Paradoxes of Care: Children and Global Medical Aid in Egypt By RaniaKassab Sweis. Stanford, CA: Stanford University Press, 2021. 208 pp.

Rania Kassab Sweis's compelling ethnography exposes the hypocrisies and self-defeating logics of global medical aid for children in Egypt. Sweis argues that foreign-funded interventions are riddled with paradoxes: they create harm even as they offer helpful support, and they ameliorate “the immediate bodily suffering of some extremely vulnerable children” while “also prolong[ing] the conditions that caused sickness and suffering across child populations” (p. 3). This tightly crafted monograph is a model of ethnographic analysis and will be essential reading for anthropologists of humanitarianism or children/youth. Sweis's secondary argument should come as no surprise to scholars of childhood: that children's rights organizations are premised on a “Westernized” image of the child that assumes its passivity and dependence. Where Sweis stands out from much of the literature on children's rights is in actually establishing why these misrepresentations matter, concretely, in the lives of beneficiaries. Her intricate account of a French-funded shelter for Cairo's street children in the first half of the book exemplifies this. The traits of volatility, willfulness, and agency that aid workers try to deter in children are the same qualities that enable young people to survive and retain dignity on the streets. In one example, 10-year-old Nada resists the authority of aid workers, chafing against their demands for her docility. However, in following Nada into the backroads of urban Giza, Sweis learns that the same assertive stubbornness that attracts censure at the shelter is fundamental to Nada's survival outside of it, where the child shrewdly negotiates with adult shopowners to create a mutually beneficial business model for selling postcards to foreign tourists. The contradictions at the core of medical aid manifest even more dramatically when the reader learns (almost by happenstance) that boys can reside at the shelter overnight, but girls like Nada are ejected back out into the streets after dark to seek refuge on their own. The reason given by the shelter—that shared housing would put girls at risk of sexual abuse from the boys—is almost laughable given the greater spectrum of challenges girls face on the streets. This justification seemingly implies that sexual abuse of girls is a tragic fact of urban poverty that can be lamented, as long as there is no possibility of it occurring under the shelter's roof. While Sweis calls incongruities like this “paradoxes of care,” at times I was left wanting stronger terminology. This is not merely a paradox, as Sweis herself shows; it simultaneously accepts, naturalizes, and perpetuates the violence that it purports to combat. In this and myriad other examples, we catch glimpses of something more complex in the calculus that is used by global aid to determine risk and protection. Sweis repeatedly uncovers an implicit logic prioritizing donor and operational demands over supports that would help children on their own terms, an insight that could possibly have been more explicitly acknowledged in her overall framing. Yet this book does not demonize aid workers or set up tidy oppositions between local or foreign workers and child beneficiaries. On the contrary, Sweis recognizes that aid workers are also constrained by a humanitarian infrastructure that insists upon a particular vision of children's needs. While Sweis acknowledges similar constraints facing the Egyptian state, particularly in the penultimate chapter, she stops short of granting state actors a parallel recognition. It would hardly be fair to list that as a critique, as all books must stop somewhere, but in view of Sweis's nuanced appraisal of children and aid workers, I would have welcomed her reflections on the paradoxes that face state actors, as well. The book is organized in separate chapters for five distinct “types” of medical aid. The first three chapters relate to services provided by the same Paris-based NGO: chapter 1 is located in the abovementioned Cairo street children's shelter. Chapter 2 joins the night patrol of the shelter's mobile medical clinic, bringing medicine directly to the streets. In chapter 3, Sweis enters the offices of a psychiatrist who treats (through psychotropic medications and talk therapy) the trauma that is presumed to be shared by all boys living on the street. However, Sweis discerns that in practice, humanitarian psychiatry doesn't only target boys who are emotionally suffering. Instead, it singles out those who manifest possible aggressive or explosive tendencies. In so doing, mental health treatment “more closely associate[es] them to discourses of violence, danger, and unruly masculinity” (p. 71). Chapter 4 moves to a village initiative to protect young out-of-school girls from early marriage. Sweis attests that, despite its appeal as a space for socializing, the intervention has no effect on girls’ desire to marry young or—as we learn in an almost comical exchange between Sweis and the young women—on the kinds of men they wish to marry. Like humanitarian psychiatry, the most palpable effects seem to be a global entrenchment of Islamophobic ideas about Egyptian boys/men. The final ethnographic chapter turns to advocacy work of a third NGO, which successfully lobbied for a new Child Law in Egypt, based on the principles of globalized children's rights movements. In each of these spaces, Sweis highlights how aid fails to address the underlying structural conditions that create and perpetuate children's bodily vulnerabilities. This argument is not itself novel. What is seminal in Sweis's text, however, and what I hope will make this book a guide for scholars of global aid, is her insistence on returning to nuance rather than wallowing in a register of indignation. Her validation of the children's agency is consistently balanced by her empathy for the aid workers trying to care for them. And just as she shows the variety of motivations and challenges faced by children deemed most vulnerable in Egypt, she also resists any temptation to reduce aid workers to a coherent, dimensionless group. This ultimately, as she asserts, challenges “the typical good/bad or success/failure binaries in terms of which we typically measure global health and medical aid outcomes” (p. 155). In sum, this is an exceptionally readable and teachable text, which offers a prototype for scholars writing about morally complex subjects.

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