The words the Roman historian Livy used to describe his own time – he called it an era in which people could bear neither their “problems nor the remedies against them” – seem to resonate with how we feel about our own. It is perhaps out of such a zeitgeist – along with developments internal to specific disciplines – that the social sciences in the last decade have seen a considerable amount of work that shifts the focus of attention from the problems in the world outwards to include the study of responses, interventions, and governmentalities, both nationally and globally, and that does so from a broadly sociological perspective rather than a directly critical one.Footnote ¹

In Humanitarian Reason Didier Fassin diagnoses the rise of a specific set of responses: “a humanitarian government in which particular attention is focused on suffering and misfortune” (p. 7). The diagnosis is based conceptually on an inquiry into a specific moral economy, understood as “the production, dissemination, circulation and use of emotions and values, norms and obligations in the social” (p. 266), and a notion of government, which includes governmental and nongovernmental actors and “should be understood in the broad sense as the set of procedures established and actions conducted in order to manage, regulate and support the existence of human beings” (p. 1).

Humanitarian Reason, Fassin writes in the introduction to the book, “governs precarious lives: the lives of the unemployed and the asylum seekers, the lives of sick immigrants and people with AIDS, the lives of disaster victims and victims of conflict – threatened and forgotten lives that humanitarian government brings into existence by protecting and revealing them” (p. 4). Precarious lives, in this analysis, are not to be understood as an objective, absolute phenomenon but are instead analysed in relation to, and as defined by, those who have power over them. With this, the book raises a very important question: why do the suffering matter? If we bracket the seemingly obvious moral answer that they should matter and allow ourselves to confront this question as an empirical puzzle, we are in a better position to think about the implications of the specific ways in which they get to matter in our times.

The book draws to some extent on the author’s previously published work, which in itself would provide an impressive record of the kind of scholarship and intellectualism Fassin has practiced. Trained in medicine and the social sciences, Fassin has often come to public issues early and has worked in an impressive range of empirical settings. When Fassin was writing on undocumented migrants in the mid 1990s this was starting to be a political issue in France but it was not the object of much academic analysis and it was certainly not the popular topic it is now in the social sciences. By writing about the intersections between public health and migration, Fassin was pushing two subfields – medical sociology and anthropology, and scholarship on migration – to new frontiers. Likewise, his work on MSF (Doctors Without Borders), has become foundational for sociologists, political scientists, and anthropologists working on humanitarian relief.

Fassin has long combined work on and in France with work on Africa and Latin America and he argues in this book that it is necessary to use “the same theoretical approach, and the same empirical procedure to address what is being played out in our society and in distant worlds, what is arising in both national and international arenas” (p. 12). The book includes chapters on the French camps for migrants along the Channel, the Venezuelan response to a natural disaster, and the dilemmas around Doctors Without Borders’ operations inside Iraq. Fassin argues that “the moral economies in operation in health clinics for the disadvantaged and in a refugee camp, in a listening center or the excluded in a poor neighbourhood and in trauma consultation in a war zone in the allocation of scarce resources to the unemployed in the French welfare system or to patients in an African medical aid program, have many points in common which need to be grasped as a whole” (p. 12).

This approach of examining international and national cases of humanitarian government together opens up a focus on phenomena that would otherwise not be visible in the same way. In a remarkable chapter on the distribution of the Fonds d’urgence sociale (Social Emergency Fund) in the late 1990s, Fassin shows that during this period in France humanitarian responses were added to the repertoire of the state itself in the area of social welfare addressing its own citizens. This is an interesting case to consider, given that this type of compassion has largely been associated with charities and with what in Britain is called “the third sector” or “voluntary associations”. We would have expected this type of response as part of state institutions’ dealings with non-citizens, perhaps, and we know it is part of their approach to natural disasters. The case described here does not fit these criteria and it raises important questions about how humanitarian and traditional welfare responses coexist inside state-bureaucracies.

“Humanitarian reason” is for Fassin a cultural phenomenon in an anthropological sense, a phenomenon to be interpreted and analysed in terms of what it includes and excludes symbolically. His analysis of the discussion of AIDS in South Africa, for example, concludes that the focus on children as victims of aids in South Africa sets the responsibility of adults in stark relief. Adult male victims of the disease are seen to bear the greatest burden of guilt. The focus on innocent children also leads to a neglect of the treatment of women beyond the prevention of mother-to-child transmission.

Fassin’s focus on discourse – though he does not use that term very often – also comes through when he explains the hyperbolic reportage of child rape, also in South Africa, with its effects: a focus on child rape, in his analysis, serves to obscure the broader problem of sexual violence and leads to the continuation of essentialist discourses on African men. But Fassin is not afraid to combine this level of analysis with a close and careful look at situations on the ground: he sets discourses on aids orphans in the context of complex demographic data. And he goes into the details of individual applications to the French Emergency Fund, both in an analysis of their wording and in a consideration of the complicated welfare rules that underlie the specific circumstances of the applicants.

Fassin’s insistence on using “the same theoretical approach, and the same empirical procedure to address what is being played out in our society and in distant worlds, what is arising in both national and international arenas”, makes the case studies assembled in this book so interesting to read alongside each other. But, in light of this ambition, it seems an odd choice for Fassin to divide the book into three sections, one with four chapters on France, one with four chapters on the non-Western world and one in-between on France’s border. It is odder that he titles the section with chapters on France “politics” and the section with chapters on other, non-Western, countries “worlds”.

This is partly, one assumes, an issue of making a book that first appeared in France available in an English edition. But it also raises broader questions and points to a theoretical potential, which, from a sociological point of view at least, seems underexploited. One wonders what section headings and what theoretical categories Fassin could have come up with had he allowed himself to go beyond the division into “France”, on the one hand, and “the non-Western world”, on the other, which is, as he himself describes it, a distinction drawn within humanitarian reason itself.

In the conclusion of the book, Fassin makes an interesting observation about a bifurcation within humanitarian reason. He argues that “in poor countries [humanitarian reason] deals with large and often undifferentiated populations, for whom mass initiatives are set in place. In rich countries, it is faced with individuals, whose narratives it examines and whose bodies it scrutinizes” (p. 253). But this still leaves many questions unanswered: What are other variations within humanitarian reason? What are the actors and institutions that matter in the different settings analysed and how do they relate to each other? Doctors Without Borders might be an especially interesting humanitarian organization but it is also a highly unusual one. Different kinds of states, and different scales of statehood, different kinds of ngos, journalists, and other experts might all be part of “government” in a broad sense but how they intersect and how they change is still an interesting question. Do actions of the populations addressed by humanitarian government ever matter? How does humanitarian government relate to and coexist with other forms of government? How does the “present” invoked in the subtitle of the book relate to more specific historical phases? In other words, what are the elements of humanitarian government if we go beyond the level of discourse?

More specificity on these questions across cases would also help trace the history of the elements of humanitarian government. There is, perhaps, no better starting point for such inquiries than this book – with the range and quality of the studies presented – but the framing of the chapters and the combining of general diagnosis and case studies, with little in-between, means Fassin has not yet done all the work for us.