Neuman's book looks at a number of case studies in which local MSF staff made judgment calls, at times deciding to overlook a government's inhumane actions – such as the aerial bombing of civilian areas in Yemen in 2009 or the shelling of Tamil civilians by the Sri Lankan Army in 2009 – in order to maintain health facilities for larger dependent communities.
What aid groups need to do, Neuman says, is use their ethical and practical judgment to design projects that help as many people as possible and to "make sure they are not causing more harm than good."
Heather Hughes, the global security adviser for Oxfam Great Britain in London, agrees that aid groups have to make decisions based largely on whether the reward of making a difference – in saving lives at Somali refugee camps, for instance – is worth the risk of losing staff members in what appear to be targeted attacks.
Such attacks, Ms. Hughes says, force aid groups to question not just their security protocols but also their reason to be in a risky zone. "Globally, we do accept a higher level of risk for certain kinds of work, where there is a humanitarian imperative, such as camps where if we pull out then people will die," she says.
If aid workers are getting targeted, it's because they work on the front lines of what is effectively a broader war for political control. In Afghanistan, where US troops and contractors have taken on traditional development work – building schools, digging wells, training hospital personnel – aid workers complain that villagers have difficulty distinguishing between aid workers and combatants.