Caroline Williamson Sinalo reviews The Clinical Witness: Conflict, Catastrophe and Medical Testimony, engaging with the complex interconnectedness of contemporary crises and the moral ambiguities, responsibilities, and pain that come with bearing witness to them.
The medical profession occupies a unique, often fraught position within the landscape of human rights, conflict, and global disaster. To interrogate this complex territory, The Clinical Witness, edited by Nicolas Barnett, Nicholas Chare, and Dominic Williams, offers an expansive, interdisciplinary examination of what it means to bear medical witness. By exploring how the status of the physician confers distinct privileges of access and authority in times of crisis, the volume reveals how healthcare professionals are simultaneously exposed to the “unspeakable” and forced to navigate the space between moral compromise and death. Ultimately, these chapters explore the enduring friction between the clinician’s role as an objective scientific observer, their acute moral and professional obligations, and their inherent human fragility in the face of atrocity.
Scope, strengths, and positioning
The volume offers impressive geographical and thematic breadth. It moves beyond traditional clinical boundaries to include “conservation medicine,” forensic nursing, and activist humanitarianism. By addressing contexts as diverse as the Holocaust, the Khmer Rouge regime, the Bhopal industrial disaster in India, the genocide against the Tutsi in Rwanda, and the Haitian earthquake, the volume explores the diverse roles medics can play, whether as victims, activists or collaborators, often highlighting the overlap between these positions. Overall, the text challenges the hegemony of quantitative data, arguing that while “numbers trump narrative” in the medical science “game” (270), statistics alone cannot capture the complex interplay of environmental disruption, conflict, and poverty.
My appraisal of the text draws on my research background in African media studies and the health humanities. Having written extensively on psychological trauma following violence and conflict, my current research focuses on the 2024 mpox emergency—centred in the Democratic Republic of the Congo—and its representation in African news media. By exploring the interaction between this disease and concurrent phenomena such as conflict, inadequate healthcare infrastructure, poor sanitation, environmental degradation, and extractive mining, this work conceptualizes mpox as a critical case study of our contemporary “syndemic” era.
Syndemic theory is a conceptual framework developed by medical anthropologist Merrill Singer (1996), who combined the terms “synergy” and “epidemic” to explain how coexisting health crises interact both biologically and socially within environments of structural inequality. The inherent complexity of analysing health phenomena synergistically—combined with stark inequalities regarding access to what Mohan Dutta terms “communicative infrastructures” (Dutta et al. 2024, 3586) for articulating marginalized perspectives—underscores the vital importance of narrative and storytelling in capturing the lived experiences of syndemic crises.
Central to the theoretical framework in The Clinical Witness is an interview with Robert Jay Lifton, who introduces the concept of “malignant normality”—a state wherein professional structures adapt to and normalize systemic atrocity. For Lifton, the “witnessing professional” is one who explicitly exposes this manufactured normality (151), arguing that “bearing witness is a means of carrying through that responsibility as professionals” (153). This “exposure of truth” (153) is framed not as neutral, detached observation, but as active political advocacy. While acknowledging the structurally ambiguous roles often occupied by such figures, the volume ultimately emphasizes the power of narrative as a vital dimension of medicine in the context of the interconnected crises of our current historical moment.
The syndemic era
The volume’s primary strength lies in its refusal to simplify the medical experience. For example, in its “Coda” on Covid-19, Nicolas Barnett reminds us that we live in a “syndemic” where biological illness is inseparable from the social environment. “Overcrowding, poor housing stock, air quality, psychological well-being, wealth, income inequality and education are some of the manifold factors combining in predictable and unpredictable ways to shape outcomes from Covid-19 and other similar epidemics,” he writes (274).
Since the inception of syndemic theory (Singer 1996), researchers have identified several location-specific syndemics. These include the SAVA syndemic (substance abuse, violence, and AIDS) observed within low-income urban environments (Singer 1996; Hatcher et al. 2019), the VIDDA syndemic (violence, immigration stress, depression, type 2 diabetes, and abuse) shaping the health outcomes of Mexican immigrant women in the United States (Mendenhall 2012), and the DAV syndemic (depression, alcohol use, and violence victimization) intersecting with HIV burdens among transgender women in India (Chakrapani et al. 2017). More recently, syndemic theory has been deployed to deconstruct the intricate interplay among Covid-19, socioeconomic class, racialization, structural violence, and co-occurring chronic diseases (Fronteira et al. 2021; Singer and Rylko-Bauer 2021). The framework has likewise proven vital for analysing a broad array of contemporary health-environment synergistic interactions (Singer et al. 2017).
Several chapters in The Clinical Witness illustrate syndemic thinking without explicitly deploying the term. The most developed example occurs in Section Three, on psychiatric and psychosocial witnessing. Evaluating the Ebola and Covid-19 outbreaks in the DRC, Olea Balayulu Makila (Chapter 9) identifies a profound “crisis in the relationship between the medical establishment and the community” (140). This friction has induced localized “avoidance behaviour,” as medical professionals are frequently viewed as “blood marketeers” profiting from disease—a scepticism further exacerbated by severe social stigma.
This widespread mistrust is not unfounded; public health interventions in the region have historically relied on coercive containment and enforced medication (Richardson 2020). As Richardson (2020, 33) observes, since the colonial era, “the dominant logic for epidemic disease containment … has dictated isolation of sick individuals, with little in the way of patient care.” During outbreaks of Ebola in the DRC, these punitive isolation strategies generated documented cases of depression and anxiety among patients (Epstein et al. 2015 and Etard et al. 2020, cited in Makila, 142). Consequently, Makila underscores that a successful intervention must operate symmetrically with the syndemic itself—simultaneously managing the epidemiological crisis while delivering vital psychosocial support to patients and their families (147).
The ambiguous witness
All while underscoring the analytical power of narrative and storytelling, The Clinical Witness also, crucially, complicates its own paradigm of the “witnessing professional.” In postcolonial contexts, the editors acknowledge that the concept “risks delegitimizing or devaluing the testimony of people who do not have a background in Western science and/or do not belong to recognized professions despite their testimony potentially offering important insights” (Introduction, 14). To illustrate this epistemic exclusion, they cite the Inuit angakkuq (shaman) in northern Canada, whose deep, generational knowledge of localized environmental shifts is routinely marginalized within dominant climate crisis discourses.
This central paradigm is further contested by several contributors who question the inherent virtue of professional structures. Derek Summerfield (Chapter 11), for instance, offers a sober counterpoint to Lifton’s idealism. He notes that while many professions “seem to offer an alternative pole of moral authority,” in practice they “largely served the dominant order” (167). Summerfield directly challenges the presumed moral exceptionalism of the medical field, asserting that “whatever they think privately, most people act pragmatically, not idealistically. The question is whether, say, doctors are any different” (168). His historical survey of institutional complicity in Nazi Germany, apartheid South Africa, and Guantanamo Bay leads him to a “qualified no” (174). Summerfield concludes that physicians are “traditionally a politically conservative group, often closer to power than to those without,” creating an enduring tension between the “doctor as doctor and the doctor as citizen” (174).
This ambiguity surrounding the integrity of the medical witness is a recurring theme throughout the volume. Opening with an examination of the Holocaust, a period that fundamentally fractured the moral architecture of the medical elite, Section One explores the liminal space between accomplice and victim inhabited by camp system physician-survivors.
This moral complexity is most apparent in Dominic Williams’ study (Chapter 3) of Miklós Nyiszli, a Hungarian forensic pathologist forced to perform autopsies for Josef Mengele. Williams highlights the profound ethical precarity of a man occupying the fluid boundary between resistor, objective physician, and functional accessory. Similarly, Monika Rice’s examination (Chapter 4) of Elie Aron Cohen’s confessional narrative explores the fractured division between the moral narrator and the compromised protagonist. Rice traces the severe “moral injury” embedded within Cohen’s traumatic disclosures, revealing a state of self-accusation and self-hatred that disrupts conventional paradigms of survivor identification (83).
A chapter from Section Four, on communication and politics, reinforces the editors’ initial observations regarding structural power imbalances and the inherent “ambiguity of the act of bearing witness” (192) within humanitarian interventions. Didier Fassin (Chapter 13) examines the work of Médecins Sans Frontières (MSF) and Médecins du Monde in Palestine, highlighting the severe sociopolitical asymmetry that characterizes such conflicts and complicates the ethical execution of humanitarian testimony.
The responsible specialist
Without romanticizing its subjects, the volume nonetheless underscores the imperative for practitioners to mobilize their professional privilege and specialized clinical knowledge into active resistance. Section Two illustrates this dynamic through twentieth-century conflicts where the medical record serves as a primary tool for breaking structural silences. Jan-Thore F. Lockertsen (Chapter 6) examines nurses as a distinct category of witness within the Norwegian Mobile Army Surgical Hospital (NORMASH) during the Korean War. He argues that nursing training—rooted in patient ethics and rights—fosters a highly specific, clinical mode of observation unavailable to combatants. This section concludes with Shari Eppel’s powerful evaluation of forensic archaeology in Zimbabwe’s Matabeleland (Chapter 8), which frames forensic reporting as an advanced form of scientific witnessing. By deploying objective empirical methodologies that definitively corroborate unacknowledged community narratives of catastrophic state violence, the forensic team leverages scientific expertise to facilitate a profound “restoration of truth and personhood” for the deceased (134).
The moral and professional responsibility to bear witness reaches its conceptual apex in Section Five. Here, Virginia Lynch (Chapter 16) outlines the specialized competencies of the forensic nurse, who must operate as a “clinical liaison” between medical and legal structures to decipher the systemic “source of the patient’s trauma, pain, turmoil, or illness” (228). Expanding this responsibility to a global scale, Sara Chare (Chapter 17) reflects on the historical evolution of Médecins Sans Frontières, asserting that bearing witness fundamentally requires “acting as a mouthpiece for something bigger and calling people to follow” (238). The expansive duty of the witnessing professional is further exemplified by Satinath Sarangi’s account of the Bhopal chemical disaster (Chapter 18). Sarangi, who faced imprisonment for his political activism, firmly establishes that healthcare workers possess an ethical “role in documenting short- and long-term consequences of corporate crime” (250).
Overall, this final section solidifies the volume’s core thesis: the mandate to bear witness is neither a passive act of observation nor a neutral exercise in clinical reporting. Instead, whether resisting state terror, industrial negligence, or colonial erasure, the witnessing professional leverages specialized knowledge as a deliberate tool of advocacy and accountability.
The nauseated witness
As a scholar who has written extensively on violence, conflict, and genocide in Africa’s Great Lakes region, I was moved by the volume’s penultimate chapter, authored by Hans Husum (Chapter 19). Husum describes the “existential nausea” encountered during his tenure as a conflict surgeon, advocating for a radical shift toward subjectivity and compassion. For Husum, authentic witnessing necessitates active, empathetic alignment rather than detached clinical observation. He fiercely critiques the institutional adherence to “so-called objective narratives” and “evidence-based” medical and media representations, asserting that “a true witness has to stand up and be counted” (264). Yet, as his testimony demonstrates, executing this professional responsibility requires immense moral courage and carries a heavy cost of personal pain.
In summary, The Clinical Witness stands as a vital contribution to the medical humanities, successfully demonstrating that medical practitioners are far more than mere technicians of the body; they are “witnessing professionals” whose narrative authority provides an indispensable check on state violence, systemic conflict, and corporate negligence. While the role of the clinical witness remains structurally and morally ambiguous, it is an entry point uniquely capable of capturing the biosocial complexities of our contemporary era, ultimately working “to help new beginnings emerge” (264).
About the author
Caroline Williamson Sinalo is Lecturer in World Languages at University College Cork, author of Rwanda after Genocide: Gender, Identity and Posttraumatic Growth (Cambridge University Press, 2018), and co-author of Transmitting Memories in Rwanda: From a Survivor Parent to the next Generation (Brill, 2023). She is also co-editor of Representing Gender-Based Violence: Global Perspectives (Macmillan, 2023). Williamson Sinalo sits on the Editorial Board for Critical Arts: A Journal of South-North Cultural Studies and on the Steering Committee of the Development Studies Association of Ireland. Her latest research focuses on multilingual news media narratives of infectious diseases across the African continent.
References
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