As initially posted on the Heartfile blog. Heartfile is a non-profit NGO think tank with a focus on policy analysis and innovative solutions for improving health systems in Pakistan.

It is a great privilege to contribute to Heartfile’s blog, particularly on a day when the only possible first words must honour the Pakistani aid workers brutally shot and killed only a few hours ago. They were leaving a community center with a primary school and medical clinic that press reports note took part in the polio vaccination campaign.I am not an expert in Pakistani health policy. However, my work in organizational ethics raises a reminder relevant to this tragic incident for all engaged in the delivery of health and other human services: security is an ethics issue. Today is not a day for declaring quick-fix solutions. Rather, today is an occasion for reconsidering some fundamental ethical questions linked to security: Where does the responsibility for protection of the lives of aid workers lie? How do we allocate limited resources across many competing healthcare priorities, of which security is only one? What is the appropriate level of global engagement in security issues within a sovereign state but reflecting a danger arising increasingly in many sovereign states?

First, my consulting and teaching work frequently asks “who should be doing what?” to address healthcare challenges from healthcare policy to the extraordinarily complex decision-making, service delivery, funding, and evaluation involved. By this, I mean amongst the constellation of key players – governments, multi-lateral organizations, business, non-profit organizations, donors (individual and institutional), academic and research institutions, individual members of civil society, and beneficiaries of the services (patients and the public) – how do we define the  most effective entry point and contribution for each? How do we link the various players depending on the issue – whether in linear fashion or some complicated web? For today, the question is how should we be rethinking the question of allocation of responsibility for security of aid workers and others? What are the ethical considerations? The only answer for today is that the allocation of roles involves ethics questions and, unlike many issues, every player (including the general public) should have a role.

Second, like all other aspects of the healthcare challenge, ensuring security requires resources. For today, the question is how should we consider the collection and allocation of financial and other resources needed to assure security along with the myriad other healthcare delivery priorities? What are the ethical considerations? The only answer for today is that the allocation of financial and other resources for security involves ethics questions.

Third, tragically incidents involving harm to aid workers are cropping up in many countries.  Today’s tragedy is the entire world’s to mourn. For today, the question is whether and how is this tragedy, and the normalization of harm to aid workers, the world’s challenge to solve or an internal Pakistani problem? The only answer for today is that the role of the global community involves ethics questions.

In sum, as we honour and express our gratitude to today’s victims and their families, we should not forget the ethics of security as the experts scour the technical, logistical, and political aspects of the challenge. No ethics oversight plan or risk management system is complete without addressing security even if no individual or collective ethics efforts can guaranty safety. No security plan is complete without ethics oversight.

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