A century ago doctors began to take notice of a disturbing condition affecting white men in “the tropics”. These men, hard at work with empire-building and civilising natives, were suffering from a kind of nervous breakdown: a mysterious condition that was so widespread it accounted for as many medical discharges as better known illnesses, such as malaria. Symptoms included incompetence, melancholia, paranoia, nervousness, alcoholism and sexual deviance.

In 1905 Charles Woodruff, an American army doctor in the Philippines, decided that these men were suffering from “tropical neurasthenia”. As a diagnosis, it placed the blame squarely on the burden of civilising work in uncivilised spaces, on the heat and humidity. Colonial officers were overexerting themselves, and at the same time deprived of important distractions such as “five-o’clock teas”, and “ball-room dancing”. As a result, they were succumbing to the temptation to have sex with natives. As the colonial historian Kim Wagner has pointed out, in India “British brutality could be explained and even justified with reference to the climate, physical exhaustion and, ultimately, the savagery ascribed to their Indian victims”.

For more than half a century, tropical neurasthenia gained great traction. It’s easy to see its appeal. It harnessed anxiety about masculinity and the purity and superiority of the white race, and put failures in the supposedly moral project of empire down to the local climate and population, rather than colonials themselves.



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The theory fell out of fashion after the second world war, but to this day our understanding of countries that receive humanitarian assistance is still deeply grounded in the same colonial thinking. We see the still struggling countries of Europe’s former empires as short of “civilised” values, where “most of us would not tread” – as classicist Mary Beard controversially tweeted at the weekend regarding the Oxfam sexual abuse scandal.

The irony of Haiti in particular being viewed this way cannot be lost on anyone who understands the significance of its role in the Enlightenment – the French abolitionist Abbé Henri Grégoire viewed the Haitian republic, not the United States of America, as a beacon to the world and the custodian of revolutionary ideals.

Our ignorance and prejudice towards countries such as Haiti has long been on open display. Aid agencies have blatantly held themselves up as white saviours in the way they operate. A toxic and exploitative mentality is highly visible: in the dehumanising images of children in fundraising campaigns, in the language that foreigners have implanted into the very geography of the places they work. When I worked in development organisations in west Africa 15 years ago, I remember hearing Sierra Leone’s war-torn capital described as Freaktown; in Chad I heard Kome, the oil-producing region saturated with bars and prostitutes for foreign oil workers, nicknamed Satan.

Play Video 2:53 Oxfam: '7,000 people have cancelled their regular donations' – video

Now that the trickle of sexual abuse and exploitation revelations against British aid organisations has turned into a flood, much can be discerned by the language used: the way some of the alleged victims of Oxfam staff in countries such as Haiti are being described as “child prostitutes”, when people who have sex with children below the legal age of consent are, in fact, rapists.

We hear so many of the local women whom aid workers paid for sex described as “sex workers” without understanding the context. In countries where aid agencies have a large and permanent presence, people who live in their shadow have been conditioned to believe these organisations are there to offer them help. For example, everyone in Accra, Ghana, knows where the Save the Children offices are; in Liberia, almost anyone can direct you to the headquarters of Médecins Sans Frontières. These organisations are visible, and flashy – with expensive, branded four-wheel drives, and offer locals the possibility of rare and lucrative permanent employment.

In my experience, particularly in the aftermath of disaster, when foreigners are sometimes the only source of resources, women seek from them any help they can get. What’s emerging now is that handouts have been offered, allegedly, in exchange for sexual favours. It’s a transaction that is obviously unequal and exploitative.

Handouts have been offered in exchange for sexual favours. It’s a transaction that is obviously unequal and exploitative

We have all been conditioned to believe that aid agencies and charities operate in an uncivilised vacuum. It’s hard to overstate how much influence large NGOs have over the information we receive. These days few newsrooms can afford the cost of sending correspondents into crisis zones without their help. As a result, the news we consume is filtered through the prism of humanitarian relief work, where the civilised help the uncivilised – and if the helpers become deviant, what can you expect in such a climate?

The revelations about sexual abuse and misconduct – long overdue – have prompted a depressing combination of tropical neurasthenia and faux moral outrage. I say faux because this is really all about money. Our interest in these organisations is based on the fact they have received millions from British taxpayers. It is this that has been the centre of our concern rather than the wellbeing of the victims themselves.

Meanwhile, we have remained utterly uninterested in the thousands of incidents of UN peacekeeper sexual abuse that have emerged over the past decade, including a rape-for-food initiative in Central African Republic, a child-sexual-abuse ring in Haiti, regular sexual assaults of girls as young as 12 in Liberia, and other incidents whose depravity is hard to grasp, such as the time blue helmets are alleged to have tied up four young girls and made them have sex with a dog.

What is yet to emerge is the scale with which British and other foreign business travellers prop up local developing economies through prostitution. There are few, if any, official figures on the scale of this, but time and time again I have seen white men with clearly underage girls in hotels and bars throughout Africa, Asia and the Caribbean. I have never been able to understand how this became normalised.

International organisations are now delivering some long overdue basic accountability – such as the measures Oxfam is now putting in place to conduct independent investigations and re-examine past cases. The charity’s chief executive, Mark Goldring, apologised profusely for the actions of his staff in front of a parliamentary committee today. As for the underlying worldview, in which aid workers see poor countries as a moral vacuum in which to purchase pleasure while we sympathise because they are working in difficult situations – that won’t change until we fully understand the colonial hinterland on which some attitudes rest.

• Afua Hirsch is a Guardian columnist