In a column today, Nicholas Kristof raises possibly the most difficult philosophical question regarding the moral demands of affluence. Kristof and two guests on a trip to Congo met a starving woman who, unless taken immediately to a hospital, would die.
“Instead of spending a few hundred dollars trying to save Yohanita, who might die anyway, we could spend that money buying vaccines or mosquito nets to save a far larger number of children in other villages.
And yet — how can you walk away from a human being who will surely die if you do so?”
The tension here is between the standard utilitarian notion for what we ought to do–the greatest good for the greatest number–and our moral sentiments.
For those who can’t view NY Times Select, the entire column is pasted below.
A Student, a Teacher and a Glimpse of War
June 21, 2007
I’m taking a student, Leana Wen, and a teacher, Will Okun, along with me on this trip to Africa. Here in this thatch-roofed village in the hills of eastern Congo, we had a glimpse of war, and Leana suddenly found herself called to perform.
Villagers took what looked like a bundle of rags out of one thatch-roof hut and laid it on the ground. Only it wasn’t a bunch of rags; it was a woman dying of starvation.
The woman, Yohanita Nyiahabimama, 41, weighed perhaps 60 pounds. She was conscious and stared at us with bright eyes, whispering answers to a few questions. When she was moved, she screamed in pain, for her buttocks were covered with ulcerating bedsores.
Leana, who had just graduated from medical school at Washington University, quickly examined Yohanita.
“If we don’t get her to a hospital very soon, she will die,” Leana said bluntly. “We have to get her to a hospital.”
There was nothing special about Yohanita except that she was in front of us. In villages throughout the region, people just like her are dying by the thousands — of a deadly mixture of war and poverty.
Instead of spending a few hundred dollars trying to save Yohanita, who might die anyway, we could spend that money buying vaccines or mosquito nets to save a far larger number of children in other villages.
And yet — how can you walk away from a human being who will surely die if you do so?
So we spoke to Simona Pari of the Norwegian Refugee Council, which has built a school in the village and helped people here survive as conflict has raged around them. Simona immediately agreed to use her vehicle to transport Yohanita to a hospital.
The village found a teenage girl who could go with Yohanita and help look after her, and the family agreed that it would be best to have her taken not to the local public hospital but to the fine hospital in Goma run by Heal Africa, an outstanding aid group with strong American connections (www.healafrica.org).
Now, nearly four days later, Yohanita is on the road to recovery, lying on a clean bed in the Heal Africa Hospital. Leana saved one of her first patients.
What almost killed Yohanita was starvation in a narrow sense, but more broadly she is one more victim of the warfare that has already claimed four million lives in Congo since 1998. Even 21st-century wars like Congo’s — the most lethal conflict since World War II — kill the old-fashioned way, by starving people or exposing them to disease.
That’s what makes wars in the developing world so deadly, for they kill not only with guns and machetes but also in much greater numbers with diarrhea, malaria, AIDS and malnutrition.
The people here in Malehe were driven out of their village by rampaging soldiers in December. Yohanita’s family returned to their home a few months later, but their crops and livestock had been taken. Then Yohanita had a miscarriage and the family spent all its money saving her — which meant that they ran out of food.
“We used to have plenty to eat, but now we have nothing,” Yohanita’s mother, Anastasie, told us. “We’ve had nothing to eat but bananas since the beginning of May.” (To see video of our visit and read blogs by Leana and Will, go to nytimes.com/twofortheroad.)
I’m under no delusion that our intervention makes a difference to Congo (though it did make quite a difference to Yohanita). The way to help Congo isn’t to take individual starving people to the hospital but to work to end the war — yet instead the war is heating up again here, in part because Congo is off the world’s radar.
One measure of the international indifference is the shortage of aid groups here: Neighboring Rwanda, which is booming economically, is full of aid workers. But this area of eastern Congo is far needier and yet is home to hardly any aid groups. World Vision is one of the very few American groups active here in the North Kivu area.
Just imagine that four million Americans or Europeans had been killed in a war, and that white families were starving to death as a result of that war. The victims in isolated villages here in Congo, like Yohanita, may be black and poor and anonymous, but that should make this war in Congo no less an international priority.
You are invited to comment on this column at Mr. Kristof’s blog, www.nytimes.com/ontheground.