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Ethical dilemmas and aid prioritization

  • Page updated on18 de April de 2025
Ethical dilemmas
Photo: Bruno Abarca

Humanitarian organizations are continually faced with ethical dilemmas of all kinds, from operational decisions to more strategic aspects. Many of the dilemmas to be faced arise from the application of the humanitarian principles, when none of the options to choose from is free from potential negative consequences. Other common ethical dilemmas are related to how to fairly distribute scarce resources when there are not enough for all the people affected by a humanitarian crisis who need them for their survival.

Applying humanitarian principles is an enormous challenge

Although humanitarian principles provide a basis for decision-making, this basis is never sufficient to directly address the complexity of the contexts in which we work.

The apparent simplicity (and even obviousness) of the statement of the principles of humanity, impartiality, neutrality and independence vanishes the moment they are rethought from the real world (no battle plan survives first contact with the enemy) and begin to conflict with each other or with other values and priorities.

Humanitarian principles can clash with each other

Humanity (prioritizing the alleviation of human suffering) can be questioned in several classic dilemmas that serve as examples: Should we assist people in need if that means risking the safety of humanitarian personnel? Is it ethical to accept to offer humanitarian assistance in camps for displaced persons where the authorities force the population to stay against their will and against their rights? And should we denounce abuses committed by authorities that we witness if we risk being expelled by the same authorities or limit our humanitarian access to the population in need?

Moreover, humanity can easily come into conflict with the other principles, such as neutrality (not taking sides in hostilities or disputes), if an armed group extorts us by asking for the payment of an "illegal tax" in exchange for letting us offer humanitarian assistance to the population living in the area they control, with the principle of impartiality (non-discrimination) if we yield to the demands of an authority that allows us to intervene in one area but forbids us to intervene in another where the population is favorable to opposing groups, or with the principle of independence (autonomy of powers) when our programs are largely defined by the requirements and priorities imposed by international donors who, indirectly (with financial or arms support), are involved in the hostilities.

Tackling these dilemmas involves making difficult choices

When these moral issues arise, in any of their many different forms, we are obliged to analyze such complex aspects as the possible impact of each option, which values, principles and rights may be compromised, and which decision seems more beneficial (or less harmful) for the most vulnerable people.

In any case, we will rarely find an ideal solution. A perfect deliberation will help us to make imperfect and difficult, but also necessary decisions, to anticipate possible negative consequences and risks, and to identify possible mitigation measures. This analysis must continue after the solution is made and implemented, to monitor its impact and to accompany us in the accountability to the people we assist and those who give us the means to do so.

Moral traps and humanitarian silence

The existence of frameworks or tools to assist in these deliberations should not lead us to think that facing these dilemmas is easy. Likewise, it is naïve to think that humanitarian organizations that make imperfect decisions are simply morally irresponsible. 

Many times these organizations are forced to face ethical dilemmas in which all options are bad as a result of the moral traps to which they are subjected by authorities and powers that leave them little room for maneuver. In these cases it is not a robber who shouts "Money or life!" but an authority, an armed group or an economic power that shouts "Your humanitarian action (on my terms) or their lives!" in a clear exercise of extortion.

Often, and as a result of all of the above, there are humanitarian organizations that, for ethical reasons and out of fear that a denunciation campaign that they do not believe will have any positive effect will block humanitarian access to the most vulnerable people, choose to maintain an apparent silence in the face of abuses, injustices and extortions that many find difficult to understand. Many of these silences are legitimate and powerful, when they hide a strong condemnation of injustice that cannot be made visible without danger and that is channeled through advocacy actions that are invisible to the public.

The most common dilemma: what to do when resources are scarce?

How to distribute insufficient resources while maintaining aid quality and effectiveness?

The most common operational ethical dilemma in humanitarian action is related to a maxim of our interventions: there are never enough resources available to meet all needs. The funding available is only sufficient to cover a small proportion of humanitarian response plans based on coordinated analyses of humanitarian needs and situations, skilled personnel are always in short supply, and there are enormous logistical constraints to making essential goods and resources available in the desired volume and time.

This translates into many practical moral issues that often conflict with the principles of humanity and fairness: Should we devote our scarce resources to serve more less vulnerable people or fewer very vulnerable - and sometimes hard to reach - people? Is it right to discriminate positively on the basis of the greatest and most urgent needs even if this drains our resources first? How do we decide what actions to take when there is no capacity to implement all the necessary ones?

Many common dilemmas related to resource scarcity also have to do with the risks that cutting costs in interventions (to avoid reducing coverage) will mean a loss of quality and effectiveness: Should we sacrifice the quality of our actions in order to carry out simpler and less costly actions that reach more people in need of humanitarian assistance? What do we do if we cannot import drugs from humanitarian purchasing centers that meet all the desirable conditions of quality and safety? What level of training and supervision should we ensure for health workers or community health workers? Where do we place the threshold of "priority" when selecting vaccines for use in an emergency mass immunization campaign?

When resources are scarce, you need to be more efficient

There have been many advances in the humanitarian system to optimize the cost-effectiveness of international action.

Some of the more general advances are related to better coordination among actors (and thus avoiding unnecessary duplication or overlapping), or to improving population needs analysis (which allows us to be more precise about where there is more need and of what type). Others consist of increasing the involvement and participation of the population in decision-making.

On the other hand, progress has also been made in technical aspects. This includes professionalizing and systematizing intervention models (allowing us to scale actions with less cost and effort and in less time) and designing minimum packages of essential interventions. A good example of this is the MISP (Basic Initial Service Package for Sexual and Reproductive Health in Crisis Situations), which helps to discern what is most important in an acute phase of emergency, avoiding devoting resources to reproductive health actions with less impact. Investing in solid learning plans and in the generation of scientific evidence is also key to better identify what works and what needs to be readjusted.

Prioritization is inevitable: the ideal is far from the feasible

It is not enough to be more efficient; it is also essential for humanitarian organizations to be able to carry out an adequate prioritization of geographic areas, populations, humanitarian sectors and specific actions within a sector. This requires not only technical rigor, but also an ethical and political commitment by organizations to prioritize what is most urgent and that the affected population and local duty bearers have less capacity to cope with, the most immediate needs and those that can minimize major risks in the future (such as climate and environment), or geographical and technical areas where our organization has a certain comparative advantage to develop viable interventions, without this being overridden by geopolitical interests or mere socio-cultural proximity.

This prioritization, moreover (to complicate matters a bit more) when improvised, usually goes wrong. It is not possible for an international humanitarian organization that is implementing institutional support programs for health services to react quickly to a sudden emergency and change its intervention model, if it had not addressed the possibility of an eventual change of approach with the local actors with whom it collaborates, or if it had not prepared to access new geographic areas with major obstacles in terms of security, supply chains or availability of personnel, among other things.

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