Paradoxes of Care: Children and Global Medical Aid in Egypt By Rania Kassab Sweis, Stanford, CA: Stanford University Press. 2021. pp. 208.
Jess Marie Newman
How can a single child body remain healthy when society at large is sick? The tensions embedded in this motivating question ripple out through Rania Kassab Sweis’s lucid and compassionate ethnography Paradoxes of Care: Children and Global Medical Aid in Egypt. With clear, evocative writing, Sweis shows how multiple logics of aid mark specific bodies and locations as variously dangerous, vulnerable, innocent, traumatized, and promissory. Paradoxes of Care brings anthropological critiques of humanitarianism into conversation with childhood studies to explore the gaps between vulnerable Egyptian children’s lived experiences and the way that humanitarian interventions constitute vulnerable children through daily practices of care and discipline across shelters, mobile clinics, and rural empowerment programs.
The book’s episodic organization grounds readers in different ethnographic moments to unpack how humanitarian practices apprehend the book’s two primary populations: street children and out-of-school village girls. The transnational will to empower certain child subjects and the fixation on child bodies as substrates for emancipation are key problematics that weave together each of the book’s ethnographic episodes. Through close attention to the bodily practices and discourses that constitute these two multifaceted figures, Sweis unpacks the local stakes of giving and receiving aid in a context of ambient violence. Sweis asks readers to consider what it means to heal physical wounds without attending to daily, multiple harms that “vulnerable children”—a category that forms and deforms throughout Egyptian political history and humanitarian logics—navigate beyond the discrete spaces of care.
Paradoxes of Care demonstrates how the Western, post-Enlightenment bracketing of childhood as a distinct biological and social phase fails to obtain in Egyptian contexts, and how this very failure signals key blind spots in global humanitarian logics. Sweis critically interrogates “the child” and especially “the girl” as categories that cut across post/colonial encounters, highlighting the endurance of Islamophobic, imperial logics in employee manuals, grant documents, and United Nations declarations.
Through interviews and observations with aid workers and children, Sweis shows how the categories “street children” and “village girl” activate parallel, gendered constructions of vulnerability that operate through the body. To gain access to shelter and services, Cairene street children “had to exhibit the marks of homelessness: an unmistakably thin, frail body, worn-out, dirty clothes, an odor that indicated they were on the streets, and unwashed, matted hair” (78). Frail girl bodies that appeared “beaten (madrubin)” (81) constituted an instantly legible category of “deserving” street child (79) who was physically, emotionally, and sexually vulnerable. These same bodies become the locus of interventions designed to empower the girl child through exercise and hygiene.
As aid workers elaborated the deserving girl child through bodily care and discipline, they also constructed her opposite: the “suspicious” (79) or threatening street boy. Aid workers understood Egyptian street boys to be fundamentally traumatized, both physically and psychically. Boys nevertheless provoked anxiety in institutional spaces of care, in part because norms of Egyptian masculinity conflicted with the assumed passivity and dependence of normative childhood. Smoking, fighting, and other bodily practices structure how street boys grow into adult Egyptian masculinity. Aid workers understood these gendered survival strategies and, in some cases, were more lenient with boys than girls when they asserted their independence.
A particular, subtle strength of Sweis’s analysis of Egyptian childhood is her attention to how psychiatric framings of childhood trauma blend sociomedical and security discourses, thereby investing child bodies with frictious futurities. Beyond statist rhetoric laying claim to children as the nation’s future, traumatized boys and out-of-school village girls embody divergent potential impacts on their communities. Traumatized boys were a particularly urgent figure in nongovernmental organization (NGO) documents and professional imaginaries because their trauma was also a perceived threat: without the right care, traumatized boys would grow into violent men who harmed their communities and, by extension, the nation. The traumatized boy gives readers local purchase in familiar global development discourses surrounding youth bulges and unemployment in the Global South, and especially the Middle East and North Africa. In this way, Sweis’s work intervenes not only in critical studies of humanitarianism but also in security and terrorism studies.
Out-of-school village girls, on the other hand, embodied a different set of threats and promises for rural aid workers. Sweis attends to the ways that village girls become targets of child rights advocacy targeting child marriage and domestic labor. Intensive focus on her body—its confinement or freedom, its role in self-esteem—justifies a host of interventions facilitating the village girl’s access to her right to play. Programs were premised on the assumption that village girls were always already vulnerable to exploitation through child marriage and domestic labor, two critical imaginaries in child rights advocacy. Theoretically, village girls who benefited from empowerment programming would not only improve their own life prospects but also bring progress to their communities. Through close attention to program goals and beneficiaries’ self-perception, Sweis explores how the bodies of village girls become the terrain on which aid workers and families struggled over “culture” and “rights” (109).
One of the titular paradoxes of care surrounding the village girl, however, was the reality that these girls actively desired marriage and exercised agency in accepting or rejecting proposals. Beyond this, empowerment programs did not prevent girls from participating in domestic labor; they merely shifted the hours that girls devoted to these duties. Through this and other examples throughout the book, Sweis consistently demonstrates that interventions targeting isolated bodies from their social and structural contexts will inevitably fail to achieve their desired outcomes.
Paradoxes of Care begs to be taught alongside the canonical literatures it engages. Chapters like “Do Muslim Village Girls Need Saving?” lend themselves to introductory feminist and area studies courses alike. Sweis’s careful engagement with her key literatures provides a positive example to young scholars seeking to build theory, although it sometime pulls focus from her ethnography and argument. Graduate students with a background in anthropology or Middle East studies will intuit how Sweis engages with theory and canon, while an undergraduate reader would require more historical and regional explication.
Sweis’s ability to capture Cairo with an economy of words, and to bring the traffic, noise, and pollution into her theorization of vulnerability and exposure, is another signal accomplishment of Paradoxes of Care. Readers familiar with Egypt and the region more broadly will recognize modes of sociality and meaning making against a backdrop of urbanization and class struggle. Others more staked in NGOs and development work will understand aid workers’ frustration and the sense of futility that can accompany care work in the modern postcolony. Paradoxes of Care deserves a spot in any lecture or seminar course on gender, public health, medical anthropology, and the Middle East and North Africa.