Food Insecurity, Nutritional Inequality, and Maternal–Child Health: A Role for Biocultural Scholarship in Filling Knowledge Gaps
Barbara A. Piperata & Darna L. Dufour
Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health, especially on nutritional status and, more recently, mental well-being. Current research is dominated by surveillance-type studies that emphasize access, one of food security’s four dimensions. Findings are inconclusive regarding the association between food insecurity and women and children’s nutritional status, but some evidence indicates that it is a key contributor to mental distress in women. To understand these inconsistent findings, we emphasize the need for research on the strategies that people use to cope with inadequate access to food. We contend that biocultural approaches that recognize the importance of local contexts and the role of broader political-economic factors in shaping them are well suited for addressing current knowledge gaps.
Syndemics: A Cross-Disciplinary Approach to Complex Epidemic Events Like COVID-19
Merrill Singer, Nicola Bulled, Bayla Ostrach & Shir Lerman Ginzburg
In this review, we trace the origins and dissemination of syndemics, a concept developed within critical medical anthropology that rapidly diffused to other fields. The goal is to provide a review of the literature, with a focus on key debates. After a brief discussion of the nature and significance of syndemic theory and its applications, we trace the history and development of the syndemic framework within anthropology and the contributions of anthropologists who use it. We also look beyond anthropology to the adoption and use of syndemics in other health-related disciplines, including biomedicine, nursing, public health, and psychology, and discuss controversies in syndemics, particularly the perception that existing syndemics research focuses on methodologies at the individual level rather than at the population level and fails to provide evidence of synergistic interactions. Finally, we discuss emerging syndemics research on COVID-19 and provide an overview of the application of syndemics research.
Catalyst (Open Access)
Special Section: Probing the System: Feminist Complications of Automated Technologies, Flows, and Practices of Everyday Life
In May 2019 the photographic cellphone application Snapchat released two company-generated image filters that were officially dubbed “My Twin” and “My Other Twin,” though users and media labeled them as feminine and masculine, respectively. While touted in most commentary as a “gender swap” feature, these digital imaginaries represent a unique opportunity to consider what features contribute to classification of faces into binary gender buckets. After all, the commonly considered “male” filter makes various modifications—including a broader jaw and addition of facial hair—to whichever face is selected in the photograph. It does not ask and cannot detect if that face belongs to a man or woman (cis- or transgender) or to a non-binary individual. Instead, the augmented reality that it offers is a preprogrammed algorithmic reinscription of reductive gendered norms. When interacting with a novel face, humans similarly implement algorithms to assign a gender to that face. The Snapchat “My Twin” filters—which are not neutral, but rather human-designed—offer an analyzable projection of one such binarization, which is otherwise rarely articulated or visually recreated. Here I pair an ethnographic exploration of twenty-eight transgender, non-binary, and/or gender diverse individuals’ embodied experiences of facial gender legibility throughout life and with digital distortion, with a quantitative analysis of the “My Twin” filter facial distortions, to better understand the role of technology in reimaginations of who and what we see in the mirror.
In contemporary India, AI-enabled automated diagnostic models are beginning to control who gets access to what kind of medical care, with the most invasive systems being aimed at underserved communities. I critically question the dominant narrative of “AI for social good” that has been widely adopted by various stakeholders in the healthcare industry towards solving development challenges through the introduction of AI applications targeted towards the sick-poor. Using feminist theory, I argue that AI systems should not be seen as neutral products but complex sociotechnical processes embedded with gendered knowledge and labor. I analyze the layers of expropriation and experimentation that come into play when AI technologies become a method of using diverse bodies and medical records of the sick-poor as data to train proprietary AI algorithms at a low cost in the absence of effective state regulatory mechanisms. I posit that an overwhelming focus on “spectacular technologies” such as AI derails public efforts from solving the actual needs of populations targeted by the “AI for social good” narrative, and from the development of sustainable, responsible, situated healthcare solutions. Lastly, I offer social and policy recommendations that would enable us to envision inclusive feminist futures in which we understand and prioritize the needs of underserved populations over capitalist market logics in the development, deployment, and regulation of AI systems.
Human/Machine Fusions and the Future of the Cyborg
In 2019 the US Department of Defense (DOD) published a report describing cyborg soldiers equipped with powerful implants, to be deployed by 2050. The DOD’s cyborg enables transhuman fantasies of controlling, augmenting, and weaponizing the body and the environment. The Cyborg Foundation, non-profit organization run by two artists, offers a different approach. These artists identify as cyborgs who aim to perceive the world differently, connect with nature, and expand normative human bodies and senses. In these human/machine fusions, and in cyborg theory, hybridity is an essential part of the cyborg’s appeal. Hybridity, however, can also reinforce binary oppositions or provide the veneer of choice under the mantle of self-regulation and governmentality. Calculated illegibility might afford a different vantage point into cyborg politics, negotiating the sites at which the body is identified and known, and the possibility for opacity, sousveillance, or subversive misrecognition. The Cyborg Foundation offers a useful illustration of calculated illegibility, a way of performing cyborg identity and embodiment that runs counter to traditional cyborg narratives. This article engages a close reading of the DOD report and the Cyborg Foundation, and an interview I conducted with one of the organization’s founders, Moon Ribas, to argue that illegibility better aligns with Donna Haraway’s call for a cyborg politics that disrupts and recodes the hegemonic communication systems and militarized control over the body and the planet.
This article calls for an abolitionist turn in Science and Technology Studies (STS) in order to engage with mass incarceration and the carceral-industrial-complex. Based on my ethnographic fieldwork in New York City jails, this article sets out to (1) argue for an abolitionist STS that intervenes in the racialized logics of “criminal man”; (2) offer the carceral body as arising from this abolitionist intervention into mass incarceration; and (3) illustrate how ontological multiplicities and critical phenomenology might be deployed as abolitionist STS tools. The premise is that ending mass incarceration requires philosophical interventions that resist the current racist, capitalist framework of the carceral-industrial-complex by disrupting the very foundations of reality. Abolitionist STS arises out of feminist and critical race STS as an intervention not only into criminology, but also into social theory’s ontological turn by attending to the interplay of carceral epistemologies and ontologies. When multiplicities, experientialities, complexities, contradictions, and power dynamics are drawn out, abolition is no longer an undoing but a proliferation that disinvests and contravenes carceral logics.
A practice theory approach to primary school physical activity: opportunities and challenges for intervention
Fiona Spotswood, Gareth Wiltshire, Sara Spear, Yvette Morey & Jennifer Harris
A significant body of critical scholarship exists problematizing the dominant behavioural-individualist approaches to public health policy and intervention, and practice theories have been noted for their potential in providing an alternative. Children’s physical activity in primary school settings continues to be a major area of attention in public health, yet no critical examination of a practice theory approach exists in this context. This paper addresses this gap by applying the prevalent three-elements model of practices to the case of children’s school-based physical activity. Drawing on focus group, interview and observation data from pupils, staff and parents at one primary school setting in England, our analysis highlights; first, how the configurations of (a) physical resources (e.g. playground space and equipment), (b) practical know-how (e.g. a skilled understanding of performing the activity), and (c) the socio-cultural significance of practices (e.g. the values and meanings of the activity) impact how, and whether children’s physical activity happens, and is sustained or interrupted; and second, by showing how physically active practices are contingent on being simultaneously in harmony or conflict with other routinized practices of the school day. We conclude that the three-elements model offers a helpful framework for understanding school physical activity which de-centres the individual, but that there are challenges in using this analysis to support primary schools as they attempt to enable physically active practices more effectively. Further research is required to develop and evaluate a practice theory approach to promoting children’s physical activity.
Knowledge and uncertainty in Lyme disease detection: an evidence-based activism research study in the UK
Kate Bloor, Vahsti Hale & Alex Faulkner
There are increasing levels of concern about policy and practice related to Lyme disease testing and diagnosis in the UK. A complex debate has emerged, with patient groups challenging clinical and testing practices. This paper focuses on four dimensions of diagnostic testing: accuracy, types of test, clinical application and test interpretation, to illustrate the divergence amongst and between official and patient group views. We explore these issues via analysis of information from sources including patient organisations’ documents and statutory policy and professional publications, supplemented by data from an online questionnaire survey. Our analysis shows a lack of consistency in policy, consumerist strategies among patients, and official policy that inhibits illness identity and maintains hard boundaries between patients’ experience and public health practice. We suggest that medical policy and practice have become entrenched in defensive testing and clinical protocol. We note recently emerging trends in consultation and patient group involvement, illustrating more participative public health governance. As a joint patient organisation-academic project, we contribute to understanding of patient organisation activism in public health by demonstrating our own collaborative, reflective ‘evidence-based’ activist research. Notably, in doing so we deploy a variety of forms of knowledge and ‘evidence’ beyond the often-acknowledged ‘experiential’ and ‘embodied’ forms. On this basis, we recommend that shared-decision-making and ‘facilitational’ advocacy would improve patients’ empowerment and their experiences of testing and diagnosis. We argue that such reforms will enhance the perceived legitimacy of ‘chronic’ Lyme disease claims even under the prevailing conditions of scientific and medical uncertainty.
In April 2013 the local public health function in England was returned from the National Health Service (NHS) to local government, reversing the transfer to the NHS made in 1974 with the abolition of the medical officer of health. Although many in the field had long felt that local government was the appropriate home for public health given its wide-ranging responsibilities for the social determinants of health, the timing was poor. Local government was in the third year of what continued to be an unprecedented ten-year period of austerity imposed by central government with cumulative cuts of the order of 40% for many local authorities. And despite an initial commitment to a ring-fenced public health grant, this grant has been cut each year since 2015–2016 in addition to the wider local authority funding cuts which have had inevitable knock-on effects on the public health function. Crucial public health services such as early years, smoking cessation and sexual health services have all been cut. Despite these cuts the UK government continues to claim a commitment to improving public health and tackling inequalities in health. This study examines the government’s discourse on funding local public health services, and the ways in which it has responded to critics through a detailed documentary analysis of key government white papers, ministerial statements and its responses to criticisms, particularly from parliamentary select committees and professional bodies. The paper concludes by considering the implications for effective local public health action in a national regime of austerity.
Inclusive health care for LGBTQ+ youth: support, belonging, and inclusivity labour
Christy E. Newman, Sujith Kumar Prankumar, Rob Cover, Mary Lou Rasmussen, Daniel Marshall & Peter Aggleton
Drawing on findings from a study of two social generations of gender and sexuality diverse Australians, this paper offers a critical analysis of expectations and experiences of inclusive health care for LGBTQ+ youth. Data were collected by means of individual and focus group interviews with people from two different social generations who grew up in regional or urban Australia: those born in the 1970s (n = 50) and those born in the 1990s (n = 71). Data were analysed inductively to develop insights into what inclusive health care meant, and what this revealed about the potential for fostering belonging in healthcare settings. Findings raise critical questions about how inclusiveness of care might best be understood in encounters between gender and sexual minorities and health professionals. In particular, forms of ‘inclusivity labour’ were observed across the social generations, both in terms of the work involved in seeking to locate supportive services, and in assessing the performance of clinicians in healthcare settings, with implications for the continued engagement of LGBTQ+ young people with essential forms of care. Mobilising contemporary forms of inclusivity labour, including attention to the affective dimensions of healthcare engagement, has the potential to promote both better health and more meaningful experiences of belonging for gender and sexual minorities.
Antimicrobial resistance as a problem of values? Views from three continents
Alex Broom, Katherine Kenny, Barbara Prainsack & Jennifer Broom
Much has been written about the problem of antimicrobial resistance (AMR) and the action required to rein in this emerging global health threat. Addressing AMR is often operationalised as requiring ‘behavior change’ of clinicians and of patients, in combination with improving the drug development pipeline. Few have approached AMR as a challenge fundamentally embedded within the cultural fabric of modern societies and the (varied) ways they are organised economically, socially and politically. Here, drawing on a decade of work across a range of health contexts, we approach the problem of AMR as one of values and culture rather than of individual behavior. We reframe AMR as a social and political concern resulting from a confluence of factors and practices including: temporal myopia, individualisation, marketisation, and human exceptionalism. To effectively tackle AMR, we advocate solidaristic models that espouse collective responsibility and recognise relative opportunity to act rather than a continuation of the individualistic behavioural models that have, so far, proven largely ineffective.
Using the new medical science of endocrinology, scientific sex researchers in the 1920s and 1930s began studying sex hormone excretion as a means to search for the biological basis of human sexuality. One of these researchers was Abraham Myerson, a leading psychiatrist and researcher from Boston who conducted a series of innovative endocrine experiments between 1938 and 1942 in an effort to establish a relationship between sex hormone excretion patterns and homosexuality in men. While prevailing cultural models of heteronormativity identified male homosexuality as an abnormal case of biological femininity in men, Myerson’s framework and experimental research transcended this limiting duality of sexual biology. Adopting the theory of bisexuality, he argued that all men possessed a natural variability of masculine and feminine traits in their biological, social, and sexual characteristics, and that the disparity among these traits could be quantified and understood using sex hormones. In reconstructing Myerson’s research methods and data analysis, this paper uncovers how he established a distinctive diagnostic method and classification system for male homosexuality and illuminates how he conceptualized and categorized male sexuality as quantifiable and independent of personality.
This article explores the history of what the German-American endocrinologist Harry Benjamin labeled in 1966, “the transsexual phenomenon.” By mid-century, a growing number of individuals in both Europe and America were approaching physicians such as Benjamin searching for answers and means to change their bodies to match their gender. This phenomenon had started in Europe in the 1930s, when the Danish painter Einar Wegener underwent a series of operations that transformed a body defined at birth as male into the female body of Lili Elbe. The news of Elbe’s transformation ignited interest and discussion among physicians as well as the public on the capacity science had to alter bodies to fit their intended selves. The case of Elbe combines the three main aspects studied in this article—the medicalization of the homosexual, the birth of the transsexual, and the physician–patient relationship in transsexual narratives. The study of physician and patient narratives allow us to see how the transsexual phenomenon was in fact created out of the intersection of interests from both physicians and their transsexual patients.
This article explores the emergence of “new” drug users by taking a closer look at the medical records of individuals who received inpatient treatment in the Järvenpää Social Hospital in Finland due to their drug consumption during the years 1965–1975. The hospital focused on social and psychiatric care. The Social Hospital patients differentiated themselves between “classical narcomaniacs” and new users, which indicates that a new user segment had emerged. The hospital staff described the new patients’ personalities as shortsighted and dependent on others but avoided making homogenic or dogmatic psychiatric interpretations. Both the patients and the staff referred to “drug philosophy” or “drug ideology,” which positioned drug consumption in a certain work-avoiding societal context. The main argument is that the Social Hospital archive provides an invaluable source by offering a combination of medical and societal analysis together with patients’ perspectives. Drug use was seen as a social problem that was never simplified into any one cause. Instead, the files offer a nuanced view to drug use and youth culture in Finland.
Changing Psychiatry or Changing Society? The Motion for the Rights of the “Mentally Ill” in Greece, 1980-1990 (open access)
In 1980, the first formal association of mental patients, their relatives, and mental health professionals was founded in Athens, Greece. The Motion for the Rights of the “Mentally Ill” proposed a total restructuring of mental health care and a novel conceptualization of mental illness. On the one hand, it demanded that the mental health system be based on open services, psychotherapy, and on patients’ active participation in all decisions concerning their treatment and life. On the other hand, it conceptualized mental illness as a political issue that concerned all. Thus, the Motion viewed the promotion of the rights of the mentally ill as part of a broader project of cultivating conscious, active, and collective citizenship. This paper traces the Motion’s history during the 1980s, showing that it was shaped by both the socio-political conditions of Greece in the post-dictatorship period, a time of intense politicization, and by the legacy of mental patient activism in the Western world during the 1970s and 1980s. It argues that, although the Motion had a limited long-term impact, it represented the mental patient movement in Greece as it furthered the latter’s main features, most importantly its twofold endeavor to change not only the mental health system and the attitudes towards mental illness, but also society.
Covid-19 and social stigma in hospitals:a new epidemic of signification?
Rubén Muñoz Martínez
Little is known about COVID-19 related stigma and its specific impact both on medical staff and on the care they provide in hospitals in Mexico. In this article I highlight the stigma that doctors who treat COVID-19 in Mexico City hospitals both experience and practice; explore the impact of that stigma on the care they provide and on their own suffering; and describe and discuss how they respond to it. Anthropological knowledge elucidates opportunities to encourage this new “epidemic of signification” related to stigma to become a pandemic of dignity.
In this article, I explore how Marind communities in West Papua experience and interpret hunger. Drawing from Indigenous discourse and practice, I examine how agro-industrial expansion and commodified foodways provoke multiple, conflicting hungers among Marind – for sago, “plastic” foods, money, and human flesh. In tandem, Marind themselves are subjected to the insatiable appetite of various invasive entities – corporations, the government, roads, cities, and oil palm. I argue that hunger constitutes a symbolically charged, culturally constructed, and morally laden experiential mode through which Marind characterize and contest capitalist modernity and its more-than-human dynamics of eating and being eaten.
The Allure of Scapegoating Return Migrants during a Pandemic
Ato Kwamena Onoma
The stigmatization of Senegalese return migrants as COVID-19 vectors by fellow Senegalese during the early days of the COVID-19 pandemic troubles the self/other distinction that underpins the scholarly focus on epidemics and xenophobia and encourages the broader task of exploring epidemics and phobia. The casting of return migrants as COVID-19 vectors was influenced by longstanding ambivalence toward these migrants that had encouraged some Senegalese to seek to “confine” them to Europe long before the pandemic. Old preoccupations help us understand how Senegalese interpreted and deployed COVID-19 control and prevention measures like “confinement,” lockdowns, and border closures.
Medicine Anthropology Theory (Open Access)
This research article critically interrogates the implications and unintended consequences of the World Health Organization’s purported elimination of leprosy as a public health problem. I explore how leprosy has been portrayed (for nearly a century) as something from the past, recalcitrantly lingering on into the present, but surely about to be gone—a temporal framing I call the ‘grammar of leprosy’. I recount the experiences of Daniel, my interlocutor in Tanzania, whose existence became a problem for his doctors. This problem they ultimately resolved by fabricating negative test results in order to record what they already knew: leprosy had been eliminated. I also analyse how researchers working for Novartis (the supplier of leprosy’s cure) continue to push for an always imminent ‘elimination’, while field researchers repeatedly caution about the potential problems of this approach. Finally, I reveal how the grammar of leprosy operates through a complex set of temporal politics, pulling into its orbit and being enabled by multiple interwoven temporalities. I conclude that—due to this grammar, the impossible subjects it produces, and the temporal politics through which it operates—leprosy elimination campaigns may have dire consequences for the lives of people with leprosy today, impeding rather than enabling treatment.
The practice of traditional surrogacy gives rise to multiple discourses around women’s autonomy and kinship practices globally. In the Aotearoa New Zealand context, traditional surrogacy (where the surrogate donates her own egg as well as gestating the foetus) is legal only on an altruistic basis. Furthermore, it is subject to neither medical nor state oversight, unlike gestational surrogacy which is heavily regulated. Drawing on three years of ethnographic research, this article focuses on both traditional surrogates in Aotearoa New Zealand who have children of their own and those who have chosen a childfree life. Their narratives reveal multilayered motivations that align with and diverge from the ‘help’ narrative often associated with altruistic surrogacy. By drawing on and contributing to current debates on surrogacy globally, I show that traditional surrogates take on their role with clear ideas about kinship and different interpretations of reproductive participation. Their narratives bring to the fore the under-researched topic of traditional surrogacy, and in particular of women who do not want children of their own but choose to donate their eggs and gestate the foetus for another woman. I argue that their negotiation of stigma to make/resist kin disrupts pervasive heteronormative modes of kinship.
Within the last decade, challenges of diagnosis have emerged on the global health agenda, accompanied by an expansion in the use of point-of-care and rapid detection devices in low-resource contexts where laboratory facilities are scarce. Few studies have explored how these changes are shaping people’s diagnostic journeys and their modes of accessing such technologies. In this paper I show how sick people and their families in a peri-urban area in Burkina Faso attempt to access diagnostic technologies and make themselves visible to the healthcare system through papers. In this context, I show how referral papers and diagnostic papers take on significance for people as they attempt to access care and diagnostic technologies and ‘carry’ knowledge between different levels of the healthcare system. The use of papers is often an uncertain undertaking, as they remain unintelligible to the sick and the layperson. I highlight how the form of the papers makes a crucial difference to the ways that sick people are able to use them. Papers and diagnostic technologies present both opportunities and challenges, and simultaneously engender hope, uncertainty, disappointment, and despair for the sick seeking a cure. Uncertainties, especially financial ones, arise with the possibility of new referrals and diagnostic tests, and along the way many give up or are immobilised when faced with diagnostic ambiguity.
‘Stay Home, Stay Safe’: Proximity as Vitality and Vulnerability Under Lockdown
Leo Hopkinson & Lydia House
From March to May 2020 in the UK, measures that became known across the world as ‘lockdown’ curtailed personal freedoms in order to curb the spread of the SARS-CoV-2 Coronavirus. While initial criticisms of lockdown focused on the adverse impacts of social isolation on wellbeing, this research article explores how lockdown creates new and altered proximities and intimacies as well as distances. During the initial UK lockdown, the ‘household’ and ‘home’ were deployed in public rhetoric as default spaces of care and security in the face of widespread isolation and uncertainty. However, emergent proximities created by bringing people together in the assumed safety of home also deepened existing inequalities and vulnerabilities. Using anthropological theory, third sector evidence, and ethnographic interview data we explore this process. We argue that understanding proximity and intimacy as fundamentally ambivalent, not normatively affirming, is central to recognising how pandemic responses such as lockdown reinforce and reproduce existing forms of inequality and violence.
This article examines the intersection of compassion and rights, and how the two concepts are constituted and wielded in the context of human clinical trials. Doron, an ALS patient who was recruited to a clinical trial, believed that he had the right to post-trial treatment according to the wording of an informed consent form he signed before joining the trial. However, the biotech company sponsoring the trial instead offered him ‘compassionate use’ access, i.e., access at its discretion rather than as a legal obligation on its part. I argue that under a ‘bioeconomy of value’, the human clinical trial regime has been subordinated to two competing discourses: that of compassion and that of patients’ rights. Both are interpreted and deployed differently by the different stakeholders, namely the patient, the biotech company, and the medical establishment. I argue that the adoption, by bioeconomy actors, of a social value discourse of compassion is designed to preserve a hierarchy that deprives the patient of their power and their rights. Simultaneously, this practice highlights the power of the biotech industry as a moral partner and ‘saviour’ in its relationship with patient organisations and its role as a medical–scientific actor in the Israeli healthcare system.
Until recently in South Korea, the central dilemma facing children with ageing parents was how and by whom their parents should be cared for. In accordance with the norm of filial piety, the eldest son used to take responsibility. However, with the recent proliferation of long-term care hospitals, this arrangement is changing. These institutions, which play the combined role of rehabilitative hospital, long-term care centre, and nursing home, admit elderly people who do not require active medical intervention. The government’s promotion of these hospitals, centred on deregulation, ambiguity around their function, and the lack of alternative care facilities, has led to an expansion of the sector and consequently to the ‘nursing hom(e)fication’ of many of these institutions. While these hospitals ease the pressures associated with an ageing population, their mainstreaming has had an impact on healthcare, medicine, and the lives of elderly people. The hospital field has become commercialised, medical practice is being transformed, and the dignity of elderly people is being lost through hospitalisation. In this new care regime, filial piety itself is undergoing transformation—from an ideology underpinning the domestication of care, to the market idiom of service compliance. In this article, I introduce these hospitals and investigate how their growth has brought about a Korean style of elderly care commodification, revealing the undercurrents of healthcare privatisation and the neoliberalisation of welfare.
When Refugees Care for Refugees in Lebanon: Providing Contextually Appropriate Care from the Ground Up
Diane Duclos, Fouad Mohamed Fouad & Karl Blanchet
Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care.