompidou introduced the Salaire Minimum de Croissance (SMIC), now indexed to national productivity. 158 Simmons, 2009: 603. 159 Cooper, 1996: 230–231. 160 Bonnecase, Vincent. Les prix de la colère. Une histoire de la vie chère au Burkina Faso, habilitation à diriger des recherches en sciences politique. Paris: IEP, 2018: 83–89. 161 Cooper, 1996: 225–260. 162 Cooper, Frederick. Colonialism in question: Theory, knowledge, history. Berkeley: University of California Press, 2005: 209. See also: Fall, Babacar. Le travail au Sénégal au XXe siècle. Paris: Kathala, 2011: 211–214. 163 ILO. Employment, growth and basic needs: A one-world problem: Report of the director-general of the international labour office. Geneva: ILO, 1976; Speech given before the Board of Governors by Robert McNamara, President of the World Bank Group, Washington, 15 September 1972. Cited in Rist, Gilbert. Le développement: Histoire d’une croyance occidentale, 4th ed. Paris: Presses de Sciences Po, 2013: 288. 164 Grant, James P. Development: The end of trickle down? Foreign Policy 12 (1973): 43–65; Owens, Edgar and Shaw, Robert D. Development reconsidered: Bridging the gap between government and the people. Lexington: Lexington Books, 1972.

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165 Eckert, Andreas. Exportschlager Wohlfahrtsstaat? Europäische Sozialstaatlichkeit und Kolonialismus in Afrika nach dem zweiten Weltkrieg. Geschichte und Gesellschaft 32, no. 4 (2006): 467–488. 166 Quoted in Moyn, 2018: 101. 167 Quoted by Moyn, 2018: 103. 168 Gilman, Nils. The new international economic order: A reintroduction. Humanity: An International Journal of Human Rights, Humanitarianism, and Development 6, no. 1 (2015): 1–16. 169 A summary of this debate is found in Mathieson, John A. Basic needs and the new international economic order: An opening for North-South collaboration in the 1980s. Washington: Department of State, 1980: 78–79; Galtung, Johan. The new international economic order and the basic needs approach. Alternatives 4, no. 4 (1979): 455–476; Streeten, Paul. Basic needs and the NIEO: Must there be a conflict? In Report World Bank, March–April 1978; Singh, Ajit. The ‘basic needs’ approach to development vs the new international economic order: The significance of Third World industrialization. World Development 7, no. 6 (1979): 585–606. 170 Moyn, 2018: 129 and 147. 171 Moyn, 2018: 128. 172 Moyn, 2018: 132. 173 Moyn, 2018: 139. 174 Moyn, 2018: 144. 175 For the strengths and weaknesses of Ngram Viewer as a tool of analysis, see above, footnote 7 of this chapter. 176 Streeten, Paul et al. First things first: Meeting basic human needs in the developing countries. New York: World Bank and Oxford University Press, 1981. 177 “quality of the labor force” (Streeten et al., 1981: 40); “Nutrition, health, and education are elements of the level of living that are important for fuller labor utilization” (Streeten et al., 1981: 13). 178 Streeten et al., 1981: 17. 179 Cited in Kapur et al., 1997: 267. 180 “such innocent, five-letter words;” “a pragmatic response to the problem of world poverty” (preface by Mahbub Ul Haq, in Streeten et al., 1981: ix). 181 Streeten et al., 1981: 40. “Internationally, also, there is more concern with ameliorating blatant deprivation than with bringing developing countries up to Western living standards” (Streeten et al., 1981: 18). 182 “meeting the basic needs of the world’s poor has stronger moral and political appeal and therefore a higher claim on aid budgets than most other schemes advanced for the promotion of international assistance” (Streeten et al., 1981: 40–41). 183 Cited in Kapur, Devesh, Lewis, John P., and Webb, Richard C. The World Bank: Its first half century I: History. Washington, DC: Brookings Institution, 1997: 224. 184 Hopkins, Michael. Basic needs approach to development planning. World Employment Programme Research: Working Paper 3. Geneva: ILO, 1977: 10. Cited in Rist, 2013: 295. 185 Streeten et al., 1981: p. 39. 186 Streeten, Paul P., Basic Needs: Premises and Promises. Journal of Policy Modeling, 1979, 1, 1936-1946. 187 Moyn, 2018: p. 59. 188 Ibid.: p. 60.

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Classifications UNHCR and the legibility of refugees in Central Africa

In 2014, 189,802 people left the Central African Republic. Thousands crossed the border with Cameroon by car, truck, or foot, to reach the small town of Kenzou. Once there, they applied for refugee protection. Gathering on the dusty football field of Kenzou, near the police station, they waited for a chance to be interviewed by UNHCR staff. They waited for days, sometimes weeks, before they finally managed to access the small plastic tables where UNHCR clerks classified them based on their names, sex, age, place of birth, date of arrival, marital status, size of their household, etc.1 After the long hours of waiting in the heat of the football field, the registration process was relatively brief and smooth. Nevertheless, the atmosphere at the plastic tables was tense. People argued and at times yelled at each other, sometimes to the point that police forces intervened and interrupted the process. This was not just because the new arrivals were exhausted after having been harassed by rebels, custom officers, and gendarmes; rather, after the long journey from places as far away as Carnot, Berberati, and Nando, they understood that the few minutes spent with the registration clerk would determine which category they would be assigned to and would shape the next chapter of their life. They knew that classifications matter. This chapter explores how the notion of “needs” has diffused through the work of UNHCR in Central Africa. After decolonization, UNHCR expanded its action way beyond its original mandate – beyond the borders of Europe and beyond the boundaries of the 1951 Refugee Convention. Since the 1960s, international refugee aid has become increasingly stratified. International organizations have specialized, rationalized, and individualized intervention, as well as resource allocation. Access to international aid has been broadened, but aid itself has become tailored for specific groups. The notion of “needs” has diffused as a common denominator for different types of intervention. Refugee classification is an emblematic illustration of this evolution, and points to Pierre Bourdieu’s insight that life chances are not only shaped by “class struggles” but also by “classification struggles.”2 Refugee classifications determine who qualifies for protection under international law, as well as the quality of the relief aid. Access to refugee camps, tents, food rations, and basic items depends on the categories attached to a refugee’s name in UNHCR databanks, identity documents, and ration cards. Refugee status, family size, special needs: Categories

Classifications: UNHCR and the legibility of refugees in Central Africa 69 shape a refugee’s chances, opportunities, and constraints in life. They are important not only for the refugees themselves, but for the system of protection as a whole. Needs assessment, program planning, and resource allocation are all based on refugee classifications. The same categories (“refugee,” “single head of household,” “T4,”3 etc.) inform interactions between aid beneficiaries and aid workers, aid workers and headquarters, headquarters and donors. They tie together actions, persons, and places, thus making collective action possible. They link the micro-level of refugee registration in the field to the macro-level of UNHCR global policy. Yet classifications are poorly understood. Most of the time, we simply overlook them. We use refugee classifications to describe the world, assuming that they are as natural and universal as the world itself. We look at reality through the lens of UNHCR, without even noticing that we are doing so. Refugee classifications are a black box of humanitarian aid: They play a key role in the entire process, but they function virtually automatically and are barely questioned.4 They are so ubiquitous in the protection sector that it is almost impossible not to rely on them. Refugee statistics are a good example: The 189,802 refugees mentioned in the opening sentence of this chapter is an aggregated figure based on classifications provided by UNHCR in Kenzou and other similar towns in the African rainforest.5 There are good reasons for this, of course. Protection clerks do not have the luxury of engaging with ontological questions. When registering refugees, they do not usually question classifications. This does not mean that they are naive about their tools. I met a Cameroonian protection clerk, Alain,6 who, as a sharp observer and member of the same vernacular group as the refugees he was helping, could hold forth for hours about the sophisticated social distinctions of Fulani society. Yet, as an UNHCR staff member and lawyer, he applied the narrow categories of refugee protection in his work. Aid workers do not question the nature of refugee classifications while addressing their needs any more than a pediatrician questions the nature of thermometers while examining a sick child. The same is true when institutional partners (United Nations agencies, ministry officials, NGOs, etc.)7 meet in headquarters, or when UNHCR staff in Geneva aggregate statistical data. Aid workers tend to take social categories for granted, as do consultants, journalists, social scientists, and historians. There is a notable exception to this rule: Namely, critical anthropologists and those they have inspired. In the last 30 years, these scholars have studied categories as social constructions. Barbara Harrell-Bond has argued that the concept of refugee is “an artificial category maintained more for the convenience of donors than for the people involved.”8 Gérard Noiriel has shown that the category of refugee has its historical roots in the localized context of the French Revolution,9 while Liisa Mallki has revealed how, since the Second World War, refugee studies have essentialized it.10 Yet, even more importantly, anthropologists have shown that refugees themselves have challenged refugee classifications. While classifications may shape refugees’ subjectivities, this happens through a dynamic process of criticism, adaptation, and rejection.11 Far from passively waiting to be labeled, refugees try

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to make the most of classifications. They adapt their testimony, borrow identity documents, and accumulate ration cards. In Kenzou, some refugees sought, and many obtained, the protection of two different international institutions at the same time, UNHCR and the International Organization for Migration – a double classification that is theoretically impossible under international law.12 Critical anthropology has taken a decisive step towards a better understanding of refugee classification. However, in some cases, the critical analysis loses sight of historical contingencies. The structural critic attempts to uncover power relations hidden behind classification regimes, but misses the historicity of refugee protection. There is a tendency in the critical literature to reduce classification to domination.13 This criticism has been instrumental in denaturalizing refugee classifications. However, it is necessary to go further to grasp the different rationalities at work here. James Scott’s notion of “legibility” is useful in this regard. In Scott’s view, a central problem of the modern state is that it arranges populations in order to simplify state functions such as taxation and conscription.14 Scott focuses attention on categories, formats, processes of standardization, and rationalization. Similarly, this chapter focuses on the ways UNHCR arranges populations according to its mandate to protect, and on how UNHCR expertise translates multiple complex and illegible local claims into standard categories that can be recorded, compared, and used. Refugee classifications are like abridged maps of societies, representing the slices of reality that are of interest to international institutions. However, refugee classifications are more than just maps; they shape reality, have juridical and material consequences, and mediate between discourses and everyday actions. In the previous chapter, we explored three different traditions of thinking about needs (from political economy, health studies, and legal studies). In this chapter, we will see that the classification of refugees echoes these different traditions, while not simply mirroring them. The logic of humanitarian practice, it is argued, does not simply follow the logic of knowledge, but it also reacts to concrete situations. UNHCR’s classifications thus articulate different ways of making societies legible, different “modes of ordering”:15 a legal approach, a labor or developmental approach, and a vulnerability approach. These modes of ordering have a lot in common: They claim to be universally applicable, non-political, and to limit the arbitrariness of state sovereignty. They claim to be objective, in the sense of making it possible to take action towards establishing norms, standards, and categories that do not depend on who applies them. They are based on categories that enable quantification and evaluation (i.e. number of refugees, hours worked, items distributed, etc.). Moreover, they all make a clear distinction between the protectors and the protected.16 However, these three modes of ordering refer to different terminologies, actors, methods, and subjectivities. They emerged from different rationales, problems, and places. They cannot all be traced back to a single explanatory principle, “in last instance” whether it be ‘“neocolonialism,” “neoliberalism,” “sovereignty,” or “biopower.”17 There is no essence to refugee assistance, no single unifying logic of classification. Although they are distinct from one another, the three modes of

Classifications: UNHCR and the legibility of refugees in Central Africa 71 ordering do not constitute homogeneous domains. Rather, they constitute different modes of ordering refugees’ problems, various ways of articulating principles, practices, and people. They form specific knowledge about refugees, about how they behave and how to relate to them.18 They stand for different ways in which international organizations connect the “problem of refugees” at the global level with the specific fate of individuals. Let us consider the classification table included in the most well-known UNHCR manual, the Handbook for Emergencies (see Figure 2.1). At first glance, the table is a coherent grid of categories. To use Scott’s terminology, this classification makes complex emergencies legible. The terminology used in the table is consistent with the advice set forth in the Handbook’s almost 600 pages, suggesting “universal standards” to address the “global problem of refugees” on a “worldwide” scale. A second look, however, reveals different modes of ordering those in need of protection: There are legal categories (“asylum seeker,” “IDP,” “refugee,” etc.), professional categories (“student,” “miner,” “nurse,” “weaver,” etc.), categories of vulnerability (“disabled,” “blind,” “deaf,” etc.), and hybrid categories (“traditional leader,” “traditional healer,” “unaccompanied elder,” “woman at risk,” etc.). This classification system, in a document meant to guide daily practices, is the result of more than 50 years of UNHCR experience. It is the sedimentation of various layers of history. Consequently, its historicity deserves greater attention.

From migrants to refugees: Ordering through law Refugee protection was initially considered a task for lawyers. Protecting refugees meant giving legal assistance. When UNHCR was established in 1951, its mandate was to advocate international refugee law. UNHCR provided juridical advice not humanitarian relief. UNHCR staff identified refugees, distributed travel documents, assisted refugees in obtaining legal statuses provided by states, advocated for their rights, and pushed for the normalization of these procedures.19 Originally, UNHCR was also limited to protecting European displaced persons. However, by the late 1950s, the number of refugees fleeing from the aftermath of the Second World War and from the Soviet bloc had decreased. There was little left for UNHCR to do in Europe, and all of the major crises were now happening outside its jurisdiction. In Africa, several thousand people were on the run, yet they were not refugees in the UNHCR sense, since the 1951 Convention relating to the status of refugees restricted the definition of refugees to European refugees fleeing from events that occurred before 1951. Africans fleeing from colonial domination were not considered refugees, nor were those fleeing the aftermath of independence. As a result, during the 1960s and 1970s, UNHCR pushed for the expansion of refugee law. Africa, of course, had a long history of displacement. Forced migration was a banal reality in pre-colonial African societies:20 in the nineteenth century, it had been fueled by the European slave trade on the Atlantic coast, the Fulani Jihad in Northern Nigeria, Sudanese warriors’ raids in the Lake Chad area, and Zulu expansion in South Africa, while in the twentieth century, people fled from

Figure 2.1 A classification code used by UNHCR. Source: Sample codes from UNHCR, Handbook for Emergencies, 2007 (3rd edition), p. 175

Classifications: UNHCR and the legibility of refugees in Central Africa 73 imperial conquest, colonial repression, army conscription, forced labor, epidemics, and famines.21 Massive as they were, these displacements were not viewed through the lens of refugee law. Colonial administrators considered migrants a threat to their authority. They complained about “detribalization,” “floating populations,” and “vagabonds.”22 They described migration as pathology.23 Conversely, critics of colonialism considered displacement a sign of colonial brutality. A talented journalist like Albert Londres was able to write powerful pages about forced migration without mentioning refugees. He described the permanent “exodus” produced by colonialism: “2.6 million Blacks from French West Africa, and many hundreds of thousands from French Equatorial Africa left the French territory.”24 But he did not consider them refugees as defined by international law. Not much had changed by the early 1950s. The 1951 Refugee Convention did not apply to the situation in Africa, so UNHCR sought other ways to intervene. The High Commissioner argued that UNHCR statutes were broader than the Convention’s definition, since the latter related to refugees as individuals, while the statutes related to “groups and categories of refugees.” He pushed the idea of “good offices,” according to which UNHCR could provide material assistance to persons beyond the Convention’s definition.25 In 1961, this procedure was formalized in a Resolution of the United Nations General Assembly.26 A precondition was that states wanting help from UNHCR were expressly required to lend their “good offices.” Soon after gaining independence, the heads of states of Burundi and Congo engaged in this procedure. For UNHCR, the situation in the Great Lakes region was illegible (in Scott’s sense of the term), not only because the agency lacked regional experience and had no staff from Africa itself,27 but also because the mass displacements in the area were embedded in a large and complex concentric movement of labor migrants, farmers, and seasonal workers.28 All of the countries in the region had received several thousand migrants. Around 14% of the population of RuandaUrundi was living in neighboring countries. In some parts of Uganda, foreigners represented more than a quarter of the population. Around 500,000 Rwandans and Burundians lived in Uganda, and another 155,000 in Tanganyika.29 UNHCR considered it too difficult to undertake individual assessments in the region. As a result, it introduced the notion of prima facie refugees, a way to assist refugees through “good offices” without normal determination procedures, and without providing full legal protection. Thus, it created a specific category of refugees for non-Europeans, a distinction that the High Commissioner fully accepted: The “old refugees” in Europe had needed legal protection, while the “new refugees” in the “Third World” primarily needed “material assistance.”30 In this way, the juridical category of prima facie refugee distinguished African refugees from European refugees. Parallel to this, attempts were made to broaden the scope of the 1951 Refugee Convention. In 1967, states agreed on a protocol relating to the status of refugees that removed the words “as a result of events occurring before 1 January 1951” from the definition of refugee, so that non-European refugees could also benefit

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from the Convention. However, UNHCR still considered refugees in Africa to be “too numerous, dispersed and poor to make individual assessments necessary for Convention refugee designation” and continued to apply prima facie and “good offices” procedures in the region.31 African heads of states organized a response. They believed that the 1951 Refugee Convention was based on European values and felt the need for a regional instrument. The 1951 definition of refugee was in fact a product of the European tradition, emphasizing political and civil rights over cultural, economic, and social rights.32 The 1951 Convention defined refugees as persons fleeing due to legitimate fears of persecution, by which they meant “reasons of race, religion, nationality, membership of a particular social group or political opinion.”33 The list excluded disease, poverty, natural catastrophe, civil unrest, war, or state collapse as entitling individuals for refugee status. Political and civil oppression were seen as a legitimate reason for flight, while material deprivation, drought, and hunger were not.34 In 1969, the Assembly of Heads of State and Government, the highest organ of the Organization of the African Union (OAU), adopted a new convention specifically for refugee problems in Africa. The first article of the 1969 OAU Convention replicated the definition of refugee of the 1951 Convention in terms of indicating political and civil forms of persecution as reasons for flight. However, Article 2 broadened the notion of refugee to also include “every person who, owing to external aggression, occupation, foreign domination or events seriously disturbing public order (. . .) is compelled to leave his place of habitual residence in order to seek refuge in another place outside his country of origin or nationality.” This new definition expressly incorporated generalized violence as a cause for flight.35 Some 20 years after the creation of UNHCR, international refugee law remained the dominant mode for ordering refugees. International law began by distinguishing refugees from the larger groups of migrants and then multiplied the categories of protection. Some refugees were recognized by national state law, others were refugees under the 1951 Convention or under the 1969 OAU Convention, and still others were considered prima facie refugees under the UNHCR Statute (“mandate refugees”). In the words of Jennifer Hyndman, this created an “uneven geography of refugee definitions in international law.”36 Not only did “refugee” encompass several definitions, but a number of other legal categories also competed to include displacement under international and national law: Internally displaced persons (IDPs), asylum seekers, detainees, stateless persons, evicted persons, illegal migrants, war victims, evacuees, expellees, repatriates, returnees, and so forth. Of course, people on the run might qualify for several different juridical statuses in succession. For example, being forced to flee from home while remaining in the same country may make one an IDP, continuing to flee into a neighboring country thus makes one an asylum seeker; there, one may be first recognized as a mandate refugee and later as a refugee according to the 1969 OAU Convention, and so on. The prism of law made forced displacement representable, but it also created distinctions within the apparatus of protection.

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From refugees to farmers: Ordering through work During the 1970s and 1980s, the UNHCR approach became enriched by new ways of thinking. Notions like work, development, and economic integration came to play a larger role in the framing of aid programs. This is not to say that these notions did not play a role before this period, but rather that their impact on programs then started to grow rapidly. The conventional distinction between “protection” (understood as a legal task) and “solutions” (understood as longerterm, socially embedded projects) began to blur. While some UNHCR staff continued to uphold a narrow definition of protection limited to legal tasks (such as granting residence permits, travel documents, or legal protection against arbitrary arrest; helping individuals become naturalized, etc.), others reframed protection based on the notion of development: The UNHCR Legal Protection division spoke of legal rights, while experts in the Assistance division spoke increasingly of “material assistance,” “local integration,” and “zonal development.”37 The notion of work was particularly important for Central African programs, above all since international refugee law had revealed its limits in nonEuropean contexts. Thanks to the notion of “good offices,” UNHCR could justify its African programs to the Executive Committee and General Assembly, thus bypassing the 1951 definition of refugee.38 UNHCR argued that material aid was instrumental in convincing African regimes to accept refugees. This line of argumentation linked “material assistance” to “protection,” implying that African states would accept refugees within their territories, while UNHCR and Western donors would provide assistance. United Nations High Commissioner for Refugees Sadruddin Aga Khan argued that material assistance would “encourage a generous asylum policy.”39 Of course, this was a double-edged sword: African states quickly made their willingness to protect refugees conditional upon aid from the international community – that is, unless UNHCR and donor states were willing to pay for material aid, the African states would not tolerate refugees.40 Taking into account the notions of “work” and “development,” however, was not just about expanding access. A second advantage was that it gave UNHCR an idiom for addressing postcolonial African states. In the first decades after independence, there was much talk about economic growth and labor mobilization. African leaders made a tremendous effort to mobilize rural labor because they lacked the financial means to construct new infrastructure and provide services. Various forms of labor mobilization flourished: Harambee in Kenya, salongo in Zaire, bega kwa bega in Tanzania, “travaux de development communautaires” in Burundi, umuganda in Rwanda, and so forth. Since capital and technology were scarce, high-intensity labor was seen as a gateway to development. Obligatory and unpaid work was a recurrent feature in development programs in rural Africa. In Burundi, every adult was obliged to engage in community work every Saturday from 7 a.m. to 12 p.m. This free workforce was used to build and maintain roads, railways, schools, community centers, and irrigated fields. Labor was thought to be abundant, and “nation building” was given priority. As a result, even though

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labor mobilization was ambiguously related to the detested colonial compulsory labor, it became standard in nationalist toolboxes.41 African leaders were not alone in talking about work and development – all of their partners did, too. United Nations agencies such as Food and Agriculture Organization (FAO), United Nations Development Programme (UNDP), and the World Bank all had concepts of development and labor.42 By using similar language regarding work, UNHCR was able to align its interests with those of bigger and more powerful international organizations. One source of inspiration was the expertise on migration of the International Labour Organization.43 Labor migration “was becoming the focus of concern that forced labor had once been.”44 Migration was seen as causing moral decay, disrupting family life, destroying “tribal” social structure, reducing moral support for workers, and so on. UN experts saw the mobility of labor in Africa as “abnormal” and disruptive of rural communities. They envisioned labor stabilization as a precondition for improved social security. Stabilization became a consensus among international organizations.45 ILO experts encouraged village planning, family housing, social services, and the improvement of rural living conditions – topics that were all familiar to UNHCR. UNHCR experts realigned their “protection” agenda with the interests of postcolonial developmentalism. This had the undertone of a moral project linking protection to work ethic: “Material assistance,” deputy High Commissioner Prince Sadruddin Aga Khan wrote, “is meaningful only when the recipients feel they are working hard and trying to establish themselves.”46 At times, this vision was backed by optimistic faith in modernization and economic growth. “The international effort for assistance to refugees,” declared United Nations High Commissioner for Refugees Felix Schnyder, “could be regarded as a useful element in the field of international development aid.”47 Refugees were seen not as a challenge for humanitarian aid, but as an opportunity for growth. According to one expert, “the presence of refugees can act as a catalyst for overall planning and development. Their arrival in a neighboring country can serve as a stimulus for programs, sponsored and staffed by Africans and non-Africans alike, that strengthen and advance rural development.”48 UNHCR consultants resurrected an old notion that had been used for Asia Minor refugees in Greece (1922), and in India and Pakistan (1948): The notion of “refugee settlements.” The plan was to integrate refugees in their host country. UNHCR linked the 50-year-old concept to trendy ILO terminology and to the World Bank concept of “integrated rural development land settlement schemes,” as well as to the “new land settlement” ideas of USAID, and opened its first African rural settlement for Rwandans seeking refuge in Zaire in Bibwe in 1962 (Kivu).49 The rural camps were based on agricultural activities and aimed for “self-sufficiency.” The programs included irrigation and drainage, as well as the building of roads, accommodation, schools, and vocational centers. “Rural settlements schemes” were seen not only as a solution for arriving refugees, but also as potential catalysts for rural development as a whole. One of the first reports on refugee settlement stated, “The new settlements would thus become the centers

Classifications: UNHCR and the legibility of refugees in Central Africa 77 of development for the whole area.”50 In other words, it was thought that refugee settlements would contribute to economic planning. The strategy of “zonal development” was implemented in Zaire, Burundi, and Uganda, under cooperative agreements between UNHCR, ILO, FAO, and UNDP.51 Where UNHCR had once provided refugees with travel documents and legal advice, it now gave them tools and seeds. As the number of refugees in the Central African region grew steadily, the importance of material assistance also rose. Between 1959 and 1966, some 200,000 Rwandans fled to Uganda, Burundi, and Zaire. In 1980, there were 500,000 Rwandans in Uganda and somewhere between 800,000 and 1.4 million in Zaire.52 The 1966 military coup and the 1972 pogroms against the Hutu in Burundi also produced thousands of Burundi refugees, who fled to Zaire, Tanzania, and Rwanda. In 1973–1974, thousands of Tanzanians fled the authoritarian Ujamaa collectives. As a result: “In every year from 1967 through 1973, African countries received more than half of all international refugee aid.”53 In the mid-1980s, almost all UNHCR money was spent on material assistance. From 1961 to 1982, UNHCR opened 107 settlements in Africa, assisting a total of 940,000 refugees.54 Rural settlements had become the cornerstone of UNHCR policy regarding African refugees. A report noted: “It is in Africa that the major part of UNHCR’s refugee problems are now to be found, and settlement in a rural environment is still the main solution to those problems.”55 In the 1980s, 96% of the 111 organized refugee settlements in the world were in Africa.56 Both international conferences on Assistance to Refugees in Africa held in Geneva at the time – ICARA I in 1981 and ICARA II in 1984 – reaffirmed the role of local integration and the relevance of organized settlements. Looking at the question of refugees through the prism of work gave UNHCR a new way to grasp the issue.57 It translated a juridical and political problem (“protection”) into an economic and social question (“self-sufficiency” and “integration”). The link between refugee aid and labor consisted of a range of concrete tasks for refugees (draining marshland, cultivating arable land, constructing community centers and water supplies, building roads, etc.). However, it also exposed UNHCR to new kinds of criticism. UNHCR experts could not hide behind legal determination and identification procedures; they had to engage in discussions about comparative soil quality, culture rotation, chemical fertilizers, poor harvests, and tractors breaking down. Critics doubted the economic viability of refugee settlements. Unsurprisingly, UNHCR assessed its own settlement policy positively.58 But the settlements experienced the same problems as other rural development projects: Climate challenges, inconsistent soil fertility, and lack of technology. In various cases, planning experts incorrectly estimated the adequacy of water resources or the quality of the soil. Early criticism focused on the question of “dependency.” In the eyes of some observers, UNHCR settlements not only failed to make refugees “self-sufficient” but actually made them dependent on relief aid.59 Famously, anthropologist Barbara Harrell-Bond accused UNHCR of fueling the “dependency syndrome” of refugees.60

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A second criticism targeted the obsession with control in the settlements. Refugee settlements often looked like closed camps, limiting their occupants’ departures and mobility.61 UNHCR settlement policy resonated with both Western governments’ will to contain African refugees and African states’ policies of monitoring foreign populations. Some studies argued that refugees living outside the camps were better off than those inside them.62 Refugees, when they could, avoided living in camps.63 A third criticism was pointed at the political imagination of UNHCR. Rural settlement programs were accused of enforcing a sedentary view of societies that aimed for territorial permanence of populations at any price. For critics, refugee settlements seemed to be more about transforming migrants into farmers, townspeople into villagers, and groups of refugees into “communities” than about protecting refugees. However, the prism of work gave rise to a new mode of classification. An entire new class of people now qualified for inclusion in UNHCR programs: The “host population.” This category was part of “rural settlement schemes,” “regional approaches,” and “zonal development programs” that emphasized the interests of local populations.64 UNHCR activities were no longer just about refugees and returnees, but now also considered peasants and their neighbors. A new terminology had emerged that informed program planning and resource allocation: The terminology of productivity and development and of refugees’ ability to become settlers.65 The best possible refugee for a “rural settlement” program was young and able, had farming experience, and was willing to contribute to voluntary community work. The elderly, children, and persons with disabilities were not the only ones considered more difficult to integrate, so too were bureaucrats, students, and pastoralists, who were often described as unable or unwilling to adapt to farming. A conceptual opposition took shape, between “rural refugee” (poorer and less educated, but more malleable and sedentary)66 and “urban refugees” (more educated, mobile, living in a more expensive environment, and more likely to be politicized).67 This opposition still informs many work-related projects today (for instance “food for work” projects and “income generating activities”). The approach through law, legal protection, and citizenship was complemented by an approach through work, living standards, and communities.

From refugees to patients: Ordering through vulnerability During the 1980s and 1990s, health specialists became increasingly involved in UNHCR. The agency included not only lawyers and clerks, but also epidemiologists, pediatricians, and nutritionists. Refugee societies were reframed through the prism of needs. People were classified not only according to their legal status but also according to their vulnerability. Although UNHCR made a formal distinction between “material assistance” and “protection,” it became increasingly accepted that meeting refugees’ immediate needs was an integral part of protection.68 This was a conceptual shift: Old words gained new meaning. “Basic needs,” for example, was not a new term in the UNHCR vocabulary. But reports from the

Classifications: UNHCR and the legibility of refugees in Central Africa 79 1960s and early 1970s referred to “basic needs” as being met by lawyers – through the procedure of asylum, for example.69 Reports from the 1980s talked about “basic needs” with respect to rural labor in rural settlements and as a criticism of macroeconomic approaches; “basic needs” were a tool to combat poverty.70 By the 1990s, “basic needs” referred to the task of “care and maintenance assistance.”71 Today, the same notion refers to minimum standards for aid, as defined by a broad range of experts in the areas of health, nutrition, education, shelter, water, sanitation, and hygiene.72 Basic needs are now associated with immediate, life-saving services in emergency situations. This also represented a material shift. Care and maintenance activities now use up the bulk of UNHCR funding for Africa.73 The evolution of refugee camps was emblematic for the emergence of a “relief model.” Unlike settlements in the 1970s and 1980s, which were based on agricultural work and aimed to push foreign laborers towards local integration, the relief camps of the 1990s and 2000s were like hospitals, treating refugees as patients. Camps tended to be internationally managed and funded, and administrated separately from the surrounding population.74 They relied increasingly on relief handouts and food distribution, and less on subsistence farming. Camps became places of population management, medical intervention, and epidemiological analysis. As a result, they have sometimes been referred to as “bio-political” sites of intervention.75 Unlike the refugee settlements that gave refugees an opportunity to acquire land and earn a living, the new camps were sites of emergency relief and control. The concept of needs emerged in a dual context. First, there was a change in asylum policies. For the first two decades or so following Independences, African asylum policies were relatively generous. The 1969 OAU Convention established a liberal definition of refugees and made non-refoulement a norm.76 During this period, refugees were rarely rejected at the border or forcibly returned to countries where they faced persecution. Many refugees benefited from a range of legal, social, and economic rights in African states; they were offered land to settle and, in some cases, could hope to become naturalized.77 In the 1980s, however, this “open-door” policy ended. Economic growth slowed or reversed, structural adjustment programs cut public spending, official development assistance declined, and Western powers introduced harsher asylum policies to prevent refugees from going to Europe and the USA. The implicit deal between African states and the international community – generous asylum policies in exchange for material support – was broken. African states became increasingly reluctant to welcome refugees and repatriated them at the earliest opportunity.78 The second development was a rising number of refugees. In 1970, there were 1 million refugees in Africa; by 1990, this figure stood at more than 6 million. The magnitude and rapidity of flight had changed. The numbers peaked in the aftermath of the Rwandan genocide.79 Between 14 and 18 July 1994, around 850,000 Rwandans crossed the border to Zaire.80 In the following two months, some 3 million Rwandans fled to Tanzania and Zaire.81 The UNHCR described it as the fastest exodus it had ever witnessed.82 Following this crisis, several African countries closed their borders. Instead of offering external protection, these states

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pushed for keeping escapees in “safe areas” or “safe zones” within their countries of origin. In 1996, Zaire closed its borders to Burundi refugees, and Tanzania required all Rwandan refugees to leave.83 The number of internally displaced persons grew quickly. The UNHCR refocused its aid on emergency relief. While it did not stop addressing rights and work issues, it increasingly set standards for urgent aid. First, it turned to food rations, logistics, water and sanitation, shelter, latrine seats, and refuse bins.84 UNHCR codified emergency norms and guidelines, accumulated emergency stockpiles in Copenhagen and Dubai, and delivered tents, blankets, and jerry-cans to millions of refugees in dozens of countries. The delivery of basic needs and essential services now absorbs more than half (56%) of the UNHCR budget.85 Focusing on emergency relief gave UNHCR new opportunities. Just as the prism of work enabled the agency to address host populations and communities, the prism of needs helped it rethink the targets of its aid. Instead of devoting itself solely to refugees, it now also attended to “people of concern,” including registered refugees as well as internally displaced persons (IDPs), expellees, or returnees. In 2015, UNHCR has declared 11 million “people of concern,”86 only one-third of whom are refugees or asylum seekers. By expanding its original mandate and activities, the organization established itself as the “lead agency” in humanitarian catastrophes,87 managing an archipelago of thousands of camps.88 UNHCR reframed refugee protection as the “global governance” of people in need,89 offering care and support not only to refugees but also to “hungry, homeless and poor people worldwide.”90 Most of the vocabulary regarding needs was borrowed from other UN agencies (such as the World Food Programme, World Health Organization, and UNICEF) and humanitarian NGOs. The International Committee of the Red Cross (ICRC) has a long tradition of humanitarian law, which makes it possible to address the question of war victims. The 1949 Geneva Convention distinguishes “combatants” from “non-combatants” and offers a classification of vulnerable people that goes beyond “refugees.” More importantly, NGOs such as Oxfam, Save the Children, and MSF have all developed tools to prioritize the medical needs of aid recipients.91 Unlike conventional UNHCR “screening” of refugees, which seeks to determine people’s legal status, the logic of “triage” used by humanitarian organizations compares bodies and types of pain in order to establish medical priorities.92 Due to the scarcity of resources, UNHCR learned to classify individuals based on the priorities used in medicine. New criteria for action were adopted, based on epidemiology and demographics. “Protection” and “assistance” now integrated indicators such as mortality rates, nutritional status, and morbidity, as well as specific attention to high mortality diseases like cholera. Unlike the conventional approach to protection, which targeted refugees, the humanitarian approach now targeted “humans.”93 Cooperation between UNHCR and medical NGOs fostered the discourse on “global health.” This new perspective once again exposed the agency to new criticism. The relief model was accused of being short-sighted. Relief aid in camps has been

Classifications: UNHCR and the legibility of refugees in Central Africa 81 criticized from an epidemiological perspective,94 but also for its blindness to political side effects. Refugee camps have been accused of restricting refugees’ freedom of movement, favouring undemocratic modes of governance, reducing refugee participation, and ultimately endangering protection. Refugee camps have been the target of military attacks (Burundian camps in Tanzania and Sudanese camps in Chad, for example, have been attacked on several occasions) and the site of various forms of violence (from coercion to crime, including domestic violence, armed robbery, forced conscription, sexual violence, arbitrary arrest, etc.).95 As a result, camps have become emblematic of biomedical migration control.96 To underscore the dehumanizing effects of refugee relief, scholars have compared camps to prisons, psychiatric institutions, and even concentration camps.97 However, UNHCR has increasingly embraced the classification of people according to their vulnerabilities.98 UNHCR activities have been reoriented to address “people with disabilities,” “chronically ill persons,” “unaccompanied children,” “the elderly,” “teenage mothers,” “single heads of household,” “caregivers,” “survivors of rape,” and so on. Beyond merely designating target groups, these categories have also become statistical categories.99

Conclusion Humanitarian organizations are “inveterate classifiers”:100 not only do they distinguish between people who are included in their categories and those who are not, but they also stratify each group along a sliding scale of needs. Since humanitarian stakeholders often present “protection” as a unified field of intervention, the plurality of the types of logic involved tend to be overlooked. This idealistic vision is reinforced by the fact that the same word, “protection,” is used to refer to an idea (the moral impetus of treating refugees with decency), a body of legal procedures (framed by international refugee law), and specific institutional boundaries (the UNHCR Division of International Protection, “protection officers,” “protection assistants,” “protection clerks,” etc.). This is why the history of refugee protection tends to be written in linear terms, with ups and downs, moments of progress and crisis, and potential and missed opportunities. The conventional narrative presents protection as a cursor on a moral ladder; we follow the figures of “protected refugees” the same way traders follow market prices, anxiously watching stock charts. But refugee protection is not a one-dimensional process. Indeed, its success may be linked to the malleability of the notion. Paradoxically, the more UNHCR has come to reframe the question of migration through the prism of international refugee law, the more it has also engaged with other modes of ordering refugees. As this chapter shows, though current refugee classifications articulate different modes of ordering, each one has its own inherent logic, history, and materiality. The framework of international law was established for European refugees in the aftermath of the Second World War and had to be adapted to non-European settings. The framework of development and work emerged to enable engagement with African states and development organizations – UNDP, World Bank,

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ILO, etc. – after decolonization. Finally, the framework of needs and vulnerability became increasingly relevant as the number of refugees rose at the end of the twentieth century, since it allowed humanitarian actors – WFP, WHO, ICRC, MSF, Oxfam, etc. – to become involved. Each mode of ordering corresponded to an attempt to make a new situation legible and to engage with new partners. In James Scott’s study, the notion of “legibility” is backed by a second notion: “high modernism.” This term designates the ideology of the modern state and its uncritical self-confidence regarding scientific and technical progress, production, and rationality. According to Scott, high modernist planners share an uncritical optimism regarding comprehensive planning and the efficiency of social regimentation. At times, the literature on refugee camps (especially that which draws on Foucault’s notion of biopower or Agamben’s “naked life” terminology) tends to treat UNHCR planners as high modernists because of their taste for griddesigned camps, clear boundaries, and rigid order.101 However, Scott studied highly centralized and often authoritarian states such as Prussia, the Soviet Union, and socialist Tanzania – bodies that are light-years away from international organizations. The one characteristic UNHCR might be said to share with the modern states observed by Scott is the failure to consult the “people of concern” regarding classification mechanisms.102 However, UNHCR modes of action are not those of the modern centralized state, because UNHCR is neither a state nor centralized. With a staff/person-of-concern ratio of 1/5,020,103 UNHCR is a weak institution with a large mandate. It acts in a decentralized and fragmentary manner through a range of other actors: States of varying sizes and strength, UN agencies with different mandates, NGOs with diverse interests, refugee committees with varying representation, and so on.104 Its actions are not embedded in a unified and coherent vision of protection, but in a stratified world of asymmetrical cooperation and distinct solutions – in some situations, refugee assistance can take the form of an high modernist dystopia. In others however, it looks more like a baroque assemblage of successive historical layers.105 While the next chapter (Chapter 3) looks at a conventional indicator of “vulnerability,” we will come back later to the potential conflicts between different “modes of ordering” needs (see Chapters 5 and 6).

Notes 1 The UNHCR Handbook for Registration defines “refugee registration” as “the recording, verifying, and updating of information on persons of concern to UNHCR with the aim of protecting and documenting them and of implementing durable solutions” (UNHCR. Handbook for Registration. Geneva: UNHCR, 2003: 6). 2 Bourdieu, Pierre. La distinction: Critique sociale du jugement de gout. Paris: Les Editions de Minuit, 1979. 3 “T4” is for “Taille 4”: A household of four persons. 4 The notion of “black box” is borrowed from Latour, Bruno. La science en action. Introduction à la sociologie des sciences. Paris: La Découverte, 1989. 5 UNHCR. Regional update 46: Central African Republic situation: 27 December 2014–16 January 2015. The report counted a total 864,515 people of concern, 425,977 of which were refugees (including 189,802 new CAR refugees in neighboring countries since December 2013).

Classifications: UNHCR and the legibility of refugees in Central Africa 83 6 Name changed. 7 Among the organizations assisting refugees in Cameroon (besides state institutions such as the Ministry of Basic Education, Public Health, Social Affairs, etc.) were several UN agencies (IOM, UNICEF, UNFPA, UN Women, WHO, WFP) and many NGOs (including the French Action Contre la Faim, US-based Adventist Development and Relief Agency, Ethiopian Africa Humanitarian Action, Cameroonian Red Cross, French Red Cross, and the Swiss Branch of MSF). 8 Harrell-Bond, 1986: xvi. 9 Noiriel, Gérard. La tyrannie du national: Le droit d’asile en Europe (1793–1993). Paris: Calmann-Levy 1991. 10 Malkki, Liisa H. Refugees and exile: From ‘refugee studies’ to the national order of things. Annual Review of Anthropology 24 (1995): 495−523, here p. 496. 11 Fresia, Marion. Aide humanitaire et production de services publics en Afrique de l’Ouest: Le cas de la gestion des populations mauritanniennes réfugiées au Senégal. Buletin de l’APAD (2002): 23–34; Corbet, Alice. Les campements de réfugiés sahraouis en Algérie: De l’ideel au reel. Bulletin de l’Association des géographes français 83, no. 1 (2006): 9–21; Tallio, Virginie. La fabrique du réfugié: Du camp rapatriement, lieux et processus de la construction du ´réfugiés´: L’exemple des camps de réfugiés de Dadaab (Kenya) et de Nkondo (R.D.C.). Paris: Thèse EHESS, 2007; Inhetveen, Katharina. Die politische Ordnung des Flüchtlingslager: Akteure – Macht – Organisation: Eine Ethnographie im südlichen Afrika. Bielefeld: Transcript Verlag, 2010; Jaji, Rose. Social technology and Refugee encampment in Kenya. Journal of Refugee Studies 25, no. 2 (2011): 221–238; Turner, Simon. Politics of innocence: Hutu identity, conflict and camp life. New York: Berghahn Books, 2010; Jansen, Bram J. The accidental city: Violence, economy and humanitarianism in Kakuma refugee camp Kenya. PhD diss., Wageningen: Wageningen University, 2011. 12 The UNHCR assists refugees who are not protected by their state of origin, while the International Organization for Migration (IOM) assists migrants who are still protected by their state of origin. In Kenzou, IOM ran small camps for people who had fled from the Central African Republic, but with another nationality (i.e. they were neither Central African nor Cameroonian, but from Mali, Niger, Chad, etc.), and helped migrants return to their country of origin. However, since many people had lost their documents while fleeing and international migration is frequent in this context, it was not easy to determine which category applied. Several people at the registration desk in Kenzou attempted to obtain both statuses, because they did not yet know which would be the best option – to be a refugee or a migrant. Also, some Cameroonians applied for refugee status in Cameroon, arguing that they were from the Central African Republic. Refugee status would give them access to UNHCR aid. 13 Godding, Jean-Pierre. Refugees or hostages? Population movements in the Great Lakes region since 1990. Oxford Social Sciences Library, Unpublished Conference Paper, 1997. 14 Scott, James. Seeing like a state: How certain schemes to improve human condition have failed. New Haven: Yale University Press, 1999. 15 This typology is based on the reading of secondary sources as well as on UNHCR grey literature, including UNHCR Reports to the General Assembly and reports from UNHCR Archives, and especially Reports on Central Africa from Fonds 18/Records relating to Assistance/Sub-fonds 2: General technical services Series; UNHCR Headquarter Archives: Report on Central Africa from Fonds 11/Series 02 Classified Subject Files 1971–1984; and UNHCR Handbooks for Emergencies (1982, 2007). 16 This distinction between those who protect and those who are protected is illustrated by the omnipresence of ballistic metaphors in refugee protection (“target population,” “project impact,” etc.). 17 Harrell-Bond, 1986; Hyndman, 2000; Barnett, 2011; Agier, 2008; Scalettaris, 2013; Hammerstad, 2014. 18 Pols, Jeannette. Enforcing patient rights or improving care? The interference of two modes of doing good in mental health care. Sociology of Health & Illness 25, no. 3

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Classifications: UNHCR and the legibility of refugees in Central Africa (2003): 320–347. The “modes of ordering” explored in this chapter are not unlike the “regimes of truth” in Foucault’s (1979) sense, “modes of existence” in Latour’s (2012) sense, and “modes of doing good” (Boltanksi and Thévenot, 1991; Pols, 2003). Loescher, 2001; Barnett, 2011; Gatrell, 2013. Farmers practicing shifting cultivation, herders seeking fertile lands, merchants trading with the coast, etc. In the densely populated kingdoms of the Great Lakes region, demographic growth regularly triggered agricultural expansion. In lineage-based societies, when groups grew big, political organizations would splinter: A segment of the lineage would leave the settlement and establish a new compound, hamlet, or chieftaincy. Migration was entrenched in a “logic of schism,” itself fueled by low population density and the perceived abundance of land (Kopytoff, Igor (ed.) The internal African frontier: The making of African political culture. Bloomington: Indiana University Press 1987; Bayart, Jean- François, L’Etat en Afrique. La politique du ventre. Paris: Fayart 1989.). Cordell, Dennis D. and de Montclos, Marc-Antoine P. Des ‘réfugiés’ dans l’Afrique précoloniale? L’exemple de la Centrafrique: 1850–1910. Politique africaine 1, no. 85 (2002): 16–28; Guichaoua, André. Migrants, réfugiés et déplacés en Afrique centrale et orientale. In Exilés, réfugiés, déplacés en Afrique centrale et orientale. Paris: Karthala: 2004; Harms, Robert. River of wealth, river of sorrow: The central Zaire basin in the era of the slave and ivory trade: 1500–1891. New Haven: Yale University Press, 1981. A French administrator of Ubangi-Shari complained about the “massive exodus” from his circumscription. “Everyone,” he wrote, “abandons his tribe, his village, his family and plantations, goes to live in the bush like a hunted animal, to escape from recruiters.” See Administrative Report on Ubangi-Shari, 1902, quoted in Gide, Andre. Voyage au Congo: Carnets de route. Paris: Gallimard, 1927: 89–90. Colonial administrators attempted to control migration by grouping villages along roads, aggregating populations according to ethnic blocs, and establishing fixed territorial boundaries. Also, they often encamped migrant populations in mining camps in the copper belt of Katanga and Rhodesia, in concentration camps in Cameroon and Kenya, in medical camps in Congo, in disciplinary camps in Gabon, and so on (Asiwaju, Anthony I. (1976): Migrations as revolt: The example of the Ivory Coast and the Upper Volta before 1945. Journal of African history,17, 4, p. 577-594.; Bernault, Florence (ed.). Enfermement, prison et châtiments en Afrique du 19e siècle à nos jours. Paris: Karthala, 1999). Londres, Albert. Terre d’Ébène. Paris: Arlea, 2008 [1929]: 108, 218. The notion of “good office” was first used for Hong Kong in 1957 (Hyndman, 2001). Resolution 1673 (XVI) of the UN General Assembly on 18 December 1961. In 1961, the 80 professional UNHCR staff members were mainly British, French, and American, with little or no experience in Africa. There was no staff from Africa or Asia (Loescher, 2000: 109). Burundians spoke of “kurobera” (“disappearing for a moment”). Guichaoua, 2004: 112; Chrétien, Jean-Pierre. Des sédentaires devenus migrants, les motifs des departs des Burundais et des Rwandais vers l’Uganda (1920–1960). Culture et dévelopement 10, no. 1 (1978): 72–73; Chrétien, Jean-Pierre. L’Afrique des Grands Lacs. Deux mille ans d’histoire. Paris: Flammarion, 2000. “Now that the big assistance programmes for European refugees are nearing completion, legal protection, as defined and elaborated in the Statute of the High Commissioner’s Office, is on the way to becoming once more our main concern so far as these refugees are concerned. On the other hand, the problem raised by the new groups of refugees to which my attention was drawn some time ago, is essentially, at the moment, a problem of material assistance and not of legal protection.” Introductory statement by Mr. Felix Schnyder, United Nations High Commissioner for Refugees, to the Executive Committee of High Commissioner’s Programme, sixth session, Geneva, 6 November 1961. Statements by High Commissioner, 22 November 1961.

Classifications: UNHCR and the legibility of refugees in Central Africa 85 31 Holborn, Louise. Refugees: A problem of our time: The work of the United Nations high commissioner for Refugees, 1951–1972. Metuchen: Scarecrow Press, 1975. 32 Noiriel, 1991. 33 Convention Relating to the Status of Refugees, 1951, article 1. 34 Barnett, 2011; Hyndman, Jennifer. Change and challenge at UNHCR: A retrospective of the past fifty years. Refuge 19, no. 6 (2001): 45–53; Hathaway, James and Foster, Michelle. The law of refugee status. Cambridge: Cambridge University Press, 2014. 35 Rutinwa, 2002; Sharpe, Marina. The 1969 African refugee convention: Innovations, misconceptions, and omissions. McGill Law Journal 58, no. 1 (2012): 95–147; OkothObbo, George. Thirty years on: A legal review of the 1969 OAU Refugee Convention governing the specific aspects of refugee problems in Africa. Refugee Survey Quarterly 20, no. 1 (2001): 79; Bond Rankin, Micah. Extending the limits or narrowing the scope? Deconstructing the OAU refugee definition thirty years on: New Issue in Refugee Research. Working paper 113, 2005. 36 Hyndman, 2001: 48. 37 Loescher, Gil. The UNHCR and world politics: A Perilous path. Refugee Survey Quarterly 20, no. 3 (2000): 106–139. 38 Loescher, 2000. 39 Pitterman, Shelly. A comparative survey of two decades of international assistance to refugees in Africa. Africa Today 31, no. 1 (1984): 25–54, here p. 28. 40 Hyndman, 2001: 49; Rutinwa, Bonaventure. The end of asylum? The changing nature of refugee policies in Africa. Working paper 5, New Issues in Refugee Research, Geneva: UNHCR, 1999: 18. 41 Guichaoua, André. Les ‘travaux communautaires’ en Afrique centrale. Revue Tiers Monde (1991): 551–573; Cooper, 1996. 42 UNHCR. Report of the General Assembly, 25th session. Geneva: UNHCR, 1970. 43 International Labour Organization. Interterritorial migrations of Africans south of the Sahara. International Labour Review 76 (1957): 292–310. 44 Cooper, 1996: 218. 45 Cooper, 1996: 365. 46 Goetz, Nathaniel H. Towards self sufficiency and integration: An historical evaluation of assistance programmes for Rwandese refugees in Burundi: 1962–1965: New issues in Refugee research. Working paper 87, Geneva: UNHCR, 2003: 11. 47 Schnyder, Felix. Report on new Refugee situations. Submitted to the 7th session of Excom, UN Doc A/AC.96/158, 1962, quoted by Loescher, 2000: 121. 48 Matthews, Robert, O. Refugee and stability in Africa. International Organization 26, no. 1 (1972): 62–83, here p. 82. 49 In the 1960s, in the Central African region, UNHCR opened new settlements in Burundi (Kigamba, Kayongasi, Muramba, Mujera), the Central African Republic (Mboki, Mutara), Tanzania (Karagwe, Muyenzi, Mwesi, Rutamba, Lundo Muhukuru, Matekwe, Mputa, Katumba, Ulyankulu, Kigwa, Pangale), Zaire (Ihula, Bibwe, Kalonge, Mutambala, Amadi, Kypo, Kaniama), and Uganda (Oruchinga, Nakivale, Kahunge, Rwamwanja, Kyaka, Ibuga, Kyangwali, Agago). 50 UNHCR. Summary report on the refugee problem in the republic of Togo. HCR/RS/23IRev.1 Geneva: UNHCR, February 1962: 5. Quoted in Pitterman, 1984: 44. 51 Betts, Tristan F. Zonal rural development in Africa. Journal of Modern African Studies 7, no. 1 (1966): 149–153. 52 Guichaoua, 2004: 119–120. 53 Pitterman, 1984: 28. 54 Clark, Lance, Stein, Barry, and Gallagher, Dennis. Older refugee settlements in Africa: Final report. Washington, DC: Refugee Policy Group, 1985. 55 UNHCR, 1970: 1. 56 Clark, Stein, and Gallagher, 1985: 2. 57 UNHCR Archives/ Fonds 11/ Series 02/ 592 Assistance Specialist Support Unit Rural Settlements Planning and Evaluation 1984/198411.02.BOX.0908.

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58 “On the whole, the results obtained in the sphere of rural settlement in Africa are satisfactory, since the vast majority of the refugees have already been restored to living conditions which, in comparison with those of the local inhabitants themselves, are practically normal” (UNHCR, 1970: 2). 59 Harvey, Paul, and Lind, Jeremy. Dependency and humanitarian relief: A critical analysis: HPG Report 19. London: Humanitarian Policy Group and Overseas Development Institute (ODI), 2005. 60 Harrell-Bond, 1986: 151. 61 Clark, Stein, and Gallagher, 1985: 10. 62 Kok, Walter. Self-settled refugees and the socio-economic impact of their presence on Kassala, Eastern Sudan. Journal of Refugee Studies 2, no. 4 (1989): 419–440; Malkki, 1995; Van Damme, Wim. Do refugees belong in camps? Experiences from Goma and Guinea. The Lancet 346 (1995): 360–362; Hansen, Art. Angolan refugee displacement and settlement in Zaire and Zambia. In Transforming settlement in southern Africa. Edinburgh: Edinburgh University Press, 2001: 30–47. 63 Davis, John. The anthropology of suffering. Journal of Refugee Studies 5, no. 2 (1992): 149–161; Harrell-Bond, Barbara, and Voutira, Eftihia. Anthropology and the study of refugees. Anthropology Today 8, no. 4 (1992): 6–10; De Waal, Alexander. Famine crimes: Politics and the disaster relief industry in Africa. Oxford: Oxford University Press, 1997. In the mid-1980s Clark & Stein estimated that half of all African refugees were “spontaneously settled.” One-quarter lived in “relief or post-relief refugee camps” where they were dependent on food rations and other international assistance, and one-quarter lived in “organized settlements” (Clark, Stein, and Gallagher, 1985: 2). 64 For an early description of “zonal development,” see UNHCR Archives/Fonds 11/ Series 04 EA Kivu 1–2. Emergency assistance to refugees from Rwanda 1964–1966. 65 In refugee settlement surveys, for instance, particular attention was given to refugees’ agricultural and occupational background (the type of crops they had grown, agricultural systems they knew, etc.). See UNHCR. Planning rural settlements for Refugees: Some considerations and ideas. Geneva: UNHCR, 1979. 66 Hyndman, Jennifer, and Giles, Wenona. Waiting for what? The feminization of asylum in protracted situations. Gender, Place & Culture 18, no. 3 (2011): 361–379. Hyndman and Giles speak of the “feminization” of sedentary settled refugees who represent no threat, as compared to refugees or migrants “on the move.” 67 Refugees have to declare themselves “autonomous” or “self-sufficient” to become urban refugees in UNHCR terminology. From that point on, they forfeit all material assistance (except occasional assistance for the most “vulnerable” and medical assistance). 68 “Ensuring protection and providing humanitarian assistance are not two separate issues. Rather, humanitarian assistance is an integral part of protection and should be planned to ensure that the rights of refugees and others of concern are respected (right to life, right to adequate living conditions, protection of specific categories of people such as older persons, unaccompanied and separated children, single parents, survivors of SGBV etc.) and as part of a single emergency operation.” (UNHCR. Handbook for Emergencies, 3rd ed., Geneva: UNHCR, 2007: 11). 69 “The developments described in this chapter, like international protection itself, are in the main concerned with three basic needs of the refugee: To receive asylum; to be granted a satisfactory legal status in the reception country; and to be able to cease to be a refugee through voluntary repatriation or, if this is not possible in the foreseeable future, by the acquisition of the nationality of his country of residence” (UNHCR, 1970: 4). 70 On this notion of “basic needs” introduced by ILO and the World Bank, see Chapter 1. Bakhet, Omar. The basic needs approach (BNA) to self-sufficiency in rural refugee settlements. In Managing rural settlements for refugees in Africa: Proceedings of a workshop on the follow-up to Arusha recommendations on rural refugees in Africa. Dar es Salaam: UNHCR, 1981: 145–164.

Classifications: UNHCR and the legibility of refugees in Central Africa 87 71 UNHCR. Report to the general assembly: Official records forty-seventh session. Supplement No. 12A. New York: United Nations, 1992. 72 UNHCR. Report of the executive committee of the programme of the United Nations high commissioner for Refugees. Geneva: UNHCR, 2013: 38–42. 73 UNHCR, 2015: 91–92. 74 Crisp, Jeff. Forced displacement in Africa: Dimensions, difficulties and policy directions. New Issues in Refuge Research, Research Paper126. Geneva: UNHCR, 2006: 12. 75 Agier, 2002. For a critique of the term “biopolitics,” see Geissler, Paul Wenzel, Rottenburg, Richard, and Zenker, Julia. 21st century African biopolitics: Fuzzy fringes, cracks and undersides, neglected backwaters, and returning politics. In Rethinking biomedicine and governance in Africa: Contributions from anthropology. Bielefeld: Transcript Verlag, 2012: 7–19. 76 Crisp, 2006: 2. 77 Integration through work was considered a sustainable option. In countries like Tanzania or Uganda, many refugees could access the job market and even high positions in the civil and diplomatic services (Rutinwa, Bonaventura. The end of asylum? The changing nature of Refugee policies in Africa. Working paper 5, UNHCR New Issues in Refugee Research, 1999). The discourse on African solidarity against foreign oppression (especially for refugees fleeing wars of national liberation in Angola, Rhodesia, South Africa, South-West Africa, and Mozambique) contributed to the generous asylum policy. However, the “open-door” policy should not be idealized, as refugees were often required to remain in camps and, in some notable cases, refoulement and forced repatriation were practiced. 78 Rutinwa, 1999. 79 On the consequences of the humanitarian fiasco in Rwanda, see Chapter 4. 80 Borton, J. et al. Humanitarian aid and effects: The international response to conflict and genocide: Lessons from the Rwanda experience: Study 3 of the joint evaluation of emergency assistance to Rwanda. London: DANIDA/ODI, 1996: 13. 81 Mamdani, Mahmood. When victims become killers: Colonialism, nativism, and the genocide in Rwanda. Princeton: Princeton University Press, 2002; Lischer, Sarah K. Dangerous sanctuaries: Refugee camps, civil war, and the dilemmas of humanitarian aid. London: Cornell University Press, 2005; Banégas, Richard and Chrétien, Jean-Pierre. The recurring Great Lakes crisis: Identity, violence and power. London: Hurst, 2009; Lemarchand, René. The dynamics of violence in Central Africa. Philadelphia: University of Pennsylvania Press, 2009. 82 Rutinwa, 1999: 16. 83 Rutinwa, 1999. 84 UNHCR. Les réfugiés dans le monde. Cinquante ans d’action humanitaire. Geneva: UNHCR, 2000. 85 UNHCR, 2015: 83. 86 UNHCR, 2015. 87 There was a fierce competition for coordination of humanitarian activities. UNICEF, the World Food Programme, and the Office for the Coordination of Humanitarian Affairs (OCHA) were serious candidates for the role, but the influence of UNHCR was growing (Weiss, Thomas G. UNHCR should lead the international humanitarian enterprise. NIRA Paper, 2002). See also later, Chapters 5 and 6. 88 The UNHCR is present in every single country in Africa. It has offices in 449 locations in 123 countries worldwide. 89 UNHCR. Global trends 2010. Geneva: UNHCR, 2011. 90 Eggli, Ann Vibeke. Mass refugee influx and the limits of public international law, Vol. 6. The Hague, London, and New York: Martinus Nijhoff Publishers, 2002: 102. The UNHCR distributed kitchen sets to earthquake survivors in Haiti (2010), blankets to flood victims in Pakistan (2010), and tents to Typhoon escapees in the Philippines (2013) – its current activities go far beyond legal protection of refugees and even encompass material aid in natural disaster settings.

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91 Redfield, 2013; Scott-Smith, Tom. The fetishism of humanitarian objects and the management of malnutrition in emergencies. Third World Quarterly 34, no. 5 (2013): 913–928. 92 On the notion of “triage” (a mode of classification of patients according to priority), see Chapter 1. 93 Geissler, Paul W., Rottenburg, Richard, and Zenker, Julia. 21st century African biopolitics: Fuzzy fringes, cracks and undersides, neglected backwaters, and returning politics. In Rethinking biomedicine and governance in Africa: Contributions from anthropology, Geissler, Paul W., Rottenburg, Richard, and Zenker, Julia (eds.). Bielefeld: Transkript Verlag, 2012: 7–19, here p. 8. 94 Van Damme, 1995. 95 Crisp, 2006: 6. 96 A good example of the critical perspective on camps is given by Hyndman: “[Camps are] sites of neo-colonial power relations where refugees are countered, their movements monitored and mapped, their daily routines disciplined and routinized by the institutional machinery of refugee relief agencies” (Hyndman, Jennifer. Refugee Self-management and the Question of Governance. in: Refuge, 16(2): 1997, 16–22. Here p. 17). 97 Agamben, Giorgio. Homo Sacer. Sovereign Power and Bare Life. Stanford: Stanford University Press 1995; Agier, 2002. 98 On the difficulties of UNHCR to obtain a legitimacy in the production of statistics on vulnerability, see later, Chapter 6. 99 Tallio, 2007. In the early 1980s, Harrell-Bond criticized the notion of “vulnerability” on economic grounds. For her, “vulnerable” groups are all people who do not achieve economic autonomy “for whatever reason” (Harrell-Bond, 1986: xiv). Today, the critique of “vulnerability” is directed much more at biomedical criteria. See Chapters 5 and 6 for statistical categories. 100 Fourcade, Marion and Healy, Kieran. Classification situations: Life-chances in the neoliberal era. Accounting, Organizations and Society 38, no. 8 (2013): 559–572, here p. 562. 101 Godding, 1997; Weizman, Eyal. The least of all possible evils: Humanitarian violence from Adrendt to Gaza. London: Verso Books, 2011; Herz, Manuel (ed.). From camp to city: Refugee camps of the western Sahara. Zurich: Las Müller, 2012. 102 The silencing of victims has been well studied by anthropologists (Harrell-Bond, 1986; Malkki, 1995; Agier, 2002). 103 UNHCR, 2015. 104 For a conclusive description of the UNHCR’s decentralized bureaucracy, see Scalettaris, 2013. 105 For “high modernist” examples of refugee camps, see Herz, Manuel. Refugee camps or ideal cities in dust and dirt. Urban Transformation (2008): 276–289. For more other, much more nuances examples, see Inhetveen, 2014; Agier, 2010. For overviews, see Agier, Michel and Lecadet, Clara. Un monde de camps. Paris: La Découverte, 2014; Turner, Simon. What is a refugee camp? Explorations of the limits and effects of the camp. Journal of Refugee Studies 29, no. 2 (2016): 139–148.

References Agamben, Giorgio. Homo Sacer. Sovereign Power and Bare Life. Stanford: Stanford University Press 1995 Agier, Michel, and Lecadet, Clara (eds.). Un monde de camps. Paris: La Découverte, 2014. Asiwaju, Anthony I. (1976): Migrations as revolt: the example of the Ivory Coast and the Upper Volta before 1945. Journal of African history,17, 4, p. 577-594. Bakhet, Omar. The basic needs approach (BNA) to self-sufficiency in rural refugee settlements. In: Managing rural settlements for refugees in Africa. Proceedings of a workshop on the follow-up to

Classifications: UNHCR and the legibility of refugees in Central Africa 89 Arusha recommendations on rural refugees in Africa, 145–164. Dar es Salaam: UNHCR, 1981. Banégas, Richard, and Chrétien, Jean-Pierre. The recurring Great Lakes crisis: Identity, violence and power. London: Hurst, 2009. Bayart, Jean- François, L’Etat en Afrique. La politique du ventre. Paris: Fayart 1989. Bernault, Florence (ed.). Enfermement, prison et châtiments en Afrique du 19e siècle à nos jours. Paris: Karthala, 1999. Betts, Tristan F. Zonal rural development in Afrcia. Journal of Modern African Studies 7, no. 1 (1966): 149–153. Bond Rankin, Micah. Extending the limits or narrowing the scope? Deconstructing the OAU refugee definition thirty years on: New Issue in Refugee Research. Working Paper 113, 2005. Borton, J. et al. Humanitarian aid and effects: The international response to conflict and genocide: Lessons from the Rwanda experience: Study 3 of the joint evaluation of emergency assistance to Rwanda. London: DANIDA and ODI, 1996. Bourdieu, Pierre. La distinction: Critique sociale du jugement de gout. Paris: Les Editions de Minuit, 1979. Chrétien, Jean-Pierre. Des sédentaires devenus migrants, les motifs des departs des Burundais et des Rwandais vers l’Uganda (1920–1960). Culture et dévelopement 10, no. 1 (1978): 72–73. Chrétien, Jean-Pierre. L’Afrique des Grands Lacs. Paris: Deux mille ans d’histoire, Flammarion, 2000. Clark, Lance, Stein, Barry, and Gallagher, Dennis. Older refugee settlements in Africa: Final report. Washington, DC: Refugee Policy Group, 1985. Corbet, Alice. Les campements de réfugiés sahraouis en Algérie: de l’ideel au reel. Bulletin de l’Association des géographes français 83, no. 1 (2006): 9–21. Cordell, Dennis D., and de Montclos, Marc-Antoine P. Des ‘réfugiés’ dans l’Afrique précoloniale? L’exemple de la Centrafrique: 1850–1910. Politique africaine 1, no. 85 (2002): 16–28. Crisp, Jeff. Forced displacement in Africa: Dimensions, difficulties and policy directions. New Issues in Refuge Research, Research Paper126. Geneva: UNHCR, 2006. Davis, John. The anthropology of suffering. Journal of Refugee Studies 5, no. 2 (1992): 149–161. De Waal, Alexander. Famine crimes: Politics and the disaster relief industry in Africa. Oxford: Oxford University Press, 1997. Eggli, Ann Vibeke. Mass refugee influx and the limits of public international law, Vol. 6. The Hague, London, and New York: Martinus Nijhoff Publishers, 2002. Fourcade, Marion, and Healy, Kieran. Classification situations: Life-chances in the neoliberal era. Accounting, Organizations and Society 38, no. 8 (2013): 559–572. Fresia, Marion. Aide humanitaire et production de services publics en Afrique de l’Ouest: le cas de la gestion des populations mauritanniennes réfugiées au Senégal. Buletin de l’APAD (2002): 23–34. Geissler, Paul W., Rottenburg, Richard, and Zenker, Julia. 21st century African biopolitics: Fuzzy fringes, cracks and undersides, neglected backwaters, and returning politics. In Rethinking biomedicine and Governance in Africa: Contributions from anthropology, Geissler, Paul W., Rottenburg, Richard, and Zenker, Julia (eds.), 7–19. Bielefeld: Transkript Verlag, 2012. Gide, Andre. Voyage au Congo: carnets de route. Paris: Gallimard, 1927. Godding, Jean-Pierre. Refugees or hostages? Population movements in the Great Lakes region since 1990. Oxford Social Sciences Library, Unpublished Conference Paper, 1997. Goetz, Nathaniel H. Towards self sufficiency and integration: An historical evaluation of assistance programmes for Rwandese refugees in Burundi: 1962–1965: New issues in Refugee research. Working Paper 87. Geneva: UNHCR, 2003.

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Guichaoua, André. Les ‘travaux communautaires’ en Afrique centrale. Revue Tiers Monde (1991): 551–573. Guichaoua, André. Migrants, réfugiés et déplacés en Afrique centrale et orientale. In Exilés, réfugiés, déplacés en Afrique centrale et orientale. Paris: Karthala, 2004. Hansen, Art. Angolan refugee displacement and settlement in Zaire and Zambia. In Transforming settlement in southern Africa, 30–47. Edinburgh: Edinburgh University Press, 2001. Harms, Robert. River of wealth, river of sorrow: The central Zaire basin in the era of the slave and ivory trade: 1500–1891. New Haven: Yale University Press, 1981. Harrell-Bond, Barbara, and Voutira, Eftihia. Anthropology and the study of refugees. Anthropology Today 8, no. 4 (1992): 6–10. Harvey, Paul, and Lind, Jeremy. Dependency and humanitarian relief: A critical analysis: HPG Report 19. London: Humanitarian Policy Group. Overseas Development Institute (ODI), 2005. Hathaway, James, and Foster, Michelle. The law of refugee status. Cambridge: Cambridge University Press, 2014. Herz, Manuel (ed.). From camp to city: Refugee camps of the western Sahara. Zurich: Las Müller, 2012. Herz, Manuel. Refugee camps or ideal cities in dust and dirt. Urban Transformation (2008): 276–289. Holborn, Louise. Refugees: A problem of our time: The work of the United Nations High Commissioner for Refugees, 1951–1972. Metuchen: Scarecrow Press, 1975. Hyndman, Jennifer. ‘Refugee Self-management and the Question of Governance’.in: Refuge, 16(2): 1997, 16–22. Hyndman, Jennifer. Change and challenge at UNHCR: A retrospective of the past fifty years. Refuge 19, no. 6 (2001): 45–53. Hyndman, Jennifer, and Giles, Wenona. Waiting for what? The feminization of asylum in protracted situations. Gender, Place & Culture 18, no. 3 (2011): 361–379. Inhetveen, Katharina. Die politische Ordnung des Flüchtlingslager: Akteure – Macht – Organisation: Eine Ethnographie im südlichen Afrika. Bielefeld: Transcript Verlag, 2010. International Labour Organization. Interterritorial migrations of Africans south of the Sahara. International Labour Review 76 (1957): 292–310. Jaji, Rose. Social technology and Refugee encampment in Kenya. Journal of Refugee Studies 25, no. 2 (2011): 221–238. Jansen, Bram J. The accidental city: Violence, economy and humanitarianism in Kakuma refugee camp Kenya. PhD diss., Wageningen University, 2011. Kok, Walter. Self-settled refugees and the socio-economic impact of their presence on Kassala, Eastern Sudan. Journal of Refugee Studies 2, no. 4 (1989): 419–440. Kopytoff, Igor (ed.). The internal African frontier: the making of African political culture. Bloomington: Indiana University Press, 1987. Latour, Bruno. La science en action. Introduction à la sociologie des sciences. Paris: La Découverte, 1989. Lemarchand, René. The dynamics of violence in Central Africa. Philadelphia: University of Pennsylvania Press, 2009. Lischer, Sarah K. Dangerous sanctuaries: Refugee camps, civil war, and the dilemmas of humanitarian aid. London: Cornell University Press, 2005. Loescher, Gil. The UNHCR and world politics: A perilous path. Refugee Survey Quarterly 20, no. 3 (2000): 106–139. Londres, Albert. Terre d’Ébène. Paris: Arlea, 2008 [1929]. Malkki, Liisa H. Refugees and exile: From ‘refugee studies’ to the national order of things. Annual Review of Anthropology 24 (1995): 495–523.

Classifications: UNHCR and the legibility of refugees in Central Africa 91 Mamdani, Mahmood. When victims become killers: Colonialism, nativism, and the genocide in Rwanda. Princeton: Princeton University Press, 2002. Matthews, Robert, O. Refugee and stability in Africa. International Organization 26, no. 1 (1972): 62–83. Noiriel, Gérard. La tyrannie du national: Le droit d’asile en Europe (1793–1993). Paris: CalmannLevy 1991. Okoth-Obbo, George. Thirty years on: A legal review of the 1969 OAU Refugee Convention governing the specific aspects of refugee problems in Africa. Refugee Survey Quarterly 20, no. 1 (2001): 79–138. Pitterman, Shelly. A comparative survey of two decades of international assistance to refugees in Africa. Africa Today 31, no. 1 (1984): 25–54. Pols, Jeannette. Enforcing patient rights or improving care? The interference of two modes of doing good in mental health care. Sociology of Health & Illness 25, no. 3 (2003): 320–347. Rutinwa, Bonaventure. The end of asylum? The changing nature of refugee policies in Africa. Working Paper 5, New Issues in Refugee Research. Geneva: UNHCR, 1999. Schnyder, Felix. Report on New Refugee Situations. Submitted to the 7th session of Excom, UN Doc A/AC.96/158, 1962. Scott, James. Seeing like a state: How certain schemes to improve human condition have failed. New Haven: Yale University Press, 1999. Scott-Smith, Tom. The fetishism of humanitarian objects and the management of malnutrition in emergencies. Third World Quarterly 34 no. 5 (2013): 913–928. Sharpe, Marina. The 1969 African refugee convention: Innovations, misconceptions, and omissions. McGill Law Journal 58, no. 1 (2012): 95–147. Tallio, Virginie. La fabrique du réfugié: du camp rapatriement, lieux et processus de la construction du ´réfugiés´: L’exemple des camps de réfugiés de Dadaab (Kenya) et de Nkondo (R.D.C.). Paris: Thèse EHESS, 2007. Turner, Simon. Politics of innocence: Hutu identity, conflict and camp life. New York: Berghahn Books, 2010. Turner, Simon. What is a refugee camp? Explorations of the limits and effects of the camp. Journal of Refugee Studies 29, no. 2 (2016): 139–148. UNHCR. Global trends 2010. Geneva: UNHCR, 2011. UNHCR. Handbook for Registration. Geneva: UNHCR, 2003. UNHCR. Les réfugiés dans le monde. Cinquante ans d’action humanitaire. Geneva: UNHCR, 2000. UNHCR. Planning rural settlements for Refugees: Some considerations and ideas. Geneva: UNHCR, 1979. UNHCR. Report of the executive committee of the programme of the United Nations high commissioner for Refugees. Geneva: UNHCR, 2013. UNHCR. Report of the general assembly, 25th session. Geneva: UNHCR, 1970. UNHCR. Report to the general assembly: Official records forty-seventh session: Supplement No. 12A. New York: United Nations, 1992. UNHCR Handbooks for Emergencies UNHCR, Geneva: UNHCR 1982. UNHCR Handbooks for Emergencies UNHCR, Geneva: UNHCR 2007. Van Damme, Wim. Do refugees belong in camps? Experiences from Goma and Guinea. The Lancet 346 (1995): 360–362. Weiss, Thomas G. UNHCR should lead the international humanitarian enterprise. NIRA Paper, 2002. Weizman, Eyal. The least of all possible evils: Humanitarian violence form Adrendt to Gaza. London: Verso Books, 2011.

3

Artifacts Malnutrition, MUAC, and the materialization of anthropometry

In February 2012, the World Food Programme organized a crisis summit in Rome to deliberate on the ongoing famine in the Sahel region. Having been criticized harshly for its late reaction to the raging famine in the Horn of Africa, the organization wanted to act quickly on this new emergency. At the end of the summit, Kristalina Georgieva, the European Union Commissioner for Humanitarian Aid and Crisis Response, summed up the meeting’s aims. Holding a white band with red tape in her hand, she explained that, applied to a child’s arm, it served as a kind of measuring tape for hunger. “This one centimeter,” she said, “marks the difference between life and death for children. And this is what we talked about today: That we prevent one million children in the Sahel to come in the red zone.”1 The band that Georgieva showed the audience is familiar to humanitarian practitioners and donors alike. Mid-upper arm circumference (MUAC) tape is a strip of plastic, approximately 35 cm long, used to assess acute malnutrition in children aged one to five.2 The tape is wrapped around the arm, halfway between the elbow and shoulder, and a color code indicates levels of nutrition: Green for a normal child, yellow for malnourished, and red for severe malnutrition. Leading humanitarian organizations recommend it for screening in emergency situations.3 MUAC has become (together with “weight for height”)4 the main tool for nutritional assessment in emergency situations.5 Nutritional indicators (together with mortality rates) have moreover become key figures in general needs assessment. They have become instrumental for ranking and mapping emergencies.6 As a result, MUAC has been widely used in Haiti, Afghanistan, South Sudan, and Syria. The previous chapter explored the role of classification in the enactment of knowledge. This chapter, in turn, focuses on the solidification of decisions into material devices. What Science and Technology Studies (STS) scholars call “Mundane artifacts” or “small technologies” are a good entry point into the history of aid.7 The humanitarian’s notion of needs is in fact not only supported by texts, but also by a profusion of little devices – jerry-cans, water tanks, hose pipes, plastic sheeting, food rations, Plumpy’Sup biscuits, shelter units, etc. As STS shows, objects are far from innocent, for they mediate between concepts and practices. They render previous decisions invisible and forgotten controversies inaccessible. The MUAC band has become the signature device of humanitarianism. Aid workers use the MUAC tape to admit children into feeding programs, nutrition experts use it

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 93

Figure 3.1 EU Commissioner for Humanitarian Affairs Kristalina Georgieva with MUAC tape (2012). Source: © European Union, 2012 / Source: EC – Audiovisual Service/Photo: Go Takayama

to produce nutritional surveys, and senior officers use it to raise public awareness. The tape has become a “blackbox” of humanitarian aid – a tool that plays a key role in decision-making processes while “running by itself.”8 However, the evidence produced by MUAC is less straightforward than Kristalina Georgieva’s remarks might imply. This chapter traces the history of the MUAC tape back to its invention and explores the reasons for its success. In particular, it underlines the tool’s ability to make hunger commensurable on a global scale. International aid agencies feel authorized to act at the global level largely based on the universality of human needs, a creed reasserted in the agencies’ founding documents, principles, and guidelines and in the standardization of the indicators and technical devices they use. Everyday relief work relies on instruments that fit individual pain into the language of universal needs. The trend towards “evidence-based humanitarianism” epitomizes the importance of quantified comparisons on a global scale. The success of MUAC is rightly attributed to the fact that it is a quick, simple, cheap, easily transportable, and reproducible tool for identifying acute malnutrition.9 Equally important, however, is that it can be used anywhere, on any child aged one to five, without regard for environmental, economic, or cultural backgrounds. As one proponent of mid-upper arm circumference has put it, “MUAC is universally applicable.”10 Consequently, the history of MUAC can help us grasp the historicity of humanitarian universalism. Most of the grey literature issued by aid agencies takes the universality of human needs for granted. This does not mean that aid workers are

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naïve about the universal character of their organizations or that they are uncritical of their tools (in fact, some of the most radical criticism of MUAC comes from aid workers). But in operational settings, there simply is not time to dig deep into history. Aid workers do not have the luxury of engaging with the ontology of MUAC while trying to save children from death. The historiography of humanitarian aid, however, should look more closely at the history of commensurability. There are substantial works on the ideological roots of humanitarianism, on the periodization of aid, and on the history of aid workers and aid beneficiaries.11 But historians have said little about the link between relief aid and the universalization of the social in the twentieth century. Conversely, anthropologists of global health have problematized the “universal appeal” of humanitarianism.12 They have showed how relief aid has shaped its objects of intervention and reframed needs in the language of biomedicine.13 This chapter, while informed by the anthropological literature on aid,14 makes a plea for historical analysis and aims to reinsert chronology into the discussion. It examines how humanitarian experts, in their attempt to act “universally,” have changed both the regimes of care and the definition of needs. The history of MUAC dates back to the late 1950s.15 The measurement was first used in Haiti in 1958 by a tropical doctor, Derrick Jelliffe, and his team from the Caribbean Food and Nutrition Institute. In the 1950s and 1960s, tropical pediatricians experimented with different methods of nutritional assessment, with the measurement of arm circumference being just one of many other techniques of nutritional assessment. The tipping point in the history of MUAC came in 1969. In the middle of the Nigerian Civil War (1967–70), the International Committee of the Red Cross (ICRC) conducted a large survey based on MUAC, which changed the perception of malnutrition. For the first time, a humanitarian organization adapted MUAC for its own use. The Biafran War was a pivotal moment in the emergence of a group of humanitarian experts, i.e. an “epistemic” or “knowledge community.”16 MUAC provided the form of knowledge that this community needed – knowledge that not only produces data, but also publicly demonstrates the gravity of the situation.17 Since 1969, MUAC has frequently been accused of lacking accuracy. Yet, paradoxically, the more it has been criticized for inaccuracy, the more it has come to be used. This is because supporters of MUAC, rather than defending its accuracy, have pushed for its materialization and industrialization. Even though MUAC has remained an imprecise indicator, it has been transformed into a cheap and quick tool. The MUAC tape has made malnutrition comparable, quantifiable, transportable, and – not least – visible. The following pages underline three aspects of this history. First, humanitarian experts should be seen as “off-road universalists”: Their main achievements are not in the realm of moral values, but in the realm of field practices. Their main contributions have less to do with rising awareness of the universal nature of needs – the famous “moral revolution” celebrated by Michael Barnett and others18 – than with the much more ambitious and concrete task of overcoming the local nature of needs. The inventors of the MUAC tape were medical doctors specialized in

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 95 areas such as pediatrics, nutrition, tropical medicine, and general medicine.19 They inaugurated an area of knowledge that they named “field anthropometry,” which targeted the populations of “less developed tropical countries.”20 Their expertise cut across various spheres of knowledge, from conventional epidemiology and geography to anthropology.21 The inventors of nutritional anthropometry have made acute malnutrition comparable at the global level – and so successfully that we tend to forget how locally and culturally specific malnutrition was considered before. Second, the price for this impressive achievement was high. Like any other tool, the MUAC tape carries a hidden script, including the assumption that malnutrition is more important than other diseases, that prioritizing needs is essential,22 and that children around the world should be compared based on similar standards and thresholds. The MUAC tape conveys the idea that children, especially those under five years of age, should be a priority for humanitarian aid. Young children are considered more important targets of aid because they are dependent on others’ actions and die more quickly of hunger (targeting severely malnourished children is one of the fastest ways to reduce mortality rates).23 But there is also an inherent technical logic to the prioritization of children under five: The fact that children’s arm circumference grows only slightly between the ages of one and five years is one of the main arguments set forth by MUAC proponents for targeting this specific population. This technical consideration has become a self-fulfilling prophecy: Because this population can be compared using MUAC, it should be targeted by aid. Third, the MUAC tape conflates different uses of nutritional assessment. It is used as a tool of surveillance, i.e. the nutritional status of children is used as a proxy for that of larger populations and for mapping emergencies. Children are more likely to show signs of acute malnutrition: Measuring their status makes it possible to map the magnitude and geographical distribution of malnutrition.24 At the same time, MUAC is also used as a tool of triage or “emergency classification,”25 i.e. the neediest individuals are screened to determine resource allocation and admission into feeding programs.26 Beginning its career as an anonymous tool of nutritional assessment, the MUAC tape has ended up being championed as a triumphant hero by the EU Commissioner for Humanitarian Aid. As we will see, this is not a history of usurpation – there was no putsch, plot, or master plan. There was – and perhaps still is – an emancipatory value in the production of universalizing tools. However, if we want to keep this emancipatory potential alive, we must abandon the search for a magic bullet. Instead, we need to thoroughly rethink the way we use these tools, i.e. we must take care to separate the historical fruit from its metaphysical rind.

Delocalizing hunger. The rise of field anthropometry in tropical medicine The first nutritional survey to use arm-circumference measurement was conducted by Derrick Jelliffe and his team in 1958 in Haiti. Jelliffe was a British pediatrician who had worked in several decolonizing countries, including Sudan, Uganda,

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Nigeria, India, and Uganda, and who conducted nutritional surveys for the Kingston-based Caribbean Food and Nutrition Institute.27 In the 1960s, he and a team of doctors conducted surveys in Barbados, Trinidad and Tobago, Jamaica, and Guyana, for which they used a conventional measuring tape to gauge the midupper arm circumference of children. This measurement was just one of various types of information that these doctors collected to assess malnutrition (protein calorie malnutrition, or PCM, as they called it); others included other anthropometrical measurements (weight, height, calf circumference, head circumference, etc.) as well as clinical signs and the results of biochemical and biophysical tests.28 To understand why Jelliffe and his team spent so much time developing anthropometrical methods to assess malnutrition, it is necessary to consider the situation in which they found themselves. Contrary to popular assumption, it is not easy to know whether someone is suffering from malnutrition. The symptoms of undernutrition are far from obvious, so that untrained eyes cannot simply “see” malnutrition by looking at a starving child; the symptoms are sometimes counterintuitive (typically, a starving child may have a “big belly” or lack appetite) and, most importantly, depend to a high degree on contextual variables. When Jelliffe began his work, the dominant way to determine whether a child was malnourished was through clinical judgment. The problem with this method is that local factors affect this judgment. Different societies – and, within societies, different individuals – develop different types of malnutrition-based pathologies. Even the most acute forms of malnutrition-based pathologies differ from one place to another. In the late 1960s, for reasons unknown to Jelliffe and his team, some individuals were prone to marasmus, while others were more likely to develop Kwashiorkor syndrome.29 The problem of devising suitable methods is complicated by the fact that in some communities kwashiorkor is the main severe syndrome and in others marasmus. Also, the clinical features vary in prevalence from one part of the world to another, depending on the interaction of numerous local variables, including genetic characteristics, associated nutrient deficiencies, types of microbiological and parasitic conditioning infections, the sequence, severity and rate of development of malnutrition and the age of onset.30 Not only are some societies more prone to marasmus and others to kwashiorkor, but even a single pathology can take many different forms. The “kwashiorkor of Trinidad” contrasted markedly with the “usual classical textbook tropical African case,” while even in the same country – “in two parts of India,” for instance – the clinical picture of kwashiorkor could vary. In the Jamaican cases seen by Jelliffe and his team, there was even an “obese variant” of kwashiorkor known as the “sugar-babies” variant. This made it difficult to compare between societies. Doctors working in one country or region, Jelliffe noticed, often confused the various clinical features of kwashiorkor because they assumed that the clinical picture they were familiar with was “necessarily identical in detail in other parts of the world.”31

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 97 This ambiguity was even truer for less severe clinical symptoms. Virtually all clinical signs for identifying malnutrition (such as edema, hair depigmentation, and muscle wasting)32 can also be symptoms of others diseases, or even the result of non-pathological factors. The list of factors that can affect these signs – and thus also judgment of nutritional status – is long: Other factors may include the balance of other foods in the prevailing diet, genetic influences, the age and activity of the person, and the environment in which he lives, as regards both environmental hygiene and climate, and exposure to infection and parasitism.33 In the 1960s, this led to frequent mistakes in the assessment of nutritional status. Many signs thought to be associated with malnutrition were “in fact, not related to malnutrition at all.”34 An obvious example is the hair’s appearance. Depigmentation of the hair was seen as a classical sign of undernutrition, while dry and dull hair indicated a lack of protein. However, to judge hair depigmentation, it is necessary to know what constitutes normal hair color in a healthy child. In some contexts, the problem was that “it may be customary for children of one or both sexes to have their hair cut short or shaved, so that the hair color is not apparent.”35 Moreover, hair color is affected by “local factors,” such as “dyeing, the effect of sunshine, salt-spray and dust, genetic factors and the habitual use of oil.”36 In addition, “Scalp diseases or specific cultural practices (. . .), as well as environmental factors such as the exposure to salt water and a very hot dry atmosphere can have an impact.”37 One can look at whether the hair is thin and sparse, but “sparseness . . . can result in adult women in parts of Africa from the tight braiding of hair into many short pigtails (. . .). A similar frontal baldness appears to occur in older Chinese women, possibly as a result of the traditional combed-back hair style.”38 Similar problems occurred with the other signs of malnutrition. Skin depigmentation can be a sign of protein deficiency, but the skin’s appearance may also depend on “dirt, lack of washing, a dry, hot, windy climate, and the habitual use of oil on the body” – and, of course, “genetics.”39 Eye pathologies can result from malnutrition, but they may also be due to “bright sunlight, dust, wind, smoke and infection.”40 The appearance of the teeth works well enough in many parts of the world, but in India, “the excessive chewing of betel nut preparations containing large amounts of irritant lime” could lead to false conclusions. Symptoms in the mouth, skeletal system, and cardiovascular system can also be unrelated to malnutrition. “Mental confusion” can be a sign of undernutrition, but, like any symptom requiring an extended conversation with the individual in question, it is difficult to assess in field conditions due to issues of “language, cultural interpretations and witness reliability.”41 Jelliffe and his team of tropical doctors were cursed: Everything from genetics to the environment to traditional customs had the potential to falsify their results. Clinical judgment was thought to be the most accurate way to assess malnutrition. But it was slow and required extended face-to-face interactions as well as

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solid knowledge of the local community. As a result, the Caribbean Food and Nutrition Institute experimented with two other methods: Biochemical tests (blood and urine tests) and anthropometry. Biochemical tests were expensive and difficult to perform in the field. They required a laboratory, sterilized lancets, sterile syringes, vacuum tubes, a system of refrigeration, and so on. Flies could pollute the blood samples, as could fleas and dust. Also, physicians feared the “crosscultural clashes” likely to occur when they took biochemical samples. Since most biochemical tests involved questions of privacy and modesty, collection techniques were not suited to crowded survey sites. Even worse, local populations might consider taking a piece of the body – especially blood – as something associated with “occult purposes” and “suspicion of witchcraft.”42 Anthropometry is based on measuring growth failures and various bodily disproportions linked to known cases of pathology. Though approximate, anthropometrical indicators objectify malnutrition using the language of mathematical hierarchies. The most important measurements are weight, height (or length), triceps skinfold, and arm, head, and chest circumferences. These measurements can be taken by paramedical staff and require less expertise in the field than clinical judgment or chemical tests. Moreover, anthropometrical assessments can identify undernutrition before actual clinical symptoms develop.43 Arm circumference is particularly valued since, unlike measures such as weighing, which rely on expensive, heavy, bulky, and easily damageable devices, it only requires a light and easily transportable measuring tape. In other words, the tool for measuring arm circumference is portable and thus adapted for use in the field. However, originally it was always used in combination with other indicators. A nutritional survey in Kampala, for instance, included six different anthropometrical measures along with five clinical criteria and three biochemical indicators. Arm circumference was just one of many indicators used to describe nutritional status.

Depoliticizing famine. Arm circumference measurement in Biafra As has been noted, the Nigerian Civil War marked a tipping point in the use of MUAC. The massive humanitarian intervention during the Biafran conflict led to a strategic connection between humanitarian organizations (such as churches, charities, and voluntary organizations) and tropical medicine. For the first time, in Biafra, a leading organization, the International Committee of the Red Cross (ICRC), conducted a large-scale survey based on MUAC as the sole indicator of undernutrition and as a tool for determining resource allocation. On 30 May 1967, the government of East Nigeria declared Biafra’s independence. Lagos launched a brutal military reprisal and organized a blockade of the region, along with the systematic destruction of villages.44 The main feature of the Nigerian Civil War was the high civilian mortality. Combat accounted for only a small part of the war casualties, with just 10% of the victims said to have died in direct combat. Most victims were civilians, most were children, and most died from malnutrition and its consequences.45

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 99 It took months before the international community reacted, partly because Nigeria was seen as a strong, crop-exporting agricultural nation. International institutions not only had little knowledge of the nutritional situation in Biafra, but this information was a highly political matter.46 The Biafran leadership argued that Nigeria’s federal government was committing an act of genocide by attempting to starve to death the Ibo community. For its part, the federal government minimized the severity of the famine. In the eyes of the aid agencies, even the Nigerian population itself could not be trusted. The data had to objectify the needs of the population without relying on their testimony. As one medical doctor put it, after two years of siege conditions, the population knew how to present its needs to obtain relief aid: “[E]very mother in Biafra knows what kwashiorkor means,” he wrote, and would “make sure her child gets [supplementary skimmed dried milk] if it is available.”47 Voluntary organizations began their work in Biafra one year into the conflict. The ICRC took the lead in the emergency relief provided by a myriad of aid agencies and NGOs. It struggled to collect data on the famine.48 Resources were scarce, political pressure was high, and competition for leadership was harsh. The ICRC had little expertise in the area of nutritional emergencies. Traditionally, it had handled tasks such as exchanging prisoners of war and managing specific medical services such as running hospitals. In Nigeria, the ICRC had to manage staff from 14 different nations, most of whom lacked experience in developing countries, and many of whom were only sent to the field for short periods of time.49 For the humanitarian agencies, the question of selection was at the heart of the problem. The ICRC was convinced that Biafra qualified as a “mass nutritional emergency,”50 but resources were scarce. One medical doctor recalled, “The roads were choked with refugees, of whom all were hungry and many had clinical signs of overt malnutrition (. . .) Almost everyone in the former enclave was suffering from hunger.”51 It was not just a question of triaging the malnourished population, but also of targeting acute (as opposed to chronic) malnutrition. In fact, even before the war, the Food and Agriculture Organization of the United Nations (FAO) had deemed East Nigeria’s food production to be insufficient because of the region’s poor agricultural situation.52 East Nigeria was considered overpopulated and underfed.53 An ICRC report estimated that the eastern part of Nigeria had average food availability per person of only 75% to 90% of the minimum basic needs.54 In June 1969, together with the Nigerian Red Cross, the ICRC launched an investigation of the nutritional situation in the south-eastern State.55 The aim of the survey was to produce “objective figures” on malnutrition in order to avoid “political problems.”56 Information about the famine had become a political weapon. The Biafran leadership had even hired a public relations firm, MarkPress, to publicize the effects of the famine and generate sympathy for its cause.57 The ICRC pushed for statistical data on the famine, not just for internal use – that is, to find out “whether pockets of severe malnutrition remained in their territory”58 – but also for external use. The political neutrality of humanitarian actors was seen as being underpinned by the objective neutrality of mathematical reason.

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The Red Cross team selected 60 villages in the region between Opobo and Eket in the south and Ikot-Ekpene and Itu in the north. The villages could be reached by dirt road, foot, or dugout canoe. In each village, a team composed of an interpreter, a secretary, a measurer, and a member of the Red Cross examined approximately 75 children, a process that took between one and three hours. One team could survey two villages per day. The survey teams only examined children because they “generally reflect malnutrition faster than adults.”59 In other words, children were used as a “proxy” for the nutritional situation of the population as a whole. Conveniently, in Biafra, only few households did not have children of the age being examined60 – that is, children between one and ten years, an age range chosen since “biological measurements” were considered to be “less precise” above the age of ten and because the children had to be old enough to be able to stand up and cooperate.61 The measurers focused on the children’s arm circumference. They preferred this technique to other anthropometrical measures because measuring tape was easy to transport (it was smaller and lighter than weighing devices) and because the decrease in muscle mass is greater than the body weight deficit in malnourished children. Within a month, the left arms of 7,184 children had been measured.

Figure 3.2 “The height-arm circumference method being conducted by a survey team in the Southeastern State (1969).”62 Source: Larry E. Davis, “Epidemiology of Famine in the Nigerian Crisis: Rapid Evaluation of Malnutrition by Height and Arm Circumference in Large Populations,” American Journal of Clinical Nutrition 24, no. 3 (March 1971): 360. Courtesy of the American Society for Nutrition.

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 101 This is a perfect example of what Bruno Latour calls an “obligatory passage point” (OPP). Just like an army might concentrate its units on a specific bridge rather than stretching them along a valley, the ICRC chose to focus its attention on the left arms of a specific sample of the population. In Biafra, the ICRC faced chaos of epic proportions. It was unaware of the food situation prior to the war, lacked basic statistical information (even the figures for Biafra’s population varied between 8 and 12 million), and was working in a region where the roads were blocked by the military, electricity and water supplies had broken down, hospitals were overcrowded, and most people lacked food. It chose to focus on malnutrition (singling it out from other medical issues such as disease, accidents, war casualties, etc.), on mass food distribution (rather than individual treatment), on children as a proxy for all other members of society, and on the circumference of their left arms as a proxy for undernutrition. A vast and intricate political, geographical, and cultural problem was reduced to the manageable question of the size of a toddler’s arm. However, once they had measured arm circumference, the ICRC teams faced two difficulties. To begin with, they did not know the children’s ages; in the villages under study, birth dates were not systematically recorded, so a child’s precise age often remained unknown. As a result, the teams decided to use height as a proxy for age. In order to deduce age from height measurements, they relied on a survey conducted by D. C. Morley in several African villages.63 However, the figures for height and known age recorded by Morley did not provide information for children over the age of five. For these children, the team relied on another set of height-for-age figures, established in London schools in 1954.64 Combining the height-for-age curves of the West African children studied by Morley and the London pupils surveyed in the 1950s, the team was able to estimate the ages of the Biafran children. The second difficulty was the lack of Nigerian data for arm circumference. In order to determine who was undernourished, the ICRC teams had to know the normal arm circumference of a healthy child. However, “no standards for this comparison existed at the time of the study.”65 For this reason, the team chose as a reference the measurements made by Napoleon Wolanski in Warsaw.66 The ICRC combined all three sets of data – Wolanski’s Polish MUAC, Morley’s height-for-age figures for West African children, and the London averages from 1954 – to create a composite table of normal height-to-arm-circumference ratios for Biafra.67 Based on this, it defined a standard for malnutrition: “A child with an arm circumference below 80% of that expected for his height was found empirically to have severe malnutrition.”68 Let us take as an example Ugwu, a boy 85 cm tall. Based on the London study, a child of this height is around two years (24 months) old, while, according to the Wolanski study, a child of this age should have an arm circumference of 16.3 cm. If Ugwu’s arm circumference was less than 13 cm (80% of the Polish standard), he would be classified as severely malnourished; if it was between 13 and 13.85 cm (85% of the Polish standard), he would be classified as moderately malnourished; and for any circumference greater than that he would be considered healthy.

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Based on this method, the ICRC teams found that, of the 7,184 children surveyed, 480 suffered from severe acute malnutrition. Creating nutritional maps of the region, they found that “the areas adjacent to the war front had the highest levels of malnutrition.”69 Consequently, food relief was redeployed to these areas. Medical relief teams were withdrawn from the Eket and Opobo areas and moved northward to the areas along the war front. The ICRC concentrated its efforts on the region around Akpap, and, within this area, MUAC was used again to identify the families in greatest need, with relief food being distributed to families with one or more children classified as severely malnourished. The ICRC had displaced the problem of malnutrition. MUAC had become a way to navigate chaotic contexts. The conclusions drawn by a report on the survey touted the benefits of MUAC: it was reproducible and accurate; it was simple enough to be performed by unskilled Nigerians under supervision; it was economical; it yielded two levels of malnutrition, moderate and severe; it was rapidly performed; and it was based on an objective rather than a subjective standard.70 Measuring arm circumference provided a way of transforming a complex situation in unfamiliar terrain into “two levels of malnutrition.” The tool gave a path to navigate the interests of starving children, village chiefs, the government in Lagos, Biafran leaders, competing humanitarian organizations, and European donors.

Comparing malnutrition: The rhetorical style of emergency anthropometry Not all tropical doctors shared the enthusiasm of the proponents of MUAC. While the ICRC teams in Biafra used height-to-arm circumference ratios as their sole tool for nutritional assessment, others continued to argue for a combination of methods. In their view, MUAC alone was not accurate enough. The way in which the measuring tape was applied left room for many mistakes. In order to measure arm circumference properly, the child’s arm had to be hanging loosely, the exact mid-point between elbow and shoulder had to be found, and firm and constant pressure had to be applied with the measuring tape, which proved to be more complicated than it seemed.71 However, the main problem was the question of standards. Could children from different continents, societies, and classes be compared with the Polish standard? While the war in Biafra raged on, an international conference was convened to address this question.72 The participants compared the left arm circumferences of children from various places, including 379 children from eight Haitian villages,73 136 Amerindian children in Guyana, children from Barbados and Ohio (USA), 359 children in Dodoma (Tanzania),74 211 children who lived near Mount Kilimanjaro, 594 children from northern Greece,75 pupils from Sweden,76 a range of sick children from a Ugandan clinic,77 some “poorly nourished”

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 103 children from New Guinea,78 1,351 children from villages in Sierra Leone, 795 Zambian children,79 366 malnourished boys and girls from the nutrition rehabilitation center at Fond-Parisien in Haiti,80 707 Nigerian children from Owu and Oba,81 1,049 “Arab children” from Lebanese clinics,82 640 patients of the mission feeding centers around Bukavu (Congo),83 and “approximately 1,000 male and 1,000 female” school children from Tunis (Tunisia).84 The children had been selected for various reasons and in various settings; some of the MUAC measures had been taken in schools, others in religious institutions, military barracks, villages, and hospitals. Some of the children were healthy, well fed, and generally well off, while others were malnourished and yet others were sick. They came from different environments and classes with different beliefs and cultural and nutritional customs. Most of these studies used the Polish children measured by Wolanski as a standard of reference. However, several studies found that the children they were examining had arm-circumference measures slightly below the Warsaw standards.85 One doctor based in Ethiopia tried his best to find the most well-fed children in the country, selecting children exclusively from “expensive private kindergartens in Addis Ababa” and only measuring the arm circumference of the most privileged and best fed among them. Yet, despite these efforts, he was forced to conclude that the Ethiopian children had an average arm circumference below Wolanski’s standard.86 Several other doctors also found the comparison with a single European standard87 inadequate for their populations. A Malaysian doctor preferred calculating his own local standard based on the children of Malaysian soldiers.88 For another physician working in Guyana, even establishing a local standard proved to be problematic, because he found that children “of East Indian ancestry” had markedly lower measurements than those of “predominantly African descent.”89 One doctor, after conducting a survey in West Africa, concluded that “European standards” simply were “not . . . applicable.”90 Despite their attempts to compare children from around the world, physicians kept an eye out for dissimilarities. Doubting the reliability of a single standard, they felt the need to disaggregate their data along what they called “racial” or “ethnic groups.” One distinguished between the “Nilotic,” “Nilo-Hamitic,” and “Bantu” groups in Uganda,91 another between the “Pomaki” (sic) and “Moslems of Turkish origin” in Greece,92 while yet another differentiated between “a Negroid race,” “Caucasians,” “Caribs,” “East Indians,” and “children with mixed blood” on the Island of Dominica in the Caribbean.93 On the whole, the participants at the conference remained skeptical about the practicability of a single universal standard. They continued to use MUAC measurements, but, like Jelliffe in the early 1960s, merely as one among many anthropometrical and other indicators. The overall tone of the 1969 conference on arm circumference methods contrasted sharply with Davis’s enthusiastic declarations in Biafra. At least one participant, however, adopted the same rhetoric style of the ICRC doctors in Biafra. In his description of a nutritional survey in Eastern Congo, John Bennett attributed a high strategic value to MUAC.94 Like Biafra, the crisis in Kivu was a complex

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situation involving political fighting, refugee flows, and chronic malnutrition. Bennett’s paper exposed the four steps that would become emblematic of the rhetorical style of proponents of MUAC: First, humanitarians face a chaotic situation in which almost everyone is chronically undernourished (“[children] were all inadequately nourished, so that it was necessary to determine which were the worst”). Second, they choose a small sample of young children from the original population (“640 ‘under five’”). Third, all attention is concentrated on the children’s left arms. Finally, based on the sample, a decision on resource allocation is made for the whole population (“This group should qualify for supplements of protein and calories issued daily in the form of skimmed milk and cereal”).95 The crisis in the central African region gave proponents of MUAC their line of argument for MUAC, allowing them to link a certain conception of epidemiology to the practical rationality of humanitarian intervention. By stressing the role of “field circumstances,” they closely linked the production of knowledge to decision-making. It was not a question of the purity of scientific methodology – this was “front-line epidemiology,” a set of “quick and dirty” methods to save lives.96 MUAC became a way to channel humanitarian resources, to ensure that resources and needs were aligned – which, in turn, meant that needs were not to be defined independently of resources.

Pushing the advantage: The materialization of MUAC and the silencing of critics During the 1970s and 1980s, MUAC measurements remained controversial. The method was exposed to harsh criticism. A number of pediatricians rejected the method either partially or completely. However, advocates of MUAC did not defend the method based on its scientific accuracy. Rather than attempting to counter criticism with counter-criticism or an avalanche of favorable results from clinical studies, they displaced the debate onto another battleground. They materialized MUAC. Instead of waiting for solid and coherent empirical grounds of support for their method, they invented a manufactured tool to make it the easiest and cheapest approach to use in the field. Critics pointed out that, within a single group of persons, different anthropometrical methods (weight, weight-for-height, arm circumference, etc.) resulted in different individuals being identified as undernourished. Studies conducted in the Caribbean, Uganda, Ethiopia, South Africa, Brazil, and West Africa showed that weight-for-height and MUAC often led to differing diagnoses.97 And these differences could be significant. In the Caribbean case, 2.5 times more cases of undernutrition were diagnosed using weight than mid-arm circumference.98 In Uganda, the mid-arm circumference assessment led to “21% false-positive diagnoses” when compared to weight assessments.99 In other words, malnutrition-prevalence rates obtained using MUAC did not have a clear or constant relation to those diagnosed on the basis of weight. Arm circumference and weight-for-height did not identify the same population of children as malnourished.100

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 105 A study of rural children in India concluded that a diagnosis based on MUAC missed many malnourished children: “Some children, who were severely undernourished on the basis of weight for age, weight for height and muscle circumference were classified as normal based on arm circumference.”101 Indeed, the results of the two methods disagreed often; “in about 43 per cent” of cases, MUAC and weight-for-height led to different diagnoses.102 Almost one-fifth of the children classified as “normal” based on arm circumference were underweight according to weight-for-height standards. As a result, assessments based on arm circumference resulted in the omission of cases of malnutrition.103 The strongest opponents of MUAC argued for other alternatives: Using several indicators rather than just one, applying weight-for-height rather than MUAC, or using MUAC to create new aggregated indicators such as the ratio between arm and head circumference.104 Some advanced a compromise: While MUAC was not accurate enough for triaging children, it was good enough for certain tasks – nutritional mapping105 or screening in “emergency situations such as refugee camps or severe drought.”106 For some authors, mid-arm circumference was only a useful measure “in crisis situations where malnutrition is severe and many children must be assessed rapidly.”107 Proponents of MUAC did not attempt to prove their critics wrong.108 They displaced the locus of confrontation to the humanitarian field. They transformed the method into a simple manual tool. A first step in this process was getting rid of the conventional measuring tape. The problem with conventional commercial tapes was that they varied in diameter, thickness, gradations, and the placement of the numerals, making it difficult to standardize its application. Moreover, measuring a child’s arm with a conventional tape was difficult because one had to align two widths of the same tape. Most observers measured “against the 10 cm mark of the tape so that your hands did not touch the arm” and then subtracted 10 cm from the actual reading.109

Figure 3.3 Insertion tape (1975). Source: Alfred J. Zerfas, “The Insertion Tape: A New Circumference Tape of Use in Nutritional Assessment,” American Journal of Clinical Nutrition 28, no. 7 (July 1975): 783. Courtesy of the American Society for Nutrition.

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Eventually, Alfred Zerfas, a nutritionist who had worked in Biafra, experimented with a range of plasticized materials and suggested using a specific paper tape with a plastic interior considered to be durable and water resistant.110 He also designed a tape with an insertion window to allow for correct alignment of the scale and to facilitate reading.111 He then not only promoted his technique actively within his network of tropical nutrition specialists (including the Institute of Child Health in London, the Centers for Disease Control and Prevention in Atlanta, and the University of California in Los Angeles School of Public Health), but also patented his invention in Australia and began standardized production of the tape through American firms. A second and much more far-reaching innovation was getting rid of the numbers on the tape. Adnan Shakir of Baghdad University and David Morley from the Institute of Child Health in London divided the tape into three colored zones: Red for “malnourished,” yellow for “possible mild malnutrition,” and green for “normal.” Since numbers and arithmetic were complicated, why bother volunteers and paramedics in field situations with them? “Figures have less meaning for auxiliaries in the developing world than for health personnel in industrial societies,” they wrote.112 The resulting tape was a simple object that seemed to beautifully align the universality of color categories with the putative universality of young children’s needs: “Red, yellow, and green have universal significance, thanks to the ubiquitous traffic lights.”113 Shakir and Morley immediately set about standardizing their colored tape, working together with Teaching Aids at Low Cost (TALC), a non-profit organization founded in London.114 Viewed in retrospect, inventing a colored tape might seem like an innocent and commonsense idea. Yet, in the context of the raging controversy about the accuracy of the method, it was a bold strategic move. The colored tape was a Trojan Horse for several plausible yet still unproven assumptions: That the same standard could be used everywhere, was applicable independent of age (for children aged one to five years), was for boys and girls alike, and that it made sense to focus specifically on young children to assess entire populations. According to Shakir and Morley, MUAC was gender and age independent. Consequently, a single colored tape could be used to assess malnutrition among children between one and five years, based on the same cut-offs (while weight

Figure 3.4 The three-colored cord (1974). Source: Adnan Shakir and David Morley, “Measuring Malnutrition,” The Lancet 303, no. 7680 (April 1974): 759.

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 107 varies quickly in growing children, arm circumference varies only minimally).115 This was an enticing idea, since age was difficult to determine in many societies. Many users, however, remained skeptical. Some physicians doubted that MUAC did not change according to age and gender. Some found that a significant number of children were misclassified using the three-colored tape, which led to false negatives in up to one-third of cases.116 One Dutch pediatrician determined that, among the children he studied, one-year-old girls had a mean MUAC of 16.36 cm, while five-year-old girls had a mean of 17.91 cm – a difference of more than 1.5 cm.117 Several other studies confirmed that MUAC was highly dependent on age and gender.118,119 Yet these objections failed to reach their target: The threecolored tape was simply too easy to use to be rejected. The materialization of MUAC had rendered any criticism of it ineffective. The only point on which the criticism of MUAC bore fruit was the question of the cut-off. When Derrick Jelliffe chose a cut-off to define malnutrition in the 1960s, it was clear that this decision was rather “arbitrary.”120 At first, instead of establishing a single cut-off, Jelliffe preferred presenting the results according to various “levels” of malnutrition. The famous “85% of Wolanski’s standard” he suggested as the cut-off to define malnutrition was based on an informed guess at best. It was changed to “80% of Wolanski’s standard” as a “compromise” between various other standards.121 Two decades after it was established, this threshold remained “essentially arbitrary.”122 New standards have been suggested repeatedly. Some have argued for regional standards123 and others for a new universal standard.124 However, until the mid1990s, the standards used by Jelliffe in 1966, based on Wolanski’s study of Polish children in 1964, remained the international standard.125 Everyone knew that the Polish standard was far from perfect.126 However, MUAC defenders recommended continuing to use the same standard to assure that “the nutritional studies of the future will be comparable with those of the past.”127 This is a perfect example of what actor–network theory calls “technological path dependence”: Keeping a traditional tool in use to ensure system compatibility even though new information has become available that reflects reality more accurately. Finally, in 1997, the World Health Organization (WHO) published a new standard of reference for MUAC.128 The Polish children from the early 1960s were replaced by a sample of American children from the 1990s as a reference for the world, and, though this standard has been updated since, the principle of a single universal standard is still in use.129 Surprisingly, even though the international standard has changed slowly, the thresholds for undernutrition have not changed much. Let us return to our example of two-year-old Ugwu. If the ICRC team in Biafra in 1969 had encountered this 85 cm toddler, it would have deemed him “malnourished” if his arm circumference had been less than 13.85 cm (85% of Wolanski) and “severely malnourished” if it had been less than 13 cm (80% of Wolanski). If this same child had been measured by Bennett in 1969, these thresholds would have been 13 cm and 12 cm, respectively. If he had been classified using Shakir’s color tape in 1974, he would have been determined to be suffering from “possible

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mild malnutrition” if his MUAC had been under 13.5 cm and from “malnutrition” if it had been under 12.5 cm. In 1988, Gayle would use these same thresholds (13.5 cm and 12.5 cm) – but to define “moderate malnutrition” and “severe malnutrition,” respectively. If the WHO standards from 2007 had been applied to Ugwu, he would have been considered “moderately malnourished” with a MUAC under 12.5 cm and “severely malnourished” with a circumference under 11 cm. Finally, according to the WHO standards from 2009, the threshold for “moderate malnutrition” remained the same (12.5 cm), but the threshold for severe malnutrition once again changed (11.5 cm). Malnutrition, in the practices of humanitarian aid, is as much the result of a process of needs assessment as it is the origin of aid.

Conclusion Despite harsh critique, the industrialization of the MUAC tape has resulted in such massive diffusion of the tool that the current conception of malnutrition is closely linked to it. The colored tape has not been able to put an end to related criticism of standards and cut-offs, or to arguments about age-and-gender independence and the uniformity of muscle wasting, which continue to be debated.130 There is general agreement that the standards are far from perfect, the thresholds arbitrary, and that the probability of mistakes is not negligible. Nevertheless, MUAC continues to be used in emergency settings every day. Let us recall the main arguments made in this chapter. First, the invention of MUAC is not the history of a “moral” achievement. It is far more than that. The universalization of the fight against hunger did not merely require “recognizing” that hunger was a global problem; it also required making hunger globally commensurable. This meant bringing universalism to the field. The medical doctors who invented MUAC paid a great deal of attention to mundane aspects of knowledge production. They were as concerned with bringing enough fuel for their jeeps or proper waterproof equipment as they were with science. They were far from any laboratory and were well aware of this fact. Second, the invention of MUAC (and of other anthropometric tools such as weight-for-height) changed the way we address malnutrition. Determining undernutrition using clinical judgment involves an extended face-to-face interaction between a patient and a health specialist. In this interaction, the question of nutrition is not strictly separated from other needs (i.e. the health specialist may also consider other pathologies). This direct exchange requires a common language or an interpreter. It is slow and localized. In contrast, using the MUAC tape assessing undernutrition involves a brief interaction between a child and a trained individual. The knowledge – and definition – of undernutrition is inherent in the band itself, thereby making it possible to save a tremendous amount of time. However, this comes at a high price. Like any other technical device, the band contains a hidden script. It is blind to some forms of undernutrition and inherently fails to identify a certain number of malnourished children. Moreover, it implies that malnutrition can be separated from other problems, that it is more important to assess malnutrition in children than in adults, and that arm circumference is

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 109 representative of overall undernutrition. It also assumes that malnutrition is age and gender independent for young children and that it is possible – and indeed important – to compare every child with an internationally defined standard. The MUAC tape also implies that relief aid should be prioritized according to needs. This is a widespread – though not uncontested – idea (some nutritionists have for instance argued that it might be more efficient to target all children under two years rather than only the malnourished ones under the age of five).131 Third, there is a risk of overuse of the tool. The MUAC tape is currently used to survey entire populations, draw up nutritional maps, allocate resources, triage individuals in refugee camps, monitor individuals in feeding programs, etc. A year after the World Food Programme meeting in Europe, Kristalina Georgieva once again used MUAC as a didactic tool – this time to instruct her audience about the new concept of “resilience,” rendered visible in her explanation by the yellow zone of the band.132 MUAC tape, however, is probably not the magic bullet that some would like it to be. Finally, we should not overlook that the medical doctors who invented MUAC had good reasons to make the case for universal humanitarianism. They were born between 1920 and 1950, during the golden age of fascism, Nazism, and colonialism. They started their tropical career afraid of being confused with colonial doctors and hoping to heal the wounds of racialized medicine. The universalism

Figure 3.5 ACF nurse Serge Sarkadela measures a child’s arm with MUAC in Eastern Cameroon, December 2014. Source: © Glasman

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of field anthropometrists was instrumental in breaking from colonial categories as well as from Cold War politics. After all, it was not them, but Western and African political leaders, who grossly misused figures on malnutrition; it was likewise rather some of their critics who used the terminology of “race” and “tribes.” However, it remains crucial to ask up to which point – and under what conditions – this kind of universalism continues to have emancipatory potential. The recent celebration of “data-driven” humanitarianism has unleashed competition among global databases and automatized cross-cutting of nutritional indicators.133 Ironically, the run for humanitarian big data is occurring precisely at a time when it is being (re)discovered that biology depends significantly on social status and local contexts. The notions of “customary biologies”134 or “local biologies”135 “undermine the notion of biology as a universal standard against which human difference may be adequately accounted for.”136 This might be an opportune moment to historicize the tools that mediate the discourse of universality and the plurality of individual bodies.

Notes 1 Quoted in Kleinjung, Tilmann. UN-Krisengipfel zur Sahel-Zone: Afrika droht die nächste Hungerkatastrophe. [Television] Tagesschau. 2012-02-15. https://origin. tagesschau.de/ausland/sahel100.html. 2 MUAC tape is also referred to as MUAC band, MUAC strip, insertion tape, or strap. For an overview of MUAC uses, see Cook, Gordon C. and Zumla, Alimuddin I. (eds.). Manson’s Tropical Diseases, 22nd ed. London: WB Saunders Elsevier Ltd, 2009: 537–538. 3 UNHCR. Handbook for emergencies, 2nd ed. Geneva: UNHCR, 2000; WHO, UNICEF, WFP, and SCN. Joint statement: Community-based management of severe acute malnutrition. Geneva, New York and Rome: WHO, UNICEF, WFP and SCN, 2007; WHO, UNICEF, and WHO. Child growth standards and the identification of severe acute malnutrition in infants and children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund. Geneva: WHO Press, 2009; Sphere Project, 2011. 4 For the current discussion on the advantages of MUAC over weight-for-height, see Myatt, Mark, Khara, Tanya, and Collins, Steve. A review of methods to detect cases of severely malnourished children in the community for the admission into community based therapeutic care programs. Food Nutrition Bulletin 27, no. 3 (2006): 7–23; Mark Myatt et al. The effect of body shape on weight-for-height and mid-upper arm circumference-based case definitions of acute malnutrition in Ethiopian children. Annals of Human Biology 36, no. 1 (2009): 5–20; WHO et al., 2007. 5 Main rapid needs assessment mechanisms (including the United Nations Disaster Assessment and Coordination mechanism UNDAC, the USAID Disaster Assessment and Response team, and the OCHA Rapid Assessment process) recommend the use of MUAC. Many SMART-based need surveys (Standardized Monitoring and Assessment of Relief and Transitions) include MUAC as a tool. See chapter 6 on this. 6 Several instruments have been developed to compare and prioritize needs and rank vulnerability, including OCHA’s need overview tools, which combine several different indicators by sectors (shelter, education, water and sanitation, protection, etc.). However, nutritional and health statistics are generally considered as the most “robust” figures in an emergency context. See Chapter 6 on this point. 7 See Scott-Smith’s inspiring analysis: Scott-Smith, 2013: 913; Collier, Stephen J., Cross, Jamie, Redfield, Peter, and Street, Alice. Preface: Little development devices/ humanitarian good. Limn 9, 2018.

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 111 8 Latour, 2005: 21–48. 9 This technique was only said to be quick and simple after it had been experimented with for more than a decade. 10 Zerfas, Alfred J. The insertion tape: A new circumference tape of use in nutritional assessment. The American Journal of Clinical Nutrition 28 (1975): 782–787. 11 On the historiography of aid, see Barnett, 2011; Davey, Borton, Foley, 2013; Framke, Maria, and Glasman, Joël. Editorial. Werkstatt Geschichte 68 (2015): 3–12. 12 Redfield, 2013: 13. 13 Fassin, Didier. Le sens de la santé. Anthropologie des politiques de la vie. In Anthropologie médicale. Ancrages locaux, défis globaux, Saillant, Francine and Genest, Serge (eds.). Québec: PUL, 2005: 383–399; Bradol, Jean-Hervé, and Vidal, Claudine. Innovations médicales en situations humanitaires. Le travail de Médecins sans frontières. Paris: L’Harmattan, 2009; Fassin, 2010; Lock, Margaret, and Nguyen, Vinh-Kim. An anthropology of biomedicine. Hoboken: Wiley-Blackwell, 2010; Redfield, 2013; Scott-Smith, Tom. The fetishism of humanitarian objects and the management of malnutrition in emergencies. Third World Quarterly 34, no. 5 (2013): 913–928. 14 Brauman, Rony, and Médecins Sans Frontières (eds.). Utopies sanitaires. Paris: Le Pommier, 2000; Agier, 2008; Bradol, Vidal, 2009; Redfield, 2013; Scott-Smith, 2013. 15 On the history of nutrition sciences, see Chapter 1. 16 Redfield, 2013: 12; Peter Haas quoted in Davey et al., 2013. 17 Bonnecase, Vincent. Retour sur la famine au Sahel du début des années 1970: La construction d’un savoir de crise. Politique africaine 2 (2013): 23–42. 18 Barnett, 2011. 19 This chapter is based on an analysis of published journal articles and unpublished reports on child nutrition in emergency situations. A rough estimate using the Scopus database identified 926 articles with “MUAC” or “arm circumference” in the title (between 1969 and 2013 in a selection of 29 major academic journals). This is by far not an exhaustive count. Also, certain articles focus on topics other than nutrition or make only a passing reference to nutritional problems. However, this estimate was helpful for locating the main controversies and overall evolution of interest in this technique. Journals with more than 50 articles on the topic are the American Journal of Clinical Nutrition, the European Journal of Clinical Nutrition, Journal of Tropical Pediatrics, and Clinical Nutrition. 20 Jelliffe, Derrick B. Field anthropometry independent of precise age. Journal of Tropical Pediatrics 75 (1969): 334–335. 21 J. E. Gordon speaks of “field epidemiology” (Gordon, John E. Preventive medicine and epidemiology. The American Journal of Medical Science 246, no. 3 (1963): 354–376.). 22 This idea has been challenged by recent nutritional surveys; see Ruel, Marie T. et al. Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: A cluster randomised trial. The Lancet 371, no. 9612 (2008): 588–595. 23 Significantly, some experts arguing for the targeting of children aged one to five years for anthropometric reasons (assuming that the arm circumference of this age group was stable) also elicit impromptu moral arguments in favor of children. See Murray Last’s piece, who argues that the principle of putting “children first” is unacceptable in many cultures (Last, Murray. Putting children first. Disasters 18, no. 3 (1994): 192–202). 24 Sphere Project, 2011: 157. 25 Bennett, F. John. A rapid screening test in emergency child feeding in Kivu, Congo. Journal of Tropical Pediatrics 15, no. 4 (1969): 238–240, here p. 240. 26 Children with measurements in the red zone are given therapeutic feeding treatments, children with measurements in the yellow zone receive supplementary food, and children with green measurements may be given a prophylactic feeding. For a recent critique of MUAC as a tool for admission into feeding program, see Grellety, Emmanuel, Krause, Kendall, Eldin, Manal Shams, Porten, Klaudia, and Isanaka,

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29 30 31 32

33 34 35 36 37 38 39 40 41 42

43 44

45 46

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Artifacts: Malnutrition, MUAC, and the materialization of anthropometry Sheila. Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: Is MUAC alone a sufficient criterion for admission of children at high risk of mortality? Public Health Nutrition 18, no. 14 (2015): 2575–2581. Derrick Jelliffe and his wife Patrice Jelliffe are best known for their defense of breastfeeding in the 1970s, which would greatly influence the discourse on infant feeding in the tropics (see Jelliffe, Derrick B. and Jelliffe, E. F. Patrice. Human milk in the modern world. Oxford: Oxford University Press, 1978). Biophysical methods such as radiographic examinations and testing of physical functions (e.g. deviations in visual acuity, capillary fragility, lack of muscle coordination, night-blindness, etc.) were considered not practicable in field assessments (Jelliffe, Derrick B., and World Health Organization. The Assessment of the nutritional status of the community, Geneva: WHO, 1966: 94–96); Jelliffe, Derrick B. and Jelliffe, E. F. Patrice. Prevalence of protein-calorie malnutrition in Haitian preschool children. The American Journal of Public Health 50, (1960): 1355–1366; E. F. Patrice Jelliffe and Derrick B. Jelliff. The arm circumference as a public health index of protein calorie malnutrition of early childhood. Journal of Tropical Pediatrics 15, no. 4 (1969): 179–188. Jelliffe, 1966: 179. Jelliffe and Jelliffe, 1969: 179. Jelliffe, 1966: 181. Among many signs, 11 clinical symptoms of protein-calorie malnutrition were listed by Jelliffe and Jelliffe, 1969: 180. Edema (accumulation of fluid in the tissues causing swelling, usually in the feet, ankles, calves, or legs), dyspigmentation of the hair, easy pluckability of the hair, thin sparse hair, straight hair, muscle wasting, depigmentation of the skin, psychomotor change, moon-face, hepatomegaly (enlarged liver), “flaky paint” dermatosis. Jelliffe, 1966: 42. Jelliffe, 1966: 12. Jelliffe, 1966: 18. Jelliffe, 1966: 18. Jelliffe, 1966: 16. Jelliffe, 1966: 16. Jelliffe, 1966: 33. Jelliffe, 1966: 18. Jelliffe, 1966: 41. Jelliffe, 1966: 160. For an analysis of the experience of colonial medicine and the rumors of Europeans bloodsucking children in Africa, see White’s monograph: White, Luise. Speaking with Vampires: Rumor and history in Colonial Africa, Vol. 37. Berkeley: University of California Press, 2000. Nutritionists spoke of “mild moderate” undernutrition, “early” protein-calorie malnutrition, “clinically occult,” “marginal malnutrition,” or “pre-clinical” malnutrition. Stremlau, John J. The international politics of the Nigerian civil war: 1967–1970. Princeton: Princeton University Press, 1977; Wirz, Albert. Krieg in Afrika: Die nachkolonialen Konflikte in Nigeria, Sudan, Tschad und Kongo. Wiesbaden: Steiner, 1982; Gould, Michael. The struggle for modern Nigeria. London: I.B. Tauris, 2012. Aall, Cato. Relief, nutrition and health problems in the Nigerian/Biafran War. Journal of Tropical Pediatrics 16, no. 2 (1970): 69–90, here p. 75. On Biafra and the birth of modern humanitarian aid, see Ryfman, Phillipe. Une histoire de l’humanitaire. Paris: La Découverte, 2008: Chap. 4; Brauman, Rony. La médecine humanitaire. Paris: PUF, 2009: Chap. 1; O’Sullivan, Kevin. Ireland, Africa and the end of empire: Small state identity in the Cold War 1955–75. Manchester: Manchester University Press, 2013: chapters 4 and 5. Gans, Bruno. A Biafran relief mission. The Lancet 293, no. 7596 (1969): 660–665, here p. 662.

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 113 48 The population of Biafra and number of deaths were also a matter of controversy. Casualty figures vary between 1 and 3 million. 49 Moorehead, Caroline. Dunant’s Dream. New York: Harper Collins, 1998; Forsythe, 2005; Forsythe, and Rieffer-Flanagan, 2007. 50 Aall, 1970: 83. 51 Hickman, Roger. The relief operation in former Biafra. The Lancet 296, no. 7677 (1970): 815–816. 52 Food and Agriculture Organization of the United Nations (FAO). Agricultural development in Nigeria: 1965–1980. Rome: FAO: 1966. quoted in Aall, 1970: 72. 53 On the question of the transfer of nutritional science between metropole and colonies, see Worboys, 1988; Arnold, 1994; Simmons, Dana. Starvation sciences: From colonies to metropole. In Food and globalization: Consumption, markets and politics in the modern world, Nützenadel, Alexander and Trentmann, Frank (eds.). Oxford: Berg, 2008: 173–192; Vernon, James. Hunger. A modern history. Cambridge MA: Harvard University Press, 2007: 104–117. See also chapter 1 on nutrition studies. 54 1,775 kcal/person, according to Aall, 1994: 70. 55 Davis, Larry E. Epidemiology of famine in the Nigerian crisis: Rapid evaluation of malnutrition by height and arm circumference in large populations. The American Journal of Clinical Nutrition 24, no. 3 (1971): 358–364; Rainer, Arnhold. The QUAC stick: A field measure used by the Quaker service team in Nigeria. Journal of Tropical Pediatrics 15, no. 4 (1969): 243–247. 56 Davis, 1971: 360. 57 Barnett, 2011: 135. 58 The organization was not even able to determine exactly how many people lived in the area before the war: “about one to two million people.” Davis, 1971: 358. 59 Davis, 1971: 359. 60 “Only one household in 14 failed to have children” (Davis, 1971: 359). Interestingly, Davis does not mention the role of “pawning” and other practices of child mobility between families in order to cope with the famine in Igbo society (Uchendu, Egodi. Recollections of childhood experiences during the Nigerian civil war. Africa 77, no. 3 (2007): 393–418, and 410). 61 Davis, 1971: 359. 62 Davis, 1971: 360. 63 Morley, David C. et al. Heights and weights of West African village children from birth to the age of five. West African Medical Journal 17, no. 1 (1968): 8–13. 64 Report on the heights and weights of school pupils in the County of London in 1954. London County Council Report no. 3885, 1955. Quoted in Davis, 1971: 364. 65 Davis, 1971: 359. 66 Wolanski did not publish the MUAC figures for Polish children himself, but rather communicated them to Derrick Jelliffe, who printed them in his report for WHO in 1966 (Jelliffe, 1966: 228). 67 Instead of manipulating the composite table on paper, the measuring team used a “QUAC stick” (Quaker Arm Circumference measuring stick), a height measuring stick marked with arm-circumference measurements rather than height measurements. The cut-offs (85 or 80%) for expected circumference for a specific height were marked directly onto the stick at the corresponding height so that, in practice, the child’s arm circumference was measured with a tape, with the stick placed behind the child indicating an arm circumference reading. If the child’s actual height was below this mark – that is, below the level corresponding to his or her arm circumference – then their arm measurement was greater than 85% of the arm circumference of an average child of their height, and they would therefore be classified as not malnourished. If they were taller than the expected level, they were classified as malnourished (Arnhold, 1969: 243). 68 Davis, 1971: 359.

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69 Davis, 1971: 360. 70 Davis, 1971: 359. [My emphasis] 71 Arm-circumference measurement was based on the assumption that all body musculature was uniformly affected by undernutrition, which seemed “likely” but remained “unproven” (Jelliffe and Jelliffe, 1969: 185). 72 Some participants of the symposium (such as Ian Phillips, Arnhold Rainer, Ingrid Rutishauser, Meinhard Robinow, Robert Cook) worked with Derrick Jelliffe or with nutritionists trained by him in Uganda while he was the UNICEF Professor of Child Health at the Makerere Medical School of Kampala in the early 1960s. Other participants (like Ivan Beghin and Michael Gurney) had known Jelliffe from his work in Latin America while he was at the Caribbean Food and Nutrition Institute. Most of them later became consultants for UNICEF, the World Health Organization, or the World Food Program. 73 Jelliffe, Patrice E. and Jelliffe, Derrick B. The arm circumference as a public health index of protein-calorie malnutrition of early childhood, 9: Experience in the Caribbean. Journal of Tropical Pediatrics 15 (1969): 209–212. 74 Kondakis, Xenophon G. The arm circumference as a public health index of proteincalorie malnutrition of early childhood, 7: Field surveys in North Greece and Dodoma, Tanzania. Journal of Tropical Pediatrics 15, no. 4 (1969): 201–204. 75 Kondakis, 1969. 76 Karlberg, Petter et al. The development of children in a Swedish urban community: A prospective longitudinal study, III: Physical growth during the first three years of life. Acta Paediatrica Scandinavica 57 (1968): 48–66. 77 Rutishauser, Ingrid H. E. and Whitehead, Roger G. Field evaluation of two biochemical tests which may reflect nutritional status of three areas of Uganda. The British Journal of Nutrition 23, no. 1 (1969): 1–13. 78 Jelliffe and Jelliffe, 1969. 79 Blankhart, David M. The arm circumference as a public health index of proteincalorie malnutrition of early childhood: (VIII) Experience in Sierra Leone and Zambia. Journal of Tropical Pediatrics 15, no. 4 (1969): 205–208. 80 Beghin, Ivan D. (XVIII) Assessment of effectiveness of a nutrition rehabilitation centre at fond-parisien, Haiti. Journal of Tropical Pediatrics 15, no. 4 (1969): 248–250. 81 Gurney, Michael J. The arm circumference as a public health index of protein-calorie malnutrition of early childhood, XVI: Rapid assessment in a refugee camp in Nigeria. Journal of Tropical Pediatrics 15 (1969): 241–242. 82 Kanawati, Abdullah, Haddad, Nadra, and McLaren, Donald S. (XIV) Preliminary results with mid-arm and muscle mid-arm circumferences used as nutritional screening procedures for pre-school children in the Lebanon. Journal of Tropical Pediatrics 15, no. 4 (1969): 233–237. 83 Bennett, F. John. A rapid screening test in emergency child feeding in Kivu, Congo. Journal of Tropical Pediatrics 15, no. 4 (1969): 238–240. 84 Young, Boutourline H. (XII) Arm measurements as indicators of body composition in Tunisian children. Journal of Tropical Pediatrics 15, no. 4 (1969): 222–224. 85 Karlberg et al., 1968; Kondakis, 1969; Jelliffe and Jelliffe, 1969. 86 Eksmyr, Roland. Upper arm circumference of privileged Ethiopian pre-school children. Journal of Tropical Pediatrics 15, no. 4 (1969): 195. 87 As is often the case with new inventions, early discussions were marked by frequent use of inverted commas when referring to arm circumference as a “measure” of malnutrition, or to Wolanski as an “international standard.” 88 McKay, David A. (X) Experience with the mid-arm circumference as a nutritional indicator in field surveys in Malaysia. Journal of Tropical Pediatrics 15, no. 4 (1969): 213–216. 89 Ashcroft, Michael T. et. al. Anthropometric measurements of Guyanese schoolchildren of African and East Indian racial origins. Tropical and Geographical Medicine 20 (1968): 159–171, quoted in Jelliffe and Jelliffe, 1969.

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 115 90 Blankhart, 1969: 206. 91 Rutishauser, Ingrid H. E. (V) Correlations of the circumference of the mid-upper arm with weight and weight for height in three groups in Uganda. Journal of Tropical Pediatrics 15, no. 4 (1969): 196–197. 92 Kondakis, 1969: 202. 93 Robson, John, Bazin, M., and Soderstrom, R. Ethnic differences in skin-fold thickness. The American Journal of Clinical Nutrition 24 (1971): 864–868, here p. 864. 94 Bennett, 1969: 238. 95 Ibid.: 238 96 Ebrahim, Gulamabbas Juma. Front-line epidemiology. Journal of Tropical Pediatrics 37 (1991): 146–148, here p. 146. 97 Margo, G. Assessing malnutrition with the mid arm circumference. The American Journal of Clinical Nutrition 30 (1977): 835–837; Lindtjorn, Bernt. Measuring acute malnutrition: A need to redefine cutoff points for arm circumference? The Lancet 12 (1985): 1229–1230; Rees, D. G. et al. Measures of nutritional status: Survey of young children in North-East Brazil. The Lancet (1987): 87–89; Gayle, Helene D. et al. Arm circumference v. weight-for-height in nutritional assessment: Are the findings comparable? Journal of Tropical Pediatrics 34 (1988): 213–217; de Onis, Mercedes, Yip, Ray, and Mei, Zuguo. The development of MUAC-for-age reference data recommended by a WHO Expert Committee. Bulletin of the World Health Organization 75, no. 1 (1997): 11–18. 98 Margo, 1977: 836. 99 Margo analyzes Cook’s study in Uganda: Cook, Robert. The arm circumference as a public health index of protein-calorie malnutrition of early childhood, 6: The arm circumference in a field survey in Ankole, Uganda. Journal of Tropical Pediatrics 15, no. 4 (1969): 198–200. Margo, 1977: 836. 100 “AC has obvious practical advantages over w/h in field settings. Our findings, however, demonstrate that despite overlap these indicators do not identify the same population of children as being malnourished” (Gayle et al., 1988: 216). 101 Vijayaraghavan, Krishnaswamy and Sastry, J. Gowrinath. The efficacy of arm circumference as a substitute for weight in assessment of protein-calorie malnutrition. Annals of Human Biology 3, no. 3 (1976): 229–233, here p. 229. 102 The differences between diagnoses using MUAC versus weight-for-height remain a problem for humanitarian programs today. Some children are referred to aid programs using MUAC, but are subsequently denied treatment because they do not meet the weight-for-height requirement for admission (see Myatt et al., 2006). On the lack of correlation between weight-for-height and MUAC, see Ali, Engy et al. Is midupper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh? Transcript of the Royal Society of Tropical Medicine and Hygiene 107, no. 5 (2013): 319–323. 103 Even if there is no clear correlation between weight-for-height and MUAC, MUAC appeared to be useful for assessing mortality risks (Bairagi, Radheshyam. On validity of some anthropometric indicators as predictors of mortality. The American Journal of Clinical Nutrition 34, no. 11 (1981): 2592–2594; Vijayaraghavan, Krishnaswamy. Anthropometry for assessment of nutritional status. Indian Journal of Pediatrics 54 (1987): 511–520, here p. 519; de Onis et al., 1977: 11). 104 A suggestion made by Kanavathi & McLaren 1970, which has not been followed much. 105 “It is thus evident that careful consideration must be given before advocating the use of arm circumference as a field tool and particularly in identifying beneficiaries in any nutrition programme. This could only be used in selecting communities for nutrition intervention on priority basis” (Vijayaraghavan and Sastry, 1976: 233). 106 A study in India, critical of the ICRC study in Biafra, concluded that the relationship between arm circumference and height was “very poor” (Sastry, J. Gowrinath. Evaluation Of QUAC-stick for growth assessment in children. Indian Journal of Medical Research 60, no. 5 (1972): 747–751.). Also: Vijayaraghavan, 1987: 517.

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107 Margo, 1977: 837. 108 Among MUAC proponents, the staff of the Institute of Child Health in London (around J. Tanner and D. Morley), the Centers for Disease Control and Prevention in Atlanta (around D. Miller), and the UCLA School of Public Health (around D. Jelliffe) were the most influential. 109 Arnhold, 1969: 246–247. 110 Alfred Zerfas worked as a physician in the United Kingdom and for Save the Children Fund. He worked in the Biafran emergency and later joined Derrick Jelliffe at the University of California Los Angeles. He also was a nutrition consultant for UNICEF, WFP, and FAO. 111 Zerfas, 1975. 112 Shakir, Adnan and Morley, David. Measuring malnutrition. The Lancet 1 (1974): 758– 759, here p. 759. 113 Shakir and Morley, 1974: 759. 114 An alternative inspiration for the MUAC tape was the “quipu,” a knotted cord used in Inca communities to record events. The “anthropometric quipu” presented by Jelliffe & Jelliffe in 1975 indicated five levels of malnutrition (red, pink, orange, light blue, dark blue) (Jelliffe, Derrick B. and Jelliffe, E. F. Patrice. The quipu in measuring malnutrition. The American Journal of Clinical Nutrition 28, no. 3 (1975): 203–204). 115 “Normal weight increases by about half as much again in this age range, while the arm circumference increases by only about one-eighth” (Gurney, J. Michael. The arm circumference as a public health index of protein-calorie malnutrition of early childhood. 16. Rapid assessment in a refugee camp in Nigeria. Journal of Tropical Pediatrics 15, no. 4 (1969): 241–242, here p. 242). 116 Ramachandran et al. Limitations of film strip and bangle test for identification of malnourished children. American Journal of Clinical Nutrition 31, no. 8 (1978): 1469–1472; Vijayaraghavan, 1987: 517. 117 Voorhoeve, Henk W. A. A new reference for the mid-upper arm circumference? Journal of Tropical Pediatrics 36, no. 5 (1990): 256–262, here p. 262. 118 A study of American and Malawian children found out that MUAC increased by “approximately 2 cm between 6 and 59 months of age” (de Onis et al., 1977: 11). A study of Vietnamese children came to the same conclusion (i.e. that MUAC was not independent of age): Le Hop, Thi et al. Mid-upper-arm circumference development and its validity in assessment of undernutrition. Asia Pacific Journal of Clinical Nutrition 7, no. 1 (1998): 65–69, here p. 65. In 1993, an expert committee of the World Health Organization recommended abandoning the single cut-off and presented a sex-specific MUAC-for-age indicator meant to reflect “the true pattern” of mid-upper arm growth (de Onis et al., 1977: 11). 119 de Onis et al., 1977: 11. 120 Jelliffe and Jelliffe, 1969: 209. 121 “The selection of 80% of the Wolanski standard could also be regarded as a practical compromise between the higher Caucasian (. . .) and the lower Caucasian standards” ( Jelliffe and Jelliffe, 1969: 255). For criticism of the cut-offs, see Blankhart, 1969: 207, Arnhold, 1969 and Burgess et al., 1969. 122 Gayle et al., 1988. 123 The argument was as old as the invention of MUAC as an indicator itself. “[D]ifferent arm circumference standards may be needed when using this tool among different races” (Brookens, Jean H. Validation of an age-independent anthropometric tool to assess nutritional status. Journal of Tropical Pediatrics and Environmental Child Health 20, no. 5 (1974): 226–231, here p. 227). However local standards were difficult to achieve. Brookens, 1974: 227, Robson et al., 1971: 512. 124 Gerver, Wilhemus J. M. Measurement of the body proportions in children (The oosterwolde study). unpublished PhD diss., Groningen: Univ. of Groningen, 1988; Voorhoeve, 1990. 125 For the full table, see Jelliffe, 1966.

Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 117 126 If one compares Jelliffe’s figures to Gerver’s, the difference in measurement is more than 1 cm: Jelliffe’s MUAC for five-year-old girls is 16.9 cm, whereas Gerver indicates a MUAC of 17.91 (Jelliffe, 1969; Voorhoeve, 1990: 262). 127 Voorhoeve, 1990: 256. 128 De Onis and Zuguo, 1997: 11–18. The tables were calculated based on data collected by the United States National Center for Health Statistics (NCHS). 129 However, WHO experts were well aware of the shortcomings of their data and quickly announced that the standards should be “updated or replaced in the near future.” “The new reference,” some predicted, “will have a short life” (Macfarlane, “More growth-chart confusion”). 130 The universality of standards for malnutrition remains a matter of debate. During the 2011 famine in the Horn of Africa, several humanitarian workers expressed doubts about whether the same (universal) thresholds could be used for Somali children. The Ethiopian government, acting on its own initiative, had decided to lower the cut-offs in order to lower the figures for malnourished children. 131 Ruel et al., 2008. 132 She stated: “Take the example of the MUAC tape (. . .) If the circumference of the arm is greater than a certain value, this means that the child is healthy. Conversely, if the circumference is lower than a certain value, the child is acutely malnourished and in a danger of dying. The ‘resilience zone’ is the difference between these two values. If the child finds himself in this zone, the cost for helping him is around 10 euros. If it is below that value, the cost is around 200 euros. Resilience also has a significant meaning for the European taxpayer.” Speech by: Georgieva, Kristalina. European Union Commissioner for Humanitarian Aid and Crisis Response with a commission of the French Parliament. www.assemblee-nationale.fr/14/cr-cafe/12-13/c1213036. asp (Accessed 2015–09–09). 133 For an overview of the “datafication” of aid, see Meier, Patrick. Digital humanitarians: How big data is changing the face of humanitarian response. London: Taylor & Francis Group, 2015. 134 Niewöhner, Jörg. Epigenetics: Embedded bodies and the molecularisation of biography and milieu. BioSocieties 6 (2011): 279–298. 135 Lock, Margaret and Kaufert, Patricia. Menopause, local biologies and cultures of aging. American Journal of Human Biology 13, no. 4 (2001): 494–504. 136 Lock and Nguyen, 2010: 109.

References Aall, Cato. Relief, nutrition and health problems in the Nigerian/Biafran War. Journal of Tropical Pediatrics 16, no. 2 (1970): 69–90. Ali, Engy et al. Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh? Transcript of the Royal Society of Tropical Medicine and Hygiene 107, no. 5 (2013): 319–323. Ashcroft, Michael T. et al. Anthropometric measurements of Guyanese schoolchildren of African and East Indian racial origins. Tropical and Geographical Medicine 20 (1968): 159–171. Bairagi, Radheshyam. On validity of some anthropometric indicators as predictors of mortality. The American Journal of Clinical Nutrition 34, no. 11 (1981): 2592–2594. Beghin, Ivan D. Assessment of effectiveness of a nutrition rehabilitation centre at fondparisien, Haiti. Journal of Tropical Pediatrics 15, no. 4 (1969): 248–250. Bennett, F. John. A rapid screening test in emergency child feeding in Kivu, Congo. Journal of Tropical Pediatrics 15, no. 4 (1969): 238–240. Blankhart, David M. The arm circumference as a public health index of protein-calorie malnutrition of early childhood: (VIII) experience in Sierra Leone and Zambia. Journal of Tropical Pediatrics 15, no. 4 (1969): 205–208.

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Artifacts: Malnutrition, MUAC, and the materialization of anthropometry 119 Jelliffe, Derrick B. Field anthropometry independent of precise age. Journal of Tropical Pediatrics 75 (1969): 334–335. Jelliffe, Derrick B., and Jelliffe, E. F. Patrice. The arm circumference as a public health index of protein calorie malnutrition of early childhood. Journal of Tropical Pediatrics 15, no. 4 (1969): 179–188. Jelliffe, Derrick B. and Jelliffe, E. F. Patrice. Human milk in the modern world. Oxford: Oxford University Press, 1978. Jelliffe, Derrick B., and Jelliffe, E. F. Patrice. Prevalence of protein-calorie malnutrition in Haitian preschool children. The American Journal of Public Health 50 (1960): 1355–1366. Jelliffe, Derrick B., and Jelliffe, E. F. Patrice. The quipu in measuring malnutrition. The American Journal of Clinical Nutrition 28, no. 3 (1975): 203–204. Jelliffe, Derrick B., and World Health Organization. The assessment of the nutritional status of the community, Geneva: WHO, 1966. Jelliffe, Patrice E., and Jelliffe, Derrick B. The arm circumference as a public health index of protein-calorie malnutrition of early childhood, 9: Experience in the Caribbean. Journal of Tropical Pediatrics 15 (1969): 209–212. Kanawati, Abdullah, Haddad, Nadra, and McLaren, Donald S. (XIV) Preliminary results with mid-arm and muscle mid-arm circumferences used as nutritional screening procedures for pre-school children in the Lebanon. Journal of Tropical Pediatrics 15, no. 4 (1969): 233–237. Karlberg, Petter et al. The development of children in a Swedish urban community: A prospective longitudinal study, III: Physical growth during the first three years of life. Acta Paediatrica Scandinavica 57 (1968): 48–66. Kleinjung, Tilmann. UN-Krisengipfel zur Sahel-Zone: Afrika droht die nächste Hungerkatastrophe. [Television] Tagesschau. 2012-02-15. https://origin.tagesschau.de/ausland/ sahel100.html. Kondakis, Xenophon G. The arm circumference as a public health index of protein-calorie malnutrition of early childhood, 7: Field surveys in North Greece and Dodoma, Tanzania. Journal of Tropical Pediatrics 15, no. 4 (1969): 201–204. Last, Murray. Putting children first. Disasters 18, no. 3 (1994): 192–202. Le Hop, Thi et al. Mid-upper-arm circumference development and its validity in assessment of undernutrition. Asia Pacific Journal of Clinical Nutrition 7, no. 1 (1998): 65–69. Lindtjorn, Bernt. Measuring acute malnutrition: A need to redefine cutoff points for arm circumference? The Lancet 12 (1985): 1229–1230. Lock, Margaret, and Kaufert, Patricia. Menopause, local biologies and cultures of aging. American Journal of Human Biology 13, no. 4 (2001): 494–504. Lock, Margaret, and Nguyen, Vinh-Kim. An anthropology of biomedicine. Hoboken: WileyBlackwell, 2010. Margo, G. Assessing malnutrition with the mid arm circumference. The American Journal of Clinical Nutrition 30 (1977): 835–837. Mark, Myatt et al. The effect of body shape on weight-for-height and mid-upper arm circumference based case definitions of acute malnutrition in Ethiopian children. Annals of Human Biology 36, no. 1 (2009): 5–20. McKay, David A. (X) Experience with the mid-arm circumference as a nutritional indicator in field surveys in Malaysia. Journal of Tropical Pediatrics 15, no. 4 (1969): 213–216. Meier, Patrick. Digital humanitarians: How big data is changing the face of humanitarian response. London: Taylor & Francis Group, 2015. Moorehead, Caroline. Dunant’s dream. New York: Harper Collins, 1998. Morley, David C. et al. Heights and weights of West African village children from birth to the age of five. West African Medical Journal 17, no. 1 (1968): 8–13.

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4

Standards The Sphere Project and the universalization of the vital minimum after Goma

One afternoon in 1995, two British friends met in a mountain village in Switzerland. Peter Walker, Director of Disaster Policy at the International Federation of Red Cross and Red Crescent Societies (IFRC), and Nicholas Stockton, Emergency Director with Oxfam, were once again ruminating on an old problem: Anyone could pretend to be a humanitarian. This problem had grown since the end of the Cold War: While superpowers and states were keeping distant from the planet’s hot spots, everyone else was stepping in. Everyone was creating NGOs: Clergymen, TV hosts, aging billionaires, and adolescent rock stars. After the Rwandan genocide, more than 200 NGOs went to Goma. This intervention did not go well. Although international NGOs had been backed by high-tech army logistics and massive funding, they had been defeated by medieval diseases like dysentery and cholera. Even worse: The collapse of the humanitarians in Goma had been on the front pages of international media for several weeks. Venerable organizations such as Oxfam and the IFRC were struggling for legitimacy. Stockton and Walker had a long conversation while enjoying the view of Lake Geneva. After a few hours and “a six pack of beer” they had a plan: They would create “quality standards” for humanitarian action.1 After all, almost all other industries already had standards that guarantee that products and services attain a certain quality that consumers can expect. The International Organization for Standardization (ISO), the headquarters of which were not far from Walker’s office in Geneva, was an inspiring example: Its famous “ISO norms” applied to a broad range of goods and services, from the size of paper sheets, to the diameter of wool fibers, to the 4-digit PINs of international banks. Why not use the same kind of standards for the goods and services delivered by the humanitarian industry? That would make humanitarian aid more reliable, more accountable, and more predictable. The main question was: What does it take to survive a catastrophe? How many calories does a human being need? How many liters of water, how many square meters of tent, how many blankets? Do they need mobile phones? Condoms? Cigarettes? Where is the line under which less is nothing and more is optional? What is negotiable – and what shouldn’t be? Stockton and Walker titled their paper “Towards Quality and Accountability Standards in Humanitarian Relief.”2 They were neither lawyers nor specialists

Standards: The Sphere Project and the universalization of the minimum after Goma 123 in standardization processes, but they had many years of experience in aid relief, good knowledge of aid agencies, and a large network of friends in European and American NGOs. Stockton had a teacher personality (he had in fact taught sociology in the 1970s), while Walker acted as a coach, keeping everyone motivated and frequently giving pep talks. Both were good at bringing people together and pitching to donors and journalists. They brought their paper to the board of the Steering Committee for Humanitarian Response, a forum of seven of the most influential NGOs, and started the work of convincing their colleagues.3 Twenty years later, the Sphere standards have become a key reference in the humanitarian world. NGOs have adopted them. United Nations agencies require their partners to use them. Donors like the United States, the United Kingdom, and the European Union recommend them.4 Some governmental agencies draw extensively on Sphere to shape their national disaster plans.5 The Sphere standards are used in relief programs, and in the planning, monitoring, and evaluation of thousands of aid projects. They are taught to managers in headquarters, to aid workers in the field, and to graduate students in universities. The first version of the Sphere Project’s “Minimum Standards in Humanitarian Response” was published in 1998. The key argument was that humanitarian aid was, at least partly, quantifiable.6 The project was about defining “a minimum for survival.”7 The Sphere standards were backed by indicators meant to help to measure their fulfillment. For instance, a standard for water stated: “All people have safe and equitable access to a sufficient quantity of water for drinking, cooking and personal and domestic hygiene.” This standard was informed by indicators such as “At least 15 liters of water per person and per day is collected.”8 Another standard, on food requirements, said that “The food basket and rations are designed to bridge the gap between the affected population’s requirement and their own food sources.” The indicators added some planning estimates: “2,100 kcal per person,” including “10–12%” protein, “17%” fat, and an “adequate micronutrient intake.” Another standard required that “Families have access to household utensils, soap for personal hygiene and tools for their dignity and well-being,” with indicators like “Each person has: 1 eating plate, 1 metal spoon, 1 mug” and “Each person has access to 250 g of soap per month.” The Sphere standards offered many more quantifiable indicators, including a “maximum of 20 people per toilet,” and the criteria that “toilets are no more than . . . one minute’s walk” from living quarters. They codified the amount of water for hand washing in public toilets (“1–2 liters/ user/day”), for toilet flushing (“20–40 liters/user/day”), for anal hygiene (“1–2 liters/person/day”), and for animals (“5 liters/small animal/day”). They indicated the minimum sheltered area that should be available per person (“3.5–4.5 m2”) as well as the average daily requirement of Vitamin A (“1,666 International Units”). They gave several definitions of acute malnutrition (“80% of median weight-forheight” or “