Research Lead:
Anna Leander
Professor
anna.leander@graduateinstitute.ch

1. Summary
2. Key Figures
3. Research Streams
   • Continuity of Care: Caring for Caregivers and the Material Politics of Humanitarian Design
   • Digitally Designing of the Continuity of Care
   • Medical Records and Improving Continuity of Care
   • Waiting for care
   • Plastic Care: Improvising Continuity Towards Speculative Futures

Introduction

‘In the ditches, fields and valleys around the town, 40,000 soldiers lay wounded or dead, abandoned to their fate.’ Arriving in Solferino on June 24 1859, Henri Dunant was revolted by the sight. This spurred him to take immediate action, ‘dressing wounds’ and asking the victorious armies to release the surgeons they held prisoners to help treat all wounded. As he returned to Geneva, he began urging for the training of ‘relief committees’ in peacetime that could help the wounded in times of war as well as for the formulation of rules protecting these healthcare workers in times of war. This is how the ICRC introduces its ‘160 years on the side of humanity’. In spite of and against the violence of war, medical care needed to continue and medical professionals should follow of the Hippocratic Oath of their profession. This is how the ICRC locates the continuity of medical care as the impetus for humanitarianism. Today, ensuring a ‘Continuity of Care’ remains core to a humanitarianism that extends beyond the battlefield and covers much more than the surgery of wounded soldiers as the ICRC also emphasizes explaining its commitment. HUD asks how to work with design to ensure such Continuity of Care in the present.

Ensuring a Continuity of Care is crucial in all contexts where humanitarians work. Whether the people they support are victims of armed conflict, climate disasters, hunger or something else and whether these people find themselves moving, living in camps, or detained in prison like structures, caring for their health is a basic concern for humanitarians. Humanitarians provide access to care and strive to ensure a continuity of care. They care for the wounded and more. Soldiers, refugees, prisoners and displaced people give birth, fall ill, and more. Care therefore encompasses a wide range of things. First aid, basic care, chronic illnesses, psychosocial support, nutrition, and more. The prevention of epidemics and pandemics also feature centrally in contemporary humanitarian care.¹Redfield Peter (2012) Bioexpectations: Life Technologies as Humanitarian Goods. Public Culture 24(1) 157-184 : Scott-Smith Tom (2015) Control and Biopower in Contemporary Humanitarian Aid: The Case of Supplementary Feeding. So does attunement to diversity and so differential approaches to care and the related development of care that is sensitive to context as well as to the specific needs of for instance women and children or nature.

In their caring, humanitarians affect and are affected by the health care practices in the contexts where they intervene. Care is politics and power.²Tronto Joan (2020) Moral Boundaries: A Political Argument for an Ethic of Care. Routledge. Bellacasa Maria Puig de La (2017) Matters of Care: Speculative Ethics in More Than Human Worlds. U of Minnesota Press. Also in the humanitarian context. How their work relates to and intersects with local health care systems therefore has far-reaching implications for the present and the future Continuity of Care in context. The connections international humanitarian organizations do and do not establish around the treatment of patients. The trainings humanitarians do or do not offer, the management technologies they do or do not introduce, the infrastructures they do or do not build, and instruments and implements they do or do not bring are transformative. So is the funding they do or do not contribute to the local healthcare system. Humanitarian care therefore has afterlives extending beyond humanitarian operations and exceeding their scope. As the ‘internationals’, they leave deep imprints on local systems of care. These imprints may form wounds and vacuums. The imprints may also form a supportive foundation for more sustainable care. International humanitarian organizations and local care providers alike strive to ensure that the imprint is of the latter kind: that humanitarian care supports and sustains the future of care in the contexts where they intervene. How can we ensure that this happens? HUD asks how designing care differently might contribute. More practically, it strives to develop concrete ideas for working with such designs.

Designing care differently is particularly important when the beneficiaries and local care providers experience international humanitarian care is experienced as alienating. The privileged and protected compounds of international, often ‘Western’, humanitarians epitomize this problem even when there are no compounds.³Smirl Lisa (2015) Spaces of Aid: How Cars, Compounds and Hotels Shape Humanitarianism. London, UK: Zed Books Ltd. The alienation generates resentment, rejection and violence.⁴Haar Rohini J., Read Róisín, Fast Larissa, et al. (2021) Violence against Healthcare in Conflict: A Systematic Review of the Literature and Agenda for Future Research. Conflict and Health 15(1) 37. Focus on safety and protection of humanitarians is one response to the challenge this poses for humanitarians providing care but also for the millions of people that depend on their care. However, designing ever more fortified compounds or ever more effective security systems is likely to deepen the problem.⁵Leander, Anna (2019). Le Souci De Soi: The Duty of Care and the Humanitarian Politics of Life. In The Duty of Care in International Relations: Protecting Citizens Beyond the Border, edited by Nina Græger and Halvard Leira, 18-34. London et al.: Routledge. HUD therefore explores an alternative response. Its wager is that redesigning care might make it less alienating. Design solutions could help negotiate the dilemma posed by the tensions between humanitarian privilege and the need for a humanitarian presence. Designing humanitarian care, to bolster its connections to beneficiaries, to the provision of local care and to the local context more broadly is what HUD means by ‘designing care differently’. It is well aware of the challenges. The arrogance of humanitarian care ‘for strangers’ may be so ‘engrained’ that no design effort can dispel it.⁶Rodogno Davide (2020) Certainty, Compassion and the Ingrained Arrogance of Humanitarians. The Red Cross Movement. Manchester University Press. Or, perhaps the design efforts may be so skewed towards upholding these privileges that they cannot even begin the task of conceiving less alienating alternatives.⁷Duffield Mark (2019) Post-Humanitarianism: Governing Precarity through Adaptive Design. Journal of Humanitarian Affairs 1(1) 15-27. If so, the only viable option may be to design for a world without ‘international humanitarians’. Yet, the stakes are too high for us simply to give up without trying. Through a series of connected explorations, HUD therefore aims to contribute to designing care differently.

Key Figures

• In 2024, humanitarian agencies reached nearly 116 million people.
• In 2025, 305 million people are projected to need humanitarian assistance.
• In 2025 (January to May), 378 reported attacks targeting healthcare worldwide caused over 700 deaths.
• Until 2025, USAID programs annually prevented approximately
  • 1,650,000 HIV/AIDS deaths,
  • 500,000 deaths from lack of vaccines,
  • 310,000 deaths from tuberculosis,
  • 290,000 deaths from malaria.
• By 2028, the USAID freeze could lead to 1,200 maternal deaths and 109,000 additional unwanted pregnancies in Afghanistan.
• By 2029, AIDS-related deaths could increase by 400% worldwide if the PEPFAR funding is discontinued.
• By 2030, WHO predicts a shortfall of 11 million health workers in low / lower-middle income countries.

Spotlight:
DR Congo and Colombia

In Colombia and the DRC, humanitarians are crucial for the continuity of health care. In Colombia, the 520.000 migrants crossed the Darién in 2023, the 3 million Venezuelan in Colombia and the victims of acute crisis such as the 900.000 persons impacted by El Nino in 2023 or the violence in Catatumbo that displaced 75.000 people in early 2025 depend on them. In the DRC, the same is true for the more than 6.9 million internally displaced persons and also those affected by acute crises such as the 2025 cholera outbreak, the 2024 resurgence of Ebola, or the 2023 severe food insecurity that affected over 25 million. Across both countries, humanitarians are often the only access point to care —especially for remote communities, survivors of gender-based violence, and ex-combatants reintegrating into society. (In both countries, humanitarian care is essential for the most vulnerable groups, including remote communities, survivors of gender-based violence, and former combatants reintegrating into society). Strengthening sustainable, community-based health care solutions remains a priority in this complex humanitarian landscape.

2. Digitally Designing of the Continuity of Care

An application that will help optimize the use of electricity resources is one of three ‘aid innovations’  discussed as a potential winner of the 2024 ‘Aid Innovation Challenge’ at the Geneva AidEx. Its aim is to ensure the steady electricity supply necessary of a ‘continuity of care’ in humanitarian contexts. The app did not get the prize. Nonetheless, the developer tells me it being ‘rolled out’ in collaboration with Medecins du Monde in Colombia. She is on her way there. She has all kinds of practical and pragmatic concerns. The potential of digital solutions is not one.  ‘Obviously!’ She blurts when asked. She is not alone. The AidEx and the humanitarian world is replete with digital tools and solutions that promise to improve humanitarian health care. Far from the Geneva AidEx, the road leading from the Simon Bolivar Bridge border crossing between Colombia and the Venezuela is lined with little stands selling sim cards and used phones. There is very little else on sale. One might have expected snacks, drinks, shoes, bags and other things a traveler/walker might need. I express my surprise. ‘Obviously!’ My companions balk. The sim cards provide the internet access is the precondition for staying in touch and for getting basic information such as where to head next, or what the rules for accessing health care in Colombia are. They give access to the many platforms and administrative forms that migrants, refugees and people on the move have to access to register for basic support, including to ensure a ‘continuity of care’. The ‘obviously!’ resonates across my conversations with activists, humanitarians, healthcare workers, hospital directors, migrants and public administrators in Colombia and in Geneva and probably beyond.

Any ‘obviously!’ is invitation to question.

The question about the ‘Obviously!’ this research stream will pursue is what the pervasiveness of digital solutions and designs is (not) doing to the politics of humanitarian health care and the possibilities of governing it. Across the world, the continuity of humanitarian care is digitalized and datafied.¹²Johns Fleur (2023) # Help: Digital Humanitarianism and the Remaking of International Order. Oxford University Press.  A forest of applications, platforms, and tools have been developed.¹³Madianou Mirca (2021) Nonhuman Humanitarianism: When ‘AI for Good’ Can Be Harmful. Information, Communication & Society 24(6) 850-868. How do these technologies play into the violence generated by the alienation of the caregivers from those they care for? How are they appropriated by ‘local humanitarians’ and their beneficiaries for their own purposes? What do they do to the tension between the privilege and the desperately needed presence of international, humanitarians? Could designing differently help (further) alleviate these tensions? What would it take to develop such different designs? Rather than starting from the technology, the search for answers begins from the practices that ensure the continuity of humanitarian care, focusing specifically on practices through which care of ‘local humanitarians’ that often begin before international humanitarians arrive and continue after they withdraw. The focus is on locally sustainable forms of continuity of care. To this end, it explores a range of questions about the role of digital design in making the continuity of care and in motioning it ahead, into the future. It asks two sets of questions:

• What do digital designs do to the practices of ‘humanitarian’, ‘continuity’ of ‘care’? How do they merge with, transform and stake out a future for the humanitarians, the kinds of continuity involved in providing care and the notion care itself?
• How do the ‘creative’, ‘commercial’, and ‘collective’ qualities of digital design orient these practices? What are their implications for the sustainable continuities of care involving the local? How does digital design feed into the politics and governance of the continuity of care and for the prospect of different digital designs that alleviate the tensions between humanitarian privilege and presence?

The stream seeks answers these questions with those directly involved, ranging from the developer at AidEx to the client buying a sim card at the Simon Bolivar Bridge. Relying on discussions, observations and participations, it to connects their situated experiences to grapple with what digital designs are doing to the politics of humanitarian continuity of care. Fieldwork in the Colombian regions bordering Venezuela (Norte de Santander and the Carribean Atlantico) and Panama (Antioquia) and ‘International Geneva’ makes this possible. However, the findings are intended to provoke discussions both about the potential of different digital designs in of humanitarian health care and about the significance of digital designs for politics and global governance also beyond the humanitarian continuities of care specifically.

3. Medical Records and Improving Continuity of Care

For migrants traveling through often-treacherous conditions like the passage through the Darien Gap, tracking medical treatment for both acute and chronic conditions is not their main concern. Migrants around the world face disruptions in healthcare due to both lack of access to treatment on the move but also the absence of healthcare records to facilitate proper treatment within existing healthcare systems. Humanitarian organizations and the local healthcare system working in this space are particularly interested in how they can have a comprehensive picture of the health history of the migrants they serve, while acknowledging the privacy concerns that migrants have navigating borders and countries without a legal immigration status.¹⁴Gutierrez, A. M., Hofstetter, J. D., Dishner, E. L., Chiao, E., Rai, D., & McGuire, A. L. (2020). A Right to Privacy and Confidentiality: Ethical Medical Care for Patients in United States Immigration Detention. Journal of Law, Medicine & Ethics, 48(1), 161–168.; Matlin, S. A., Hanefeld, J., Corte-Real, A., Da Cunha, P. R., De Gruchy, T., Manji, K. N., Netto, G., Nunes, T., Şanlıer, İ., Takian, A., Zaman, M. H., & Saso, L. (2025). Digital solutions for migrant and refugee health: A framework for analysis and action. The Lancet Regional Health – Europe, 50, 101190.; Straßner, C., Noest, S., Preussler, S., Jahn, R., Ziegler, S., Wahedi, K., & Bozorgmehr, K. (2019). The impact of patient-held health records on continuity of care among asylum seekers in reception centres: A cluster-randomised stepped wedge trial in Germany. BMJ Global Health, 4(4), e001610.

Access to medical records without sacrificing the identity of a migrant is a complicated issue, particularly in the landscape of the humanitarian organizations increasingly turning to digital tools to assist their missions. While technologies like biometrics, blockchain, and simply the data collected through mobile apps has the potential to help humanitarians in better serving migrants, these technologies also expose migrants to risks.¹⁵Madianou, M. (2019). Technocolonialism: Digital Innovation and Data Practices in the Humanitarian Response to Refugee Crises. Social Media + Society, 5(3), 2056305119863146. Additionally, the simplistic techno solutionist view overlooks the complexities of migration that often results in stolen smartphones or smartphones being traded for services, and the lack of complementary infrastructure like internet and electricity to make use of mobile apps. Therefore, this research explores how technology can be used responsibly to assist migrants and the humanitarians serving them have reliable, simple and secure access to medical records.

4. Waiting for care

Humanitarianism stands against the “sacrificial international order”, according to Médecins sans Frontières (MSF) former President Jean-Hervé Bradol. Yet, this moral position turns into a conundrum at the operational level. In a world teeming with conflicts and disasters and where resources are limited, a “waiting room stretches worldwide”.¹⁶Peter Redfield, “Sacrifice, Triage, and Global Humanitarianism,” in Humanitarianism in Question: Politics, Power, Ethics, ed. Michael N. Barnett and Thomas G. Weiss, Cornell Paperbacks (Ithaca: Cornell University Press, 2008), 196–214. Humanitarian workers face an inherent problem of intervention selection and prioritization. As such, humanitarianism is “a complicated reworking of sacrifice”.¹⁷Ibid.

Where should aid be provided, and to whom, considering scarce resources?

It is here that the notion of triage comes into play.

“Triage has the advantage of representing a system of prioritization based on the facts of suffering themselves. As such, it rejects all other claims to value, disengaging with social, political, or religious criteria that might distinguish one victim from another. Unlike sacrifice, triage is not about exchange, strategy, or passionate connection of any sort. Rather, it emphasizes dispassionate separation and a pragmatic focus on immediate action. At the same time, however, selection necessarily entails loss, giving some things up by virtue of putting others first.”
– Peter Redfield

Triage can either mean a sorting that focuses on survival, prioritizing those with a chance to live, or sorting that highlights severity of need, prioritizing those requiring immediate care. It happens at different levels. At the individuals’ level, prioritization of who “cannot wait” for care may occur through standardized equipments and guidelines such as the Rapid Health Assessment or the MUAC bracelet (Mid-Upper Arm Circumference) used in humanitarian contexts to screen for child acute malnutrition and based on color codes of emergency. Triage can also take place at a more macro level, when deciding when to “allow a project to dissipate, to close” and which ones to prioritize.

Yet, examining humanitarian care and waiting in conjunction extends beyond such logics of triage; spending long hours queuing to register for a support program or waiting by the phone to hear from an organization means this time is not available for other critical activities, like securing a livelihood or spending time with loved ones. Repeated waiting and uncertainty affect dignity and can lead to profound psychological issues. Very pragmatic decisions are always at stake; waiting activates many trade-offs and the development of some expertise and hunches in defining what is “worth the wait”. This is also usually conditioned to the ability to reach an urban center, or for mobile clinics to come when one is located in remote areas.

“I sprained my ankle while crossing the Darién jungle. The doctor in the humanitarian tent at the camp examined me and prescribed medication. The problem is that there was no medication left in stock matching the prescription. What does it mean? It means that I have to wait until I’m in town to get the necessary medicine. But the issue is, the more time you spend in town [to get the medication before taking the boat back to Colombia], the more expenses pile up, and the little money you have left dwindles: renting a mattress for a night, eating… I will wait until I’m back to Venezuela.”
– Conversation with a Venezuelan migrant who has crossed the Darien jungle (at the border between Colombia and Panama) and now forced to return to his country.

And of course, the nature of waiting is not the same when it comes to treating a sprain or caring for a survivor of sexual violence.

Waiting in cases of sexual violence can be very ambivalent. There is indeed the waiting dimension when someone has been a victim of sexual violence and actively wishes to get support. Yet, there are also situations where a person feels something is going wrong, broken, but is not in a waiting situation where they clearly know if they are waiting for something, not being aware that it is possible to ask for external support for instance. And actually, waiting spaces are used strategically: in medical stations, for instance, people go for consultations unrelated to their experience. And there, waiting for something provides the opportunity to learn about potential support. You often have posters that say, “Are you feeling down? Do you feel pain? Do you feel that you can’t talk about what you live with anybody? Here you are in the right space. When you get to a doctor, feel free to discuss your experience.” This is often a place where you send messages without mentioning the term sexual violence, but that people tend to pick up on.
– Conversation with a humanitarian worker 2024.

Waiting disproportionately affects groups that fall outside the conventional narratives surrounding victims of sexual violence. This includes specific populations that humanitarian systems often fail to recognize or understand, such as male survivors.

This research stream, by investigating waiting and care, explores the practices that constitute humanitarianism as a blend of pragmatism, politics of life¹⁸Didier Fassin, “Humanitarianism as a Politics of Life,” Public Culture 19, no. 3 (September 1, 2007): 499–520, https://doi.org/10.1215/08992363-2007-007., and politics of time.

5. Plastic Care: Improvising Continuity Towards Speculative Futures

This stream explores how plastic materials – ubiquitous, malleable, and often overlooked – reshape care practices and spaces in Necoclí, a key transit hub on Colombia’s Caribbean coast. Amid fragile state presence and high mobility, discarded plastics accumulate in the absence of robust waste systems. Yet these materials are not merely detritus: they are reused, repurposed, and revalued through practices of recycling and upcycling, becoming part of improvised shelters, makeshift infrastructures, and local economies of survival. These practices reflect emerging engagements with circular econony principles from below – shaped by necessity, creativity, and care.

Rather than treating plastic solely as environmental hazard or disposable waste, the project draws on Roland Barthes’ famous depiction of plastic as “the very idea of its infinite transformation” to think with its persistent afterlives.¹⁹Barthes, R. (1957). Mythologies. It asks how plastics, as both residue and resource, participate in configuring humanitarian environments and aesthetic-affective attachments²⁰Guyer, J. I. (2016). Legacies, Logics, Logistics: Essays in the Anthropology of the Platform Economy., as well as broader imaginaries of care and future-making. Based on empirical examples, the project contributes to ongoing debates about the material politics of aid, the temporalities of disposability, and the more-than-human dimensions of care.

Publications

ReTooling Care | Louis Potter