How closely humanitarian actors should interact with militaries was an open question during the 2016–2017 Mosul military operation in Iraq. To care for civilians injured during the nine month-long campaign by the Government of Iraq and Coalition forces to retake the city of Mosul from ISIS, the World Health Organization (WHO) coordinated a trauma response that included establishing trauma care pathways by which military forces transferred injured civilians to mobile trauma stabilization points (TSPs) near the frontlines before transporting them to field hospitals approximately one hour away.

Principles in Practice 

One of the most controversial elements of WHO’s plan was setting the TSPs as close to the frontlines as possible by “co-locating” or “embedding” them with specific Iraqi military divisions and moving the TSPs with these divisions as the frontlines shifted. WHO made this decision for security reasons (to protect civilian medical practitioners) and logistical in the reasons (it took too long to send wounded Iraqi soldiers to the Iraqi military’s equivalent of TSPs and wounded civilians to separate, NGO-run TSPs).

WHO asked the International Committee of the Red Cross (ICRC) and Médecins Sans Frontières (MSF), two actors known for their expertise in emergency medicine, to provide services at the TSPs. But both actors declined, citing security concerns and the need for them to maintain independence from the Iraqi military and Coalition forces. Moving nearer the frontlines made it difficult not to “co-embed” and increased the chances that the organizations would be perceived as working in service of the military.

The WHO’s plan was controversial because of the close ties between humanitarians and civilian medical practitioners and the military. WHO, prioritizing the humanitarian imperative and the principle of humanity, saw this as an acceptable trade-off to concerns regarding the principles of independence and neutrality. Other humanitarians felt that any short-term benefits (i.e., saving civilian lives) were outweighed by longer-term concerns about how civilian populations would view the organizations and whether their access to people in need, in Iraq or in other contexts, would suffer.


The Mosul trauma response raises challenging questions about how aid organizations should apply the humanitarian principles during conflict.


Humanitarian organizations should provide aid where it is needed, in a manner that respects individuals’ rights and dignity. Doing so requires humanitarians to consider the short- and long-term consequences (whether positive or negative) of their actions on the people they seek to assist and on their own and other organizations. During the Mosul military operation, some humanitarian organizations determined that the principle of humanity outweighed the principles of independence and neutrality. This decision, and the conflicting opinions of organizations such as ICRC and MSF, highlights the tension (whether real or perceived) between the principles and the choices that organizations must make in order to preserve their humanitarian identity.

Questions to consider 

  • How can your team balance our mandate to provide assistance with the principles of neutrality and independence? Can you find a balance in this context?
  • How might prioritizing the humanitarian imperative affect how CARE is perceived and could it negatively affect your work (understanding that perceptions may change over time)?
  • If it appears (in actuality or perception) that you are co-located or embedded with armed actors, what other actions can you take to elevate your independence and neutrality in order to protect your program participants, partners, and selves now and in the future?
  • What role could advocacy play in ensuring that all actors are held accountable for their actions and thereby help highlight CARE’s independence and neutrality?


Humanitarian organizations should provide assistance without engaging in hostilities or taking sides in ideological, political, or religious controversies. Neutrality helps humanitarian actors secure the access and operational space they need to assist as many people as possible. How armed actors and program participants perceive humanitarians’ neutrality—or whether they perceive them to be neutral at all—is just as important as how humanitarians perceive their own neutrality or whether they are neutral in reality. In the Mosul context, some humanitarians were concerned that working closely with the Iraqi military and Coalition forces required them to compromise their neutrality, harming their reputations and complicating other relief operations.

Questions to consider

  • What might be the impact if your team chooses to remain neutral, or not, in a situation—might it ultimately help or hurt your efforts and those that need aid?
  • Who are the other armed actors involved in a given context and what is the potential risk if you are perceived as too “close” with one or several of those actors?
  • Might compromising on the principle of neutrality save lives? At what cost?


Humanitarian organizations should provide aid in a manner that is autonomous from the economic, military, political, or other objectives of actors present in the operational area. Being independent helps humanitarians remain impartial and neutral. The principle of independence should not imply no or few contacts with authorities or less openness to activities; on the contrary, it should help aid workers develop, safeguard, and explain their autonomy. One challenge to the principle of independence in Mosul was the colocation or embedding of medical practitioners with the Iraqi military and Coalition forces, which made it appear that humanitarians were not autonomous from military or political objectives.

Questions to consider

  • How can you maintain a dialogue with armed actors while maintaining your independence?
  • What types of information should you share—or not or never share—with armed actors to ensure your independence?
  • What might be the impact if you do or do not engage with armed actors?

Maintaining our humanitarian identity depends upon using the principles to guide strategies and operations, which, in turn, involves making difficult decisions. The principles serve as guides in decision-making, but they do not always point in the same direction. Asking questions and thinking through challenging situations and potential benefits or consequences as a team is important.