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'From Kurdistan to Kosovo, Western political leaders have embraced humanitarian adventurism with gusto. Troops have been deployed for "active humanitarian service", more often than not to disguise a dismal lack of political vision in tackling the root causes of the crises at hand. Humanitarian assistance has become a cheap form of foreign policy bringing short-term PR gains to politicians.'

'Biafra,' said an aid worker a decade afterwards, 'was the defining moment'. It has also been called the first great international response to humanitarian disaster.

The short and bloody life (1967-1970) of this self-declared state demonstrated the kind of difficulties and controversies that have dogged aid agencies ever since. It looked straightforward: children were being killed and dying of starvation. But it wasn't. Nigeria had only been independent since 1960 and the economy was shaky. Ethnic tensions had exploded. Some countries 'recognised' breakaway Biafra; others did not. The British (the former colonial power) supplied the government with weapons; the French sent weapons into Biafra. Some Biafrans wanted cautious integration; others, remembering massacres of their people in 1966, refused to consider even negotiation - and kept the war going (at the cost of their people's lives) even when total defeat was a certainty.

When pictures of starving children reached the front pages and started an outcry in the west, a makeshift international airlift of food aid began. ('Spare parts flying in close formation - and in every plane you'd find 5 different reasons why people were there.') This, too, kept the war going; so did the belief that the Hausa were bent on genocide. Also tangled up in the war: financial interests in, yes, you guessed it, oil.

Working with the International Red Cross in Biafra from 1968 were several French doctors. They became increasingly angry and frustrated because of the agencies' failure to deal with obstacles to their work. The Red Cross was prevented from speaking out against 'what amounted to a state policy of forced starvation and migration'.

So they decided to set up their own agency, which would be completely independent. It was founded in 1971: the first non-military, non-governmental relief organisation to specialise in emergency medical assistance. They called it 'doctors without borders', Médecins Sans Frontières. 'Our mission is very simple. It is to seek to relieve suffering, to reveal injustice, to provoke change, and to locate and insist upon political responsibility.' Simple? Certainly no less ambitious than our own not dissimilar aims.

Since 1975 (when they went on their first war mission, in Vietnam) MSF teams have brought aid to conflict zones and refugee camps across the continents, sometimes in areas no other aid agency had reached, sometimes in areas where no other aid agency had stayed. By the end of the 20th century, over 2,000 MSF doctors, nurses, logisticians and engineers were working each year in any of up to 80 countries. And in 1999 they were awarded the Nobel Peace Prize.

Independence and impartiality
What makes MSF special? One thing is that demonstrable independence 'from all political, economic and religious powers'. They do their best to ensure that their funds come from the general public, not from states or state-funded organisations. They refused funding from NATO member states for their work in Kosovo. ('The same governments that were dropping bombs on Kosovo were funding NGOs to bring relief.') MSF are 'happy to co-ordinate with UN agencies, but not co-ordinated by them'; they can 'work in the presence of armed forces, but certainly not under their authority'.

One abiding and ruling principle for MSF workers is respect for the individual. Where people are being deprived of their dignity, MSF workers strive to restore it. 'Bringing medical aid to people in distress is an attempt to defend them against what is aggressive to them as human beings. More than offering them material assistance, we aim to enable individuals to regain their rights and dignity as human beings.'

Another principle is what has been called 'active impartiality': MSF will speak out against any action which they see as a breach of human rights or humanitarian law. That criticism is made on the basis of what people do, not who they are: love the sinner, hate the sin.
Once on site, they follow four excellent rules of engagement. Clarity: ensuring that the entirely humanitarian nature of their work is obvious to the people they are working with and to the warring groups. Proximity: 'the closer we are to the people and communities we're working with, the more contact we have, the more friendships we make, the deeper our understanding of a particular situation - and the deeper our appreciation of risk.' Transparency: being completely open about what they are doing, and 'not falling into the trap of becoming secretive for fear of security risk'. Vigilance: constantly monitoring the situation, being aware that it can change, watching for difficulties and responding positively to them in ways that aren't misunderstood.

'To speak the truth'
There's another reason why we peaceworkers think MSF are special: their commitment to witness. 'Silence has long been confused with neutrality and has been presented as a necessary condition for humanitarian action. From the beginning, MSF was created in opposition to this assumption. We're not sure that words can always save lives, but we know that silence can kill.'

In Ethiopia (1985) MSF publicly condemned the practices of food aid diversion and forced migration. In Somalia (1992) the population was rapidly falling (deaths in the civil war and from famine); MSF alerted the world. In North Korea (mid 1990s), they found that aid was being used to prop up a system of oppression, and said so: 'aid must not mask the causes of suffering'.

This year alone, MSF have publicly highlighted the plight of Chechen refugees facing the prospect of forced repatriation. They have also called attention to the long-term psychological damage suffered by many who have lived through Sri Lanka's recently-suspended civil war. And they have condemned the post-ceasefire response of the UN and the government of Angola to its desperately needy people, describing it as 'shamefully slow and shockingly insufficient' - and with this have sparked public debate about the poor co-ordination of UN agencies.

There's nothing arrogant about all this. As they say, understanding their own limits is important. 'MSF can't act to enforce and guarantee all human rights! We do have the responsibility to act; but we must invest more time and effort in understanding the views of the people we are working among, and in explaining what we do.' Some problems are so complex that there are no easy solutions. 'Sometimes the only thing that can be achieved is illumination of that complexity.'

'One of our liabilities is that the humanitarian movement can provide an alibi for political inaction. Doctors can't stop genocide....We constantly call into question the limits and ambiguities of humanitarian action - particularly when it submits in silence to the interests of states and armed forces. When you mix military actions with humanitarian actions there's a very real danger that independent humanitarian action can be perceived as tied in with the political process that underlies a military action. It's a risk we're unwilling to take.'

MSF's Director of Research puts it this way: 'MSF doesn't see itself as a cog in the machinery of international solidarity, responding to medical needs like some eager hired hand summoned to deal with the failures of states or of global privatisation. MSF sees in these medical needs often deliberate choices to exclude certain populations, or symptoms of the dysfunction of societies. In cases like these, material relief is not enough - and can give a semblance of normalcy to situations of extreme violence.'

War and law
Of course it is in situations of extreme violence that MSF most often work. But the point is clear. Their humanitarian action ('more than simple charity') tries 'to bring spaces of normalcy in the midst of what is profoundly abnormal', never to normalise the situation.

It's where war and humanitarian action overlap that MSF and the peace movement meet: war and the military have to be disentangled from the fabric of the humane. In 1999 the US authorised direct transfers of food aid to the rebels of Southern Sudan (fighting for autonomy and freedom from the Islamist regime). 'This,' said MSF's then president to an attentive Oslo audience when accepting the Nobel Peace prize, 'is a misappropriation of the meaning and intent of humanitarian assistance. It makes food a fuel of war.'

In the same way people can be the tools as well as the victims of war. MSF's legal director, highlighting the particular, and ironic, problems of displaced people (who get much less respect and acknowledgement than refugees do), says: 'In some situations, population displacements aren't a secondary effect of conflict but an integral part of military strategies aimed at controlling the population, the territory and its wealth, or controlling supplies and aid. This control leads to forcing the population to flee in order to free territory, directing and controlling its movements in order to obtain military advantage, or grouping people together to act as a human shield, a bargaining chip, a manpower tank, or as bait for humanitarian aid.'

Such things are, in fact, war crimes. If the rules of war have any use at all, it is that they can be called on to protect war's victims. The laws of armed conflict (as opposed to humanitarian laws) are too seldom invoked. But they do have something to offer the internally displaced.

Here's the start of an interesting dialogue. Do we refuse to have any truck with war laws? Or do we use them in the services of peace? MSF, in the interests of peace, criticise the UN for devoting more attention to its hands-tied peace programmes than to enforcing international laws that can actually protect civilians. We, too, ought to look more closely at these contradictions. We, too, are campaigning for social justice.

Action and activism
'State humanitarianism is a smoke screen that hides a profound dereliction of political duty. More often than not states have failed to uphold humanitarian law, particularly in the face of genocide and crimes against humanity. In Rwanda up to a million people died as the UN Security Council and member states stood by. After the worst of the killings were over, UN troops were deployed to neighbouring Congo to deliver aid and smile for the cameras.'

The question of political change preoccupies MSF as much as it does us. Tough on war and tough on the causes of war. 'Today, the reality is that we live in a social order that excludes, marginalises, literally leaves open to sacrifice, the lives of billions of people...Politicians and their patrons tell us all the time that we live in an era of limited resources - but there is more wealth today than at any time in human history! However, it's in fewer hands. A rising tide of wealth doesn't lift all boats. Most capsize.'

MSF, like us, recognise the challenge for a movement of NGOs 'that confronts and engages sources of power, demanding not charity but change.' Well, all organisations are made up of individuals and it's in individual action that things begin. The volunteers and staff of MSF 'struggle each day to make ideals a reality, and bring at least some small place of peace to those who have experienced immense suffering'. One doctor says that a child may be brought back to health but still have only a slim chance of survival. 'But at least the crisis has been met, and a chance has been created'. Each worker 'shows each victim a human face, stands for respect for that person's dignity, and is a source of hope for peace and reconciliation.'

'Despite grand debates on world order, the act of humanitarianism comes down to one thing: individual human beings reaching out to others in difficult circumstances. And in MSF they reach out one bandage at a time, one suture at a time, one vaccination at a time.' Or one handshake at a time, one defused conflict at a time.
MSF's resourceful and intelligent pragmatism is also instructive. After all, peace in action is - must be - a practical matter. MSF go into conflict zones without high technology and in battered vehicles that no-one wants to nick. They think laterally, improvise, look for opportunities and seize them. A warlord might become interested in diagnostics ('How do you know malnutrition is a problem?') and learn enough to decide to adapt his policies to meet his people's needs. Theft of supplies can be lessened by making it difficult or unprofitable - oil cans with the lids removed (replaced with grass tufts); cereal bags with a hole cut in them, blankets cut in half (easily resewn by the people they're meant for)... And so on: one chance created at a time.

We can learn from MSF's experiences, recognising that, in one way at least, they know a whole lot more about war than we do.
All quotations are from MSF members, unless stated otherwise.
MSF has offices in 18 countries; its international office is in Brussels. UK: MSF 124-132 Clerkenwell Road, London EC1R 5DJ, phone 020 7713 5600 website


Resisting abuse in Rwanda
After the massacre in Rwanda in 1994, the Hutu leaders of the genocide fled across the borders, taking many of the population with them ('so the Tutsis have only a desert to rule'). Soon around 2 million people were living in refugee camps in appalling conditions. For over 2 years the camps were under the care of the UNHCR and many western NGOs. In this time the Hutus created what was in effect a government-in-exile; they recruited fighters from the camp dwellers, sold aid supplies to buy weapons, and began making cross-border attacks on Rwanda.

MSF were there, but were among the first to pull out. 'The problem was that we were all bringing massive help to the criminals. All our resources went through their hands, allowing them to strengthen their power over the refugees. The humanitarian operation was an ethical disaster.' It was a terrible decision to make,' said a leader of the International Rescue Committee, which also left: 'But humanitarianism had become a resource, and people were manipulating it.'

Some people found it hard to understand. How could they deprive refugees of assistance? What about their proclaimed 'respect for the individual'? The point was that the situation did not allow such respect to be impartially delivered. Protection and assistance wasn't possible, since everyone, aid workers included, was hostage to the extremists. Where free and impartial access to humanitarian assistance is denied, people need to see that it isn't the aid agencies who are closing the door.

An MSF leader in Rwanda at the time of the genocide tried to rescue a group of Tutsi orphans. He remembers a killing squad commander saying 'These are not children. They are prisoners of war. They are insects and we will crush them.' Indeed, soon afterwards most of them were killed. 'This is how people commit atrocity,' said the MSF man. 'The first step is to dehumanise the victim. Our imperative is to create a strong humanitarian space that acknowledges the humanity of "the other".'


Margaret Melicharova




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