Peace in the Clinic: Rethinking “Global Health Diplomacy” in the Somali Region of Ethiopia


Drawing on ethnographic research with Somalis, within aid organizations, and within health care facilities in the Somali Region of Ethiopia, this article argues that what is called “global health diplomacy,” despite its origins and articulations in interstate politics, is fundamentally local and interpersonal. As evidence, I outline two very different health programs in the Somali Region of Ethiopia, and how, in each, existing animosities and political grievances were either reinforced or undermined. I argue that the provision of health care in politically insecure and post-conflict settings like the Somali Region of Ethiopia is precarious but pivotal: medical encounters have the potential to either worsen the conditions in which conflicts and crises recur, or build new interpersonal and governmental relations of trust. Effective global health diplomacy, therefore, cannot be limited to building clinics and donating medicine, but must also explicitly include building positive relationships of trust between oppositional groups within clinical spaces.

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  1. 1.

    “Habesha” is an ancient term that previously referred to persons who were part of the Axumite then Abyssinian Empires, but today is colloquially defined as persons of Amhara or Tigrynia ethnicities residing in Ethiopia or Eritrea, or persons who speak either Amharic or Tigrynia languages as a first language. In eastern Ethiopia, the term “Habesha” is the most common signifier for Amharic-speaking individuals.

  2. 2.

    No one I spoke with could provide an exact figure of the number of persons killed, and the available archival data did not detail violence or military activity in the Somali Region at this time.

  3. 3.

    All personal names have been changed to ensure anonymity.

  4. 4.

    Tuberculosis medications were not available and DOTS was not possible given the limited mission of the mobile team. I did not investigate further why Yonis received amoxicillin, but in the Somali Region, it is the most common and expected treatment for acute respiratory illnesses.

  5. 5.

    The highlands of eastern Ethiopia are known for the cultivation, consumption, and export of high-quality khat (jaat in Somali language, scientific name Catha edulis). Khat is an evergreen flowering plant picked for consumption of its mildly narcotic leaves.


  1. Abbay, Alemseged 2004 Diversity and State-building in Ethiopia. African Affairs. 103(413):593-614.

    Article  Google Scholar 

  2. Adams, Vincanne, Thomas E. Novotny and Hannah Leslie 2008, Global Health Diplomacy. Medical Anthropology: Cross Cultural Studies in Health and Illness. 27(4): 315-323.

    Article  Google Scholar 

  3. Biehl, João Guilherme, Byron, Good, and Arthur, Kleinman 2007, Subjectivity: Ethnographic Investigations. University of California Press, Berkeley.

    Book  Google Scholar 

  4. Carruth, Lauren. 2014 Camel Milk, Amoxicillin, and a Prayer: Medical Pluralism and Medical Humanitarian Aid in the Somali Region of Ethiopia. Social Science and Medicine. 120 (2014): 405-412.

    Article  Google Scholar 

  5. Cumming-Bruce, Nick 2014 W.H.O. Chief Calls Ebola Outbreak a ‘Crisis for International Peace. The New York Times. 14 Oct 2014.

  6. Federal Democratic Republic of Ethiopia Ministry of Health (FDREMH) 2011 HSDP IV. Annual Performance Report. Addis Ababa, Ethiopia.

  7. Fidler, David F 2011 Navigating the Global Health Terrain: Mapping Global Health Diplomacy. Asian Journal of WTO & International Health Law and Policy 6(1): 1–43.

  8. Hagmann, Tobias 2005 Beyond Clannishness and Colonialism: Understanding Political Disorder in Ethiopia’s Somali Region 1991-2004. Journal of Modern African Studies. 43(4): 509-536.

    Article  Google Scholar 

  9. Hagmann, Tobias and B. Korf 2012 Agamben in the Ogaden: violence and sovereignty in the Ethiopian-Somali frontier. Political Geography. 31(4): 205-214.

    Article  Google Scholar 

  10. Hagmann, Tobias, and Markus Hoehne 2009 Failures of the State Failure Debate: Evidence from the Somali Territories. Journal of International Development. 21:42-57.

    Article  Google Scholar 

  11. Hein, Wolfgang 2013 The New Dynamics of Global Health Governance. In Global Health Diplomacy: Concepts, Issues, Actors, Instruments, Fora and Cases. Ilona Kickbusch, Graham Lister, Michaela Told, Nick Drager eds. pp. 55–72. New York: Springer.

  12. Human Rights Watch 2008 Collective Punishment: War Crimes and Crimes Against Humanity in the Ogaden area of Ethiopia’s Somali Region.

  13. ICF International 2012 Atlas of Gender and Health Indicators: Data from the 2011 Ethiopia Demographic and Health Survey. Calverton, Maryland, USA: ICF International.

    Google Scholar 

  14. International Crisis Group 2013 Ethiopia: Prospects for Peace in the Ogaden. Africa Report Number 207. 6 Aug 2013. Brussels, Belgium.

  15. IRIN 2009 “Ethiopia: Malnutrition critical in Somali Region.” IRIN, July 16 (Accessed 14 Jan 2010). Provided by the UN Office for the Coordination of Humanitarian Affairs.

  16. Kickbusch, Ilona 2011 Global health diplomacy: how foreign policy can influence health. British Medical Journal. 2011:342.

    Google Scholar 

  17. Kickbusch, Ilona, Silberschmidt, Gaudenz, and Buss, Paulo 2007 Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health. Bulletin of the World Health Organization. 85(3):230–232. doi: 10.1590/S0042-96862007000300018. Accessed 11 March 2015.

  18. Kleinman, Arthur 1981 Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry. Berkeley: University of California Press.

  19. Kleinman, Arthur 2000 The Violences of Everyday Life: The Multiple Forms and Dynamics of Social Violence. In Violence and Subjectivity, Veena Das, ed. pp. 226–241. Berkeley: University of California Press.

  20. Lakoff, Andrew and Stephen J. Collier, eds. 2008 Biosecurity Interventions: Global Health & Security in Question. New York: Columbia University Press.

  21. Ratzan, S. C. 2013 Innovation in the Post-MDG Environment: Advancing Global Health Diplomacy in Pursuit of the Global Good. Journal of health communication. 18(5), 479-484.

    Article  Google Scholar 

  22. Samatar, Abdi Ismail 2005 Ethiopian Ethnic Federalism and Regional Autonomy: The Somali Test. Bildhaan: An International Journal of Somali Studies. 5:44-76.

    Google Scholar 

  23. U.S. Department of State 2015 About the Office of Global Health Diplomacy. Accessed 9 March 2015.

  24. UNICEF 2009 Mobile Health & Nutrition Team Annual Review 2008. UNICEF and the Ministry of Health. Jijiga, Ethiopia, 2009.

    Google Scholar 

  25. UNICEF 2014 Mobile Health & Nutrition Team Review 2014. UNICEF and the Somali Regional Health Bureau. Jijiga, Ethiopia.

    Google Scholar 

  26. Whyte, Susan Reynolds 2009 Health Identities and Subjectivities: The Ethnographic Challenge. Medical Anthropology Quarterly. 23(1), 6-15.

    Article  Google Scholar 

  27. Whyte, Susan Reynolds, Sjaak van der Geest, and Anita Hardon 2005 Social Lives of Medicines. Cambridge: Cambridge University Press.

    Google Scholar 

  28. Yamamoto, Donald Y 2013 Testimony. Acting Assistant Secretary, Bureau of African Affairs Before the House Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations. Washington, DC.

  29. Young, Allan 1982 The Anthropologies of Illness and Sickness. Annual Review of Anthropology. 11:257-285.

    Article  Google Scholar 

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Correspondence to Lauren Carruth.

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Carruth, L. Peace in the Clinic: Rethinking “Global Health Diplomacy” in the Somali Region of Ethiopia. Cult Med Psychiatry 40, 181–197 (2016).

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  • Global health
  • Humanitarian assistance
  • Post-conflict reconciliation
  • Peace
  • Horn of Africa