Ethical guidance or epistemological injustice? The quality and usefulness of ethical guidance for humanitarian workers and agencies.

This paper explores the quality and usefulness of ethical guidance for humanitarian aid workers and their agencies. We focus specifically on public health emergencies, such as COVID-19. The authors undertook a literature review and gathered empirical data through semi-structured focus group discussions amongst front-line workers from health clinics in Cox's Bazar, Bangladesh and in the Abyei Special Administrative Area, South Sudan. The purpose of the project was to identify how front-line workers respond to ethical challenges, including any informal or local decision-making processes, support networks, or habits of response.The research findings highlighted a dissonance between ethical guidance and the experiences of front-line humanitarian health workers. They suggest the possibility: (1) that few problems confronting front-line workers are conceived, described, or resolved as ethical problems; and (2) of significant dissonance between available, allegedly practically oriented guidance (often produced by academics in North America and Europe), and the immediate issues confronting front-line workers. The literature review and focus group data suggest a real possibility that there is, at best, a significant epistemic gulf between those who produce ethical guidelines and those engaged in real-time problem solving at the point of contact with people. At worst they suggest a form of epistemic control-an imposition of cognitive shapes that shoehorn the round peg of theoretical preoccupations and the disciplinary boundaries of western academies into the square hole of front-line humanitarian practice.