Following decades of civil strife among warring clans, and exacerbated by the worst drought in decades (2010-2012), millions of starving dislocated Somalis resided in crowded camps throughout the country. Humanitarian aid organizations made good-faith efforts to distribute food and medical treatment and supplies to those who suffered most. Almost always, however, these nongovernmental organizations (NGOs) were thwarted by so-called gatekeepers, who, backed by military force, required that all aid be delivered first to themselves and only thereafter to the intended recipients, under conditions the gatekeeper set. This case summarizes the tactics used by the gatekeepers of Al-Shabaab (a cell of the radical Islamic group Al-Qaeda) in Somalia and the corresponding risks that the United Nations and NGOs had to confront.

The case expands its companion case, "Al-Shabaab, Gatekeepers, and the Ethics of Humanitarian Aid" (ETH-1), from the level of individual-within-organization to the level of organization-within-political system. The dire need for humanitarian assistance to Somalia's hundreds of thousands of internally displaced persons (IDPs) was confounded by the presence of a government that seemed hopelessly weak. Weak governmental institutions created a power vacuum largely filled by Al-Shabaab, a jihadist group with geo-political and religious ambitions. The conditions insisted on by Al-Shabaab gatekeepers and their senior leaders (shura) resulted in the eviction of several NGOs from Somalia. Their reluctant exit left many other humanitarian aid organizations to contemplate whether "negotiating with terrorists" was worth it when such negotiations perpetuated the system of corruption, oppression, and physical danger.

Describes the initial considerations of Gilead Sciences as it designed a strategy for delivering its AIDS drug Viread to developing nations in Africa. In October 2001, Gilead Sciences received approval from the U.S. Food and Drug Administration for the commercial sale of Viread, a significant new drug for the treatment of HIV/AIDS. Viread proved to be an immediate success, increasing rapidly in sales and market share in the United States within its first year on the market. As Gilead made plans to take the drug global in early 2003, a high priority was to make the drug readily available to millions of people in the least developed nations, where the HIV virus was having its most devastating effects. Pricing and distribution were key considerations. Gilead did not have a distribution system in place in any of these countries, and the price charged in the United States would be prohibitive in the developing world.