This is a PhD thesis which has been transformed into a book. It addresses the issue of Taiwan's unique status as, in Guilloux's words, having all of the attributes of a sovereign state, and yet suffering diplomatic isolation and being unable to assert any form of sovereignty. Taiwan's irregular position is something that is returned to again and again in the work, as it looks at this issue through the specific prism of humanitarian aid, and in particular aid related to medical assistance. The key case study, which takes up the middle chapters of the book, is Taiwan's quest to be granted observer status on the World Health Organization (WHO). In fact, Taiwan was to achieve this goal early last year, after this book was completed. In that sense, the timing of its publication is a little unfortunate, as some of its main arguments need slight updating and modification. But the principles it addresses remain the same, as does the guiding question: in what way is aid a political tool for Taiwan, rather than an altruistic method, and if it is a political tool, has it so far proved successful?

The introduction and second chapter outline what Guilloux calls an “analytic framework” by which the roles of state, non-government organizations and businesses are linked both to the issue of legitimacy and sovereignty, and then to humanitarian action and governance. Taiwan's unique status, the historic background of which is sketched out, has necessitated its use of unconventional means to carve out international space. While business people on the whole have ignored government campaigns to diversify their investment and have, since the early 1990s, divested enormous amounts of capital in the mainland, regarding negatively any moves that might politically rock the boat between the mainland and Taiwan, non-government actors have been of definite interest to the government due to their ability to work internationally, promoting Taiwan's aims for greater recognition, and pushing its case in UN agencies and other multilateral organizations.

Taiwan has used NGOs in particular in its long-running campaign to join the WHO, making it difficult to extricate the political motives behind its humanitarian intervention in medical crises from the purely altruistic. This is not helped by what Guilloux explains as the government's unwillingness to be transparent about how much and where it is spending on such efforts, through fear this would arouse a counter-bidding move by the mainland. Entry to WHO is not sought because Taiwan needs any help with its own medical system, which is one of the best in the world (its developmental benchmarks are staggeringly high). And the case of Malawi, where Taiwan had a successful and active AIDS prevention project up until 2008, when it was withdrawn because of the country switching diplomatic allegiance to Beijing, is used to show that the claim that political considerations don't come into it is simply not true. Even so, the true effectiveness of Taiwan's medical humanitarian aid in gaining diplomatic returns is highly questionable. There is no clear-cut example that shows that Taiwan's efforts here secured it any recognition, nor that they made it feel more secure.

Guilloux's conclusion, after focusing on these specific issues, is that Taiwan's status remains so irregular that it is almost unique. Its options have been gradually reduced in the last decades since its departure from the UN and the refusal of the mainland to allow it any legitimate international voice of its own. In many ways, its involvement in any international organization or movement has to be renegotiated with huge effort each time. For WTO and the Asia Development Bank it is a “customs” territory. For the Economic Cooperation Framework Agreement signed in June 2010 with the mainland, it is spoken of as “a shore.” Guilloux's proposal is that Taiwan has little choice but to use what leverage it can in aid distribution and activity, but that it has to have a more focused approach. Its policies have been poorly co-ordinated in recent years, with the WHO observer status being a particular case in point.

This work contains much useful research. It is full of questions, and written in a lively style. A good part of it is as much about the structures and politics of international organizations like the WHO, UNAID, or UNESCO as it is about Taiwan's role in these. It is based on a combination of written materials and interviews with officials, NGO actors and other observers, inside and outside Taiwan. One issue that this does powerfully convey is Taiwan's diplomatic quandary – being a nation of over 20 million largely rich, largely successful, largely well-educated people who are simply denied a normal status because of a diplomatic schism from six decades before. The data cited here shows that most Taiwanese now have a far stronger sense of being from Taiwan than being Chinese. The election of Ma Ying-jeou as president is only mentioned in brief in the book, but his more conciliatory approach to cross-Straits relations, and President Hu Jintao's reciprocation, at least show some progress. Whether WHO observer status, however, will satisfy Taiwan's hunger to be recognized and normalized is another matter. For the moment, its world remains a lonely one, and there is no more hint of a final resolution in sight than four decades ago when it departed the UN.