Ethical Challenges and Working in the Grey Area

Thursday, July 28, 2016

This blog post is co-authored by Claire O’Reilly, physiotherapist & trainer at CVT Jordan, and Liyam Eloul, CVT clinical advisor for mental health.

A woman speaks with you, her CVT counselor, and reports that her husband is beating her in front of her children. You want to refer her to Social Services and support her through making a report (to UNHCR). However, she tells you she does not want a report filed. She is afraid that the authorities may deport her husband back to their country of origin, where he might be killed.

During a physical therapy session with a young woman, you notice injuries and pain consistent with rape. After some gentle questioning, the client tearfully recounts a story of being raped while in custody in her home country. She begs you not to share this information with anyone in her family because she fears her husband would leave her. However, her husband is also a client and you know he is considering divorce because he cannot understand his wife’s mood swings and withdrawal in the years since escaping their country.

A 13-year-old boy is a client and he cannot read the information materials you give him. It becomes clear he is not attending school so that he can illegally sell items at traffic lights during the day, as he is the only one who can work to support his family. As his social worker, you want to organize to enroll him in the local school, but if you do so, he says his family will go hungry as he could no longer work.

Providing help in disaster and conflict settings is complex, and wrought with ethical dilemmas: Whom do you help first? How best to help them? And for how long? The above fictional stories are examples of the decisions CVT staff must weigh every day. These difficult situations demonstrate how extreme need, limited resources, cultural differences and a constrained environment can mean making the ‘right’ decision is almost never a straightforward and simple decision.

At CVT International Service programs in Jordan, Kenya, Ethiopia and Uganda, such challenges are all too familiar. Factors such as huge demand for services, differences in how you and your client view the best course of action, and constraints in how we can allocate our limited funding, are part of our daily reality. 

A recent conference focused on Humanitarian Ethics held at SciencesPo, a research university in Paris, looked to discuss some of the issues surrounding this nuanced topic. CVT is committed to representing the voices of its clients and using the on-the-ground experience of its staff to inform conversations within the humanitarian sector. We were honored to participate in this conference as invited speakers. Other attendees included academics from across Europe and the U.S., as well as policy and field staff from major INGOs.

The conference addressed the variety of ethical challenges encountered at every level of humanitarian work. Showing that even conferences themselves are not above being analyzed through the lens of ethics, Dr. Hugo Slim, the head of policy at the International Committee of the Red Cross, flew directly from the World Humanitarian Summit in Istanbul, taking place a few days prior. He provided a summary and facilitated a discussion on the ethics surrounding the Summit itself.

The two-day conference included focused panels on topics such as the timing of humanitarian withdrawal and mental health. As members of a specialized mental health panel, we spoke about the necessity for mainstreaming mental health into broader health care interventions. We asked people to consider how effective a rights-based approach has been in facilitating this thus far, and how we can continue to push this vital agenda forward. We were interested in helping to facilitate conversations between specialties, and to shift from theoretical ideals to practical and pragmatic considerations. Our talk was well-received and is expected to lead to a book chapter in an edited volume later this year.

As has been recognized, despite increased advocacy, mental health continues to be largely an “invisible illness,” and we were honored and excited to have the opportunity to represent our work and the bravery of our clients in order to ensure that mental health does not also become a forgotten need.

The hurdles to providing care on a daily basis that meets CVT programs’ high standards should not be underestimated. As in the stories above, when there is no easy answer to be found, acting ethically is as necessary as it can be challenging; however CVT remains committed to making these difficult decisions and keeping the well-being of the individuals and communities we serve at the forefront of every such process.

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