Ethics in Humanitarian Medicine

Humanitarian medical projects are designed as temporary interventions, focused on rapid response and adaptable closure based on shifting crises. However, the impact of closing such projects, especially on non-communicable disease (NCD) care in conflict-affected settings, is rarely examined from both patient and staff perspectives. This article explores how national staff navigate the ethical challenges of medical humanitarianism and the tension between humanitarian principles and biomedical ethics during project closure. Through an examination of an international humanitarian paediatric thalassemia unit (2018–2023), I examine national staff experiences of power dynamics, continuity of patient care, and the ethical challenges of withdrawal. Based on four years of participatory ethnography-by-proxy, findings reveal how hierarchical decision-making fosters moral distress by association among national staff. Using inductive sociological analysis, this article highlights the ethical and emotional tolls on national staff, who mediate between affected families and inequitable power structures. These insights underscore the need for continuity-focused, localized approaches in humanitarian NCD care, proposing recommendations to better align organisational practices with the realities faced by national staff and their thalassemia patients. This work advances discussions on localization, advocating for more equitable, context-sensitive humanitarian healthcare frameworks.