Duke Medical Ethics Journal
COVID and Colonialism
The Past and (Hopeful) Future of Healthcare and Imperialism
By: Elaijah Lapay
On August 4, 2020, the explosion of over 2000 tons of ammonium nitrate rocked the port city of Beirut, the political and economic capital of Lebanon. In a matter of hours, Beirut and Lebanon were forced to contend with sudden irreconcilable deaths, and hospitalizations due to shrapnel and other related bodily damages. A multitude of countries around the world immediately took to aiding the city and country already ravaged by COVID-19, but one country’s attention, in particular, stood above the rest: the French Republic. Less than a week after the fated explosion hit Beirut, French President Emmanuel Macron visited the city, where he made the bold statement to the Lebanese people that “France will never let Lebanon go” (Charleton 2020). Of course, from a sovereign and legal standpoint, France already had let Lebanon go in 1946 when the official French mandate over the Lebanese people came to an end. Yet an online petition calling for Lebanon to return to mandate status in the wake of weak Lebanese leadership (Charleton 2020) paints a different view into the question of the post-colonial relationships between France and Lebanon, particularly during times of exacerbated need.
Instances like these between Lebanon and France pose a greater question as to the responsibility of the French Republic to care for the Lebanese people, particularly in times of disaster. What role have former colonial powers had in shaping health infrastructure in former colonies? Given this role, is there a “correct” recourse for the modern-day interaction between colonial powers and their former holdings? What is the correct way, if one exists, to counter the injustices of colonialism and Eurocentrism in healthcare infrastructure? Is the answer attainable through these colonial relationships or something beyond?
Upon the close of the Second World War and the formation of international organizations like the United Nations (UN), special considerations for the treatment of former colonial holdings, and the legal relationship they are to have with their former colonies post-independence, became enumerated. In the case of the United Nations, this was accomplished through Article 73 of the United Nations Charter. The text of this article called for member states administering — and in the process of relinquishing the power over — these non-self-governing territories to “ensure, with due respect for the culture of the peoples concerned, their political, economic, social, and educational advancement, their just treatment, and their protection against abuses” (Chapter XI 1945). While this section of the charter, similar to further sections of the same article regarding colonial holdings, does not directly refer to the establishment of healthcare, hospital, and medical systems for those in these colonies, it seems to be inferred through the calling for the “just treatment” of peoples, though even this is a claim grasping for straws. Unless stipulated individually within bilateral agreements between colonizing powers and their former holdings upon the granting of independence, no formal agreements were made concerning any responsibility of the colonizer to promote healthcare, no matter the form, upon the colonized. There goes a lack of legal culpability for colonial powers to provide direct health access.
Furthermore, there is documented proof of former colonial powers making explicit choices to avoid the development of healthcare systems for the sake of expenses and encroachment of organizations like the UN into sovereignty, in many cases relegating development of these essential medical services to other intergovernmental organizations and systems rather than directly from the colonizing government itself, devaluing the overall quality of healthcare in these respective countries. For example, fearing the encroachment of United Nations forces and organizations into their colonial holdings in Africa, France made deliberate efforts to stall the creation of a World Health Organization (WHO) office in Africa while at the same time making efforts to create an “inter-African network(s)” of healthcare officials (Pearson-Patel 2015, 11-12). These inter-African networks were meant to demonstrate on paper France’s colonial fulfillments of Article 73 of the United Nations charter but did not thoroughly intend to direct resources toward development since it was able to bypass international scrutiny as its own inter-colonial organization. Underfunded and understaffed, these under-resourced networks would form the basis of healthcare systems of these respective colonial holdings and the healthcare settings of these eventual “independent” colonial holdings. This history of shirking responsibility for the welfare of these countries provide a causal link to the lack of sustainable healthcare resources in the 21st century.
"there is documented proof of former colonial powers making explicit choices to avoid the development of healthcare systems for the sake of expenses and encroachment of organizations..."
The existing attitudes of the French and other colonial powers to continue to exert power and dominion at the expense of those under oppressive colonial regimes are consistent with the earliest semblances of healthcare systems in these respective former colonies. Many colonizing powers provided vague efforts to “civilize,” “improve,” and “develop” populations they ruled (Tilley 2016). Though, in practice, it would be a lack of resources from these colonizing powers that would lay the foundation for much of the early disparate developments of the state of healthcare in these colonies. Furthermore, “pathological revolutions” regarding new European-indigenous contacts and occupational injuries resulting from forced exploitative labor would drastically inflate the costs for acute healthcare, leading to little to no resources left for long term development of healthcare structures; this continual operation in “triage mode” (Tilley 2016) coupled with a lack of resources and support would set what little resources are left for healthcare completely uninvestable into long term infrastructure— the kinds necessary for sudden acute emergencies, the kinds that COVID-19 suddenly introduced to these ill-infrastructured countries.
The Eurocentricity of both the history of medicine present-day medicine is undeniable, but this Eurocentricity has been achieved through European dominance of academic thought and perception in all spheres, including in medical and healthcare professions. It is the recognition of a history of exploitation and shirking of responsibility that is necessary to move forward. Although we continue to grapple with histories of exploitation, we are still forced to confront acute stressors of our present, such as COVID-19. Providing direct aid to these countries simply for the purposes of helping in the short term, regardless if from a former colonial power or Eurocentrically dominated international organization or philanthropy, will immediately do the same thing sought by the first constructors of inter-colonial networks of healthcare did: provide a guise of aid suitable to the standards of the international community, though instead of the then-newly-formed United Nations, it is now the heavily globalized and media-connected international community.
This neoliberalistic view of COVID and other pandemic politics dominated by Eurocentricity has been identified in the past as part of a “politics of enmity,” described as the societal notion that those with the right amount of power and capital are able to determine who has the right to live and die — also known as “necropolitics” — and that these decisions are fuelled by the relative value and productivity that these members of society are able to contribute (Cordeiro-Rodrigues 2020, 118; Mbembe 2019). These politics of enmity have been theorized to trace back to the era of colonialism when colonizing powers determined which colonies deserved capital based on productivity and their ability to process goods. Now, during a time when resources regarding COVID can be considered to be a part of a shared global system dictated by those that have dictated medicine for centuries, it is very much clear when observing the state of healthcare infrastructure from the very beginning that it was the “necropolitical” decisions of colonizing powers (Mbembe 2019) that caused this imbalance of power and perpetuation toward the current state of unequal infrastructural affairs that we see today.
From this line of rationale, it may seem natural to conclude that former colonial powers should have the direct economic responsibility for re-addressing the healthcare infrastructure issues of their former colonies; however, this does not necessarily serve as the best solution either because of the exact sentiments expressed above. Colonialism and imperialism inherently divided the world into different spheres of influence, and the re-establishment of these spheres of influence would strengthen even further a “politics of enmity,” once again asserting the control and reliance of the Global South on Eurocentric resources and infrastructure, even if it was that lack of infrastructure that presented these countries their hardships from the beginning.
Speaking in regard to the exclusion of African philosophy in the development of modern bioethics, Cameroonian bioethicist Godfrey Tangwa proposed that “exploitability tends naturally (and perhaps necessarily) to simulate philanthropy” (Tangwa 2017, 108). Here is introduced additional problems with the re-introduction of colonial linkages for healthcare infrastructure: its framing as charity and its re-opening of former colonies to exploitation and reliance as a form of “moral imperialism.” Statements of mutual aid made by former colonial powers, particularly like those made by Emmanual Macron in regard to the French, are ones predominantly of acute philanthropy stimulated not by a desire to justly improve long term infrastructure, but to introduce a stopgap into the problems caused by explosions, COVID-19, and general political instability caused in part by unresolved conflicts that emerged post-imperial era. If the true intention of these offers were to truly instill aid, then they would not have been in response to an acute stressor, but in response to numerous calls to attention to inequity in healthcare infrastructure, which has even been exacerbated in the past due to previous epidemics like HIV/AIDS and Ebola (Tangwa 2017, 105-7). Offers like these sadly mirror the early “efforts” of the French during the imperial era to care for the health of their citizens, only to provide a mediocre solution that presented well to the public on paper.
COVID-19 has revealed to a great extent that the deficiency in healthcare infrastructure is one of intention and deliberacy, a continual reminder of the hierarchy of resources, and a reinforcement of the “politics of enmity.” However, what warranted these deficiencies was a global adversarial mindset, that there was an enemy to begin with, which is perhaps the most powerful remnant of the era of imperialism that is still held today, not a discourse on colonial holding legacies. In a time where the enemy is no longer one’s neighbor and global infrastructure is the one in need, the question should not lie as to whether money and economic aid should be increased in order to help places with acute need, with or without consideration of colonial linkages; the question should be what will be done infrastructurally to make sure these issues and public health crises such as COVID-19 do not occur again? The hope is that, rather than hoping to fulfill some signatory obligation to protect a subset of countries they once controlled, former imperial powers will acknowledge their modern global position and use it to aid all countries. We must acknowledge the egregious history that colonialism has had on all of our ancestors, but not use that history as a tool to divide each other once again and instead focus on the building up of one another regardless of the histories of the past, towards a more globally infrastructurally sound beyond, both now and in a post-COVID future.
"We must acknowledge the egregious history that colonialism has had on all of our ancestors, but not use that history as a tool to divide each other once again and instead focus on the building up of one another..."
"Chapter XI of the Charter of the United Nations." June 26, 1945. United Nations Foundational Conference. https://www.un.org/en/sections/un-charter/chapter-xi/index.html.
Charlton, Angela, and Sarah El-Deeb. "Is France Helping Lebanon, or Trying to Reconquer It?" The Washington Post. August 08, 2020. https://www.washingtonpost.com/world/middle_east/is-france-helping-lebanon-or-trying-to-reconquer-it/2020/08/08/3b582afe-d94b-11ea-a788-2ce86ce81129_story.html.
Cordeiro‐Rodrigues, Luis. 2020. "Toward a Decolonized Healthcare Ethics: Colonial Legacies and the Siamese Crocodile." Developing World Bioethics 20, no. 3: 118-19. doi:10.1111/dewb.12273.
Mbembe, Joseph-Achille, and Steve Corcoran. 2019. Necropolitics. Duke University Press.
Pearson-Patel, Jessica. 2015. "Promoting Health, Protecting Empire: Inter-Colonial Medical Cooperation in Postwar Africa." Monde(s) 7, no. 1: 213. doi:10.3917/mond1.151.0213.
Tangwa, Godfrey B. 2017. "Giving Voice to African Thought in Medical Research Ethics." Theoretical Medicine and Bioethics 38, no. 2: 101-10. doi:10.1007/s11017-017-9402-3.