Increasingly humanitarian organizations will find themselves responding to health emergencies provoked by the adverse effects of mining and other extractive industries, setting up a potential clash to do with the core principles and values at the heart of humanitarian medicine, writes Philippe Calain from the humanitarian medical organization, Médecins Sans Frontières (MSF), in this week's PLoS Medicine.

"A pragmatic approach of engagement with the corporate sector for the delivery of aid, or an implicit support to mainstream development agendas could compromise the legitimacy of humanitarian medicine," argues Calain. He continues, "A principled understanding of humanitarian medicine entails selfless moral commitments that are incompatible with the for-profit objectives of corporate industries."

Drawing on MSF's experience responding to the "worst lead poisoning epidemic in modern history" resulting from artisanal gold mining in Nigeria's Zamfara state, Calain explores the pitfalls, difficult alliances, and challenges medical humanitarian organizations must navigate in confronting the dire health consequences resulting from extractive industries, whether informal, illegal, or sanctioned.

He argues that, in developing countries, extractive industries (including ore mineral mining and oil extraction) have far reaching consequences on health through environmental pollution, communicable diseases, violence, destitution, and compromised food security. While humanitarian organisations might be called to intervene in areas occupied by the extractive sector, Calain argues that oil and mineral exploitation reveals a fundamental clash of values between humanitarianism, the for-profit sector, and privatised global philanthropy.

Operating in this relatively new terrain for medical humanitarian organizations -- outside the traditional humanitarian response to armed conflict, epidemics, and natural disasters -- requires a deeper examination of which types of compromises and alliances are acceptable. Responding to these kinds of emergencies, warns Calain, cannot be reduced to the development of medical and technical expertise alone.

"While advocacy and expansion of their operational expertise are obvious paths for non-governmental organizations, a more complex and ideologically loaded question to solve is about what type of relationships humanitarian organisations should entertain with the corporate sector," writes Calain. "Specific medical humanitarian organisations can respond to these challenges in different ways, based on their position between pragmatic or principled approaches, and their willingness to develop new technical capacities."

According to Calain, many mainstream medical humanitarian organisations would rather opt for no engagement with the natural resource extraction sector due to questions of values and conflicts of interest.

He concludes: "the Zamfara outbreak has called attention to a novel agenda for medical humanitarian organisations, including technical preparedness for environmental disasters, dialogue with international environmental organisations, and a better understanding of the exact role of resources extraction in perpetuating humanitarian crises."