The meanings of quality healthcare in humanitarian settings

  • Clare Atterton

Student thesis: Phd


This research seeks to answer the question What are the meanings of quality healthcare in humanitarian settings? The research is multidisciplinary in its approach and draws on literature from the sociology of health and illness, nursing, science and technology studies and anthropology. It employs an ethnographic approach using the following methods: participant observation and formal and informal interviewing techniques. Médecins Sans Frontières (MSF) is an influential international medical humanitarian organisation. In 2019, MSF provided healthcare in 436 projects in 70 different countries around the world (Médecins Sans Frontières, 2019). My fieldwork took place at three MSF project sites: Agok hospital in Agok, South Sudan, the MSF day care centre in Athens, Greece and the primary healthcare clinic in Chios, Chios Island, Greece, facilitated through MSF Operational Centre in Geneva (MSF-OCG). The conceptual framing for this study places quality as a process, mediated and determined by the collective relationships in the healthcare assemblage. Staff, patients, materials, spaces, ideas, legislation, security and assumptions are all actants that can impact on the quality of care provided. The care assemblage in humanitarian settings is dynamic, shifting and unstable, reacting to imbalances in resources, implementation of changes and fluxes of increased physical work or emotional intensity. In taking a qualitative approach to quality, framed in ethnographic methodology, this research recognises the variability in relationships of care giving in the messy context of humanitarian settings. The research does not test a hypothesis of what quality is or measure the performance of quality using specific data points. Rather, in recognising the variabilities in the care assemblage this work emphasises the importance of looking beyond things that can be counted to understanding quality as a relational process. This work is a response to the limited critique of the quality narrative and the untouched research agenda around the applicability of transferring the quality narrative from higher income, resource rich countries to resource poor settings. In addition, it addresses the paucity of knowledge on the everyday practice of health professionals in humanitarian settings. On a wider scale, the significance of this research lies in the raising of the question. In an inequitable landscape, raising the question of quality forces the recognition of inequalities, both globally and within the humanitarian system.
Date of Award1 Aug 2021
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorBertrand Taithe (Supervisor) & Rubina Jasani (Supervisor)


  • participant observation
  • quality narrative
  • South Sudan
  • Agok
  • ethnography
  • care assemblage
  • MSF
  • quality healthcare
  • Greece

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