24 Mar 2011

The Last Humanitarian

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After I left Médecins Sans Frontières in 2002, it took me some time to sort out my thoughts and feelings about that extraordinary organization. This work, the major paper for my Masters degree at U of T, provided me with the needed catharsis. I was invited to publish an abridged version in Disasters Journal (UK), a leading publication in the international relief field, but other work drew my attention away from these issues.

What if greater transparency and consistency of words and deeds leads to greater effectiveness, or at least greater moral authority in difficult situations?


Pakistani gun merchant (Photo by Chris Lowry)

THE LAST HUMANITARIAN
[original M.Ed. (OISE/UT) research thesis title, 2004:
“When is Humanitarian Work Human Rights Work?
…and Other Humanitarian Dilemmas”]

Contents
2 Introduction
7 Never Step in the Same Paradox Twice
13 No Such Thing as an International Community?
14 Human Rights in Philosophy and Law
19 History and Habits of Humanitarians
21 MSF and Human Rights Practice
27 Humanitarian Law, For What It’s Worth
31 The Last Humanitarian
34 Neutrality—Policy and Reality
38 Doctors Without Politics?
43 War Talk
46 Who Needs Mercy Without Justice?
49 Toward a Rights-Based Approach
51 Conclusion

The most benign motivations can be coupled with perverse understanding to produce dreadful results. And the most grasping, self-seeking motivations can produce massive, wonderful social benefits. Motivations may explain but, because they need not correlate with the goodness or rightness of their effects, they do not justify… The important fact is that it is apparently true of all motivations of any significance that they can have grossly harmful effects.

—Russell Hardin (quoted in de Waal 1997, 4)

For neither Man nor Angel can discern
Hypocrisy, the only evil that walks
Invisible, except to God alone,
By his permissive will, through Heav’n and Earth:

—John Milton, Paradise Lost, Book III lines 682-685

Introduction

I was a brooding 12-year-old boy in 1968, and just 15 when modern humanitarianism barged onto the world stage with the founding of Médecins Sans Frontières in 1971 after the Nigerian Civil War. Thus, at the age of 48, my growth to maturity has run parallel with the history of modern humanitarianism. Let the reader be forewarned that the writer is committed to the subject in an almost autobiographical way.
In embarking on this paper, I am aware that new precedents are being set almost daily, as the nature of humanitarian action morphs in the pressure cookers not only of Iraq and Afghanistan but wherever Western geopolitical interests have drawn the gaze of the war on terror and the arms of so-called humanitarian intervention. The words grow old in our mouths, and the sentences are out of date before the ink is dry on the page. Perhaps it is timely to reflect, in the hope of illuminating the new and perennial dilemmas of humanitarian action and human rights.

I am attempting, through an exploration of multiple perspectives on what are sometimes called paradoxes (internal contradictions) of humanitarian action, to reveal potential synergy between human rights and humanitarianism. Perhaps by looking at the commonly recognized, operational, as well as the unintended, unacknowledged and potential human rights dimensions of international humanitarian action, it will be possible to come to gain some useful insight for humanitarian practice. Many humanitarian agencies, with or without volunteer workers, proceed as if they can address social problems without social mobilization, maintaining a distance from the political dimensions of what they are up to, which includes the human rights dimensions. Some thoughtful people within these organizations are acutely uncomfortable with this, and
the debate on humanitarian practice continues to evolve. This paper is premised on the idea that greater transparency and consistency of words and deeds leads to greater effectiveness, or at least greater moral authority in difficult situations. This does not rule out the tactical use of simplifications of intent in order to assist populations in danger, for example when negotiating with warlords to prevent violence, but it does rule out self-deception and inadequate education of field personnel vis à vis their understanding of the social and political implications of what they are actually doing, what they can and can’t do, etc. The paper is a philosophical enquiry into the intentions and consequences of humanitarian action and inaction which, it is hoped, will have practical implications for humanitarian workers.

Later we will look at various meanings and more or less precise invocations of the terms “human rights” and “humanitarianism” that are used by humanitarian actors, human rights workers, politicians, journalists and academics. In the context of the title of this paper, human rights refer to the full spectrum of rights defined by the International Bill of Human Rights, not only the so-called basic rights but also others including social and economic rights, to be discussed in more detail later. Humanitarianism emerges from the Western traditions of humanism, and refers to the will to promote the welfare of one’s fellow human beings. While it encompasses efforts to provide assistance to protect or restore human dignity wherever needed, it is commonly defined as referring to assistance to non-combatants affected by armed conflict, under the euphemism of “man-made disasters”, with the phrase “and natural disasters” added on in some definitions. In practice, many international humanitarian agencies do respond to natural calamities such as hurricanes if an international response is called for, but the paper will focus on the discourse regarding international humanitarian assistance (IHA) in situations of armed conflict.

We will attempt to discover to what extent they are separate fields of action and advocacy, and to what extent they may be interdependent or aspects of the same work. Does all humanitarian action inevitably serve to expose and influence the realization of human rights (social justice), regardless of the intentions of the actors, or can traditional (“classic”) humanitarian action keep its distance from issues of justice beyond its own narrow definition of protecting human dignity? For some humanitarian agencies, the debate is over, while for others, these questions of positioning and policy with respect to human rights, political engagement, peace processes and so-called just wars are of the essence. The humanitarian agency that has the perhaps highest profile in its isolation from its peers on these issues is Médecins Sans Frontières-Doctors Without Borders (MSF).

The discussion will focus on the experience, external debate and internal dialogue of MSF to illuminate the discourse about humanitarianism and human rights, which includes not one “paradox of humanitarian action,” but several dilemmas and paradoxes that fascinate, bewilder and appall the most field-seasoned veterans. (“Paradox of humanitarian action” is an oft-repeated phrase that rarely refers to the same self-contradictory problem twice). The paper will consider the question of why MSF defines its mission and focus as humanitarian (medical relief) but not human rights, and will analyze the tension in MSF between its advocacy mandate, which includes human rights, and its claim to political neutrality. The paper will also look at the mission of Amnesty International, and the way its human rights mandate has changed since its inception in relation to the broader realm of social, economic and ecological rights.

Agencies involved in humanitarian action have proliferated greatly over the last 25 years, from less than a dozen key actors in the 70’s to several hundred today, swimming in a sea of over 25,000 international NGOs (Fielding-Smith, 2004, 1). These agencies may be small, perhaps with a regional focus like Rights Action, or large, like World Vision ; focused on emergency relief like MSF, or socio-economic development like Street Kids International, or some hybrid of the two like Save the Children; claiming to uphold the humanitarian tradition like International Committee of the Red Cross (ICRC), or human rights focused like Human Rights Watch; or practicing a hybrid rights-based approach to aid and relief like Oxfam. Many are church-based, many are secular; some are volunteer-driven, others are professionalized service providers. Overwhelmingly, they are Western-based.

The focus on MSF is intended to be constructive, and is not meant to exempt other humanitarian agencies from criticism. While most international NGOs have incorporated rights-based language into their mandates in recent years, and indeed they may raise funds by marketing themselves as embodiments of citizens’ moral sense, many of the largest agencies are actually public service contractors focused on action to alleviate suffering without any active commitment to mobilizing rights-based activism for clients to influence their own political destiny. As de Waal has pointed out, both approaches are valid. The problem is one of self-delusion and misrepresentation (De Waal 1994, 6). The rights-based ‘lite’ approach of some big aid NGOs and Western governments, with its emphasis on individual victim rights, tends to obscure the social and political actions that must be taken locally if rights are to be protectable at the local level after the aid agencies are gone.
I will draw on the work of a number of writers who focus on MSF in relation to the field of humanitarian action including Rony Brauman, David Rieff, and Fiona Terry, as well as writers on humanitarian practice including Alex de Waal, Mark Duffield, and Hugo Slim. Much of this work is passionate, deeply committed, and savagely indignant about perceived failures of the aid industry and the “humanitarian international”. To illuminate the philosophical and cultural issues that emerge in this discourse, the paper will humbly stand on the shoulders of diverse thinkers including Johan Galtung, Richard Rorty, Gusatavo Gutiérrez, Edward Said, Albert Camus and Jürgen Habermas.

Adam Hochschild, in his account of the systematic colonial rape and terrorization of the Congo by the Belgians in the name of commerce and God (King Leopold’s Ghost), speaks of the urgent need to bring a ‘psycho-historical’ perspective to international political analysis. Who were, and who are the key players who make the choices that generate cycles of human cruelty? Where do they come from, what formed their personalities, what makes them tick? This approach is no less valid for the humanitarian international, the ones who generate cycles of human compassion, and it is striking to note that the writers who wrestle with the dilemmas of humanitarianism all share in common some direct experience of living hell. They share with General Romeo Dallaire the experience of shaking hands with the Devil, and like him, they are scarred by it. Even though many humanitarians are psychologically resilient and may not manifest long term symptoms of post-traumatic stress, they share an intensely emotional investment in their “story” about humanitarian dilemmas, their version of the truth—what is and is not possible, what is hypocritical, what is hopelessly idealistic—what the ‘true’ humanitarian story is. In this paper, the effort to establish a critical distance from the raw and bleeding wounds of the world is offered as a way beyond some of the defenses that humanitarians may construct, and repeat over and over like the Ancient Mariner in Coleridge’s poem, in order to carry on.

Never Step in the Same Paradox Twice

Let’s begin with an initial sketch of some of the dilemmas of humanitarianism, many of which bear on the question of when humanitarian work is, or is not, human rights work. In the course of my reading and reflections I have discovered, as some others probably have, not one but multiple paradoxes and dilemmas of humanitarianism.

Alex de Waal says that the most intractable paradox is that the road to hell is paved with good intentions. “The intrusion of humanitarian institutions represents, in an insidious but profound way, a disempowerment of the people directly engaged in the crisis, which drains their capacity to find a [political] solution” (de Waal 1997, xvi). He adds to this a second self-poisoning tendency, which is that what he calls the humanitarian international, the elite of humanitarian managers, thinkers and movers, absorbs criticism without reform. Regardless of how damaging or ineffectual they are proven to be, the humanitarian discourse seems to strengthen humanitarians’ sense of entitlement to manage other people’s suffering. This is echoed by Abdullahi An-Na’im, at one time Director of Human Rights Watch: “International organizations should be asking themselves how to make themselves redundant. But they don’t; they perpetuate themselves” (Bedell 1999, 2).

There is Fiona Terry’s formulation in her book, Condemned to Repeat? The Paradox of Humanitarian Action, that humanitarian action “can contradict its fundamental purpose by prolonging the suffering it intends to alleviate.” It can lose its sense and become, in effect, “a technical function in service of evil,” particularly in the context of militarized refugee camps that support resurgent refugee warriors such as the Khmer Rouge, the Nicaraguan contras, or the Rwandan Hutu génocidaires (Terry 2002, 2). The unintended consequences of “neutral” humanitarian aid include many moral and material benefits to combatants and the economy of war (Terry 2002, 27 ff.).

Another dilemma of humanitarianism that is not fully grasped by the aid agencies, let alone the donors and the general public, is the marginality of relief aid in some contexts. Aid agencies suggest, at least for fundraising purposes, a very inflated sense of their own impact. International food aid, for example, is not only a drop in the bucket of misery, but it is often a very small contribution to the solution. A particularly egregious example was the Ethiopia famine in 1984-85, where no more that 10 per cent of the average daily ration came from food aid while more than 90 per cent was provided by the efforts of the local people. “Relief is generally merely a footnote to the story of how people survive famine” (De Waal, 1994 p. 2).

On the other hand, there are those who have insisted that the core dilemma for humanitarians is the physically insecure nature of all emergencies, and the lack of political will to provide internationally sanctioned, legitimate forces to address the need for security. They contend that this lack of security (i.e. mortal danger) is a worsening feature of complex emergencies. This point of view, coming from CARE Canada in 1999 in the wake of its problematic post-Rwanda experience, was one of the early, initially controversial, NGO calls for privatized security forces to protect humanitarians from “predators” (Bryans, Jones and Stein, 1999, 4). It can be argued that this argument for armed escorts opened space for the sort of militarized humanitarianism that is now in the ascendency.

A dilemma that is rarely discussed is that even in an agency such as MSF that presents an image of dedication to emergency relief to both its public and its volunteers, 70% of MSF programming is longer term, beyond the initial emergency. This is due to the protracted nature of conflicts and the tenacity of refugee camps in places like the Horn of Africa, Sri Lanka, and Central America. It can be argued that focusing on the improvement of the health and safety of individuals in these circumstances is a self-deception and a failure to acknowledge the collective dimensions of their suffering, the political dimensions of the situation, and the socioeconomic (development) imperatives of the work. Millions of children grow up in these contexts of chronic instability. In the majority of so-called humanitarian crisis situations, perhaps what is required from humanitarian assistance is not just alleviation of suffering, not pure charity, but support for social regeneration.

David Rieff suggests that most critics of aid believe the humanitarian trap is the problem of how aid prolongs wars, or how it gives states a humanitarian fig leaf to hide their inaction or their politically motivated intervention. But Rieff contends that the first humanitarian paradox is “the need to simplify, if not actually lie about, the way things are in crisis zones, in order to make the story more morally and psychologically palatable—in short, to sugarcoat the horror of the world, which includes the horror of the cost of a good deed” (Rieff 2002, 56).

De Waal frames it as a ‘law’ of humanitarian competition, that the agency that most aggressively seeks media attention by distorting the truth of a crisis will raise the most money and this debased approach to IHA will tend to dominate and debase the other humanitarian action in the context (de Waal 1997, 138). Images of innocent child victims are particularly popular for the marketing of misery. However, “while it may be the suffering of children that gets people to contribute back home, a humanitarianism that infantalizes its beneficiaries or holds itself aloof from the political consequences of its actions is increasingly becoming indefensible” (Rieff 2002, 26).

Perhaps an even more troubling paradox is the perceived need to simplify the perspective on each new crisis inside an agency, the idea that they need to simplify reality in order to act in a concrete way. In the case of MSF-France, they simplify the essence of the humanitarian imperative down to life-saving. In order not to be paralyzed or compromised by politics, they rise above politics (invoking the principles of independence and neutrality). This combines compassion with pragmatic and principled motives. It is a very sophisticated, subtle and complex approach, and it has taken MSF-France a long way, but it is highly problematic.

Rony Brauman, former president of MSF-France and one of the intellectual leaders in the movement, recently suggested his version of “the” paradox in a presentation at the Carnegie Council on ethics and international affairs in New York City in April 2004. “The paradox of humanitarian action is that it is based on gifts but no counter-gift. It means that it denies any possibility of social linkage, of social construction. If humanitarian aid is given in exchange for something, it is no longer humanitarian. Yet if it is given without any counter-gift, it is a destroyer of social cohesion” (Brauman 2004, 1). This startling idea will merit closer scrutiny in the course of the discussion.

In a new book, In the Shadow of Just Wars (2004), Brauman and other MSF writers argue that the greatest problem facing humanitarians now, in the era of just war conflated with humanitarian action, is the denial of the right of humanitarian independence from political and military actors in conflicts.
Modern humanitarian action developed out of armed conflicts in the nineteenth century by asking, ‘who needs help because of this war?’ instead of ‘who is right in this war?’ These origins are not recalled as a dogma to condemn some heresy, but to stress the continued importance of this position if aid is to be effective (Brauman and Salignon, 2004, 1).

It is precisely this issue of absolute independence in opposition to Anglo-American “newspeak” which seems, to most other humanitarian NGOs, like bloody-minded isolationism, “a humanitarianism trapped in its own self-involved adolescence and refusing to grow up” (Rieff 2002, 225). Perhaps, however, this thorny issue of independence and the problem of conflating war with mercy is not so easily dismissed.

Hugo Slim recently suggested that the dilemmas of humanitarianism are exaggerated by critics like Rieff and Brauman. In crisis? No, says Slim, times are good, really! Best in 125 years. “Never have humanitarians been this rich, this powerful or this numerous.” He said that the humanitarians he had met recently were not “plagued with the scabby pustules of politicization or bent double with the terrible intestinal cramps of sub-contraction. And they were not obviously deluded with a psychosis of co-option and its split personality. None of them spoke in a strange voice that suggested possession by some US/UK alter ego” (Slim 2004, 2). Slim suggests that creative responses are needed to the perennial humanitarian problems of “outright rejection, co-option, politicization, belligerent funding and blurring.” He recommends avoiding an “excessively colonial or invasive” style of action that is “felt to be arrogant, ignorant, disempowering and culturally
insensitive” (Slim 2004, 5, 8). It is hard not to read here the suggestion that there is some acceptable level of imperialistic “style”—and that “our” arrogance can be forgiven and condescension to the locals may be useful, as long as they don’t notice. Despite these sanguine views, the humanitarian field is plagued by doubt and a widespread sense of shame. Many feel that change is imperative. There is acute urgency to struggle to reclaim the ethos and language of humanitarianism, to radically transform, redefine, and find new language or else “pack it in” (James Orbinski, former MSF International president, personal communication August 2004).
Humanitarian advocates like Slim repeat the accepted wisdom that the laws of war humanize war (Slim 2001). However, perhaps the most deeply hidden paradox, the shadow of humanitarianism, is that the laws of war actually serve to legitimate violence, and in upholding those laws, humanitarians lend moral approval to any and all violence.

Examination of the historical development of these laws reveal that despite noble rhetoric to the contrary, the laws of war have been formulated deliberately to privilege military necessity at the cost of humanitarian values. As a result, the laws of war have facilitated rather than restrained wartime violence. Through law, violence has been legitimated (Jochnick and Normand 1994, 50). This, the Achilles’ heel of humanitarian law, will be discussed in more detail later (see “Humanitarian Law, For What It’s Worth”).

Another underlying dilemma of humanitarianism is that the Western assumption of the universality of human rights is false. The debate and disagreement on the universality of Western-rooted normative regime known as human rights is complex and ongoing—most intensely, and with deadly effect, between the imperial West and militant Islam. “Universality is a myth. Not only are human rights observed differently—certainly to differing degrees—in different countries; but they are also conceived of differently” (Cassese 1999, 152).
This plays out in the day-to-day reality of the humanitarian who is instructed that his or her code of ethics is underpinned by the full spectrum of international human rights covenants. In armed conflict settings, humanitarian field workers often witness or hear reports of egregious human rights violations. Humanitarian emergencies inevitably involve the violation of or failure to protect human rights. People are wounded, tortured or intimidated; loved ones, livestock and crops have been killed; homes have been razed to the ground. According to the humanitarian code promulgated by the ICRC, despite being “underpinned” by human rights law, humanitarians are expected only to supply assistance to people in need. If they start to collect information on human rights issues, they may expose themselves to the danger of harassment or reprisals. “Why is a humanitarian worker asking questions related to human rights?” If this is outside of the humanitarian worker’s mandate, he or she may resort to subterfuge, further compromising personal and organizational security. It is extremely serious to be caught in covert activities in the field. The organization may be accused of being ‘political’ by local authorities, and be expelled from the country or denied access to the population they want to help. There is a risk of long-term retaliation against witnesses, so the humanitarian worker may put the local informant in mortal danger by taking testimony. After working with a humanitarian NGO, local staff and their families are permanently labeled, and if they have done advocacy work, it sticks to them for years (MSF-Holland, 1996). There are many dimensions to the security risks involved in field-based advocacy. Human rights issues are part of the daily reality of humanitarian workers, and yet if you are perceived as a human rights worker, you may be targeted for assassination. Thus, for this and other reasons it is understandable that this subject continues to be controversial in the aid and relief sector. As we examine the rhetoric and practices of humanitarianism, this must be kept in mind. We should be cognizant of the difference between the risks taken by human rights advocates and humanitarian workers on the ground.

Before examining some of these problems more closely, it will be useful to briefly discuss the evolution of human rights philosophical and legal frameworks.

No Such Thing as an “International Community”?

Both human rights and humanitarian law are predicated on the existence of the international community. However, some people contend that there is no such thing. David Rieff, a journalist who specializes in war correspondence, claims that “the international community is a myth and a way to conceal the bad news about the present in septic sheets of piety about the future… Despite the dreams of those who founded the UN… there is no world consensus on most matters of importance” (Rieff 2004, 9) Rieff sees the international community as a pernicious fiction and human rights law as utopian verbiage that has no authority among warriors or warlords. Is it a fiction? If not, what is the “international community”? Johan Galtung defines it as the community of states. The creation of international governmental and people’s organizations and of international law (the Hague system) in the 19th century defined the common interests of a community of states (Galtung 1994, 4). Jürgen Habermas goes further, saying that today this community gains its sole recognized base of legitimacy from human rights, and thus this legitimacy is precarious outside the main power alliances of the West. Since “the general validity, content and ranking of human rights are as contested as ever” (Habermas 2001,119), it is true that the international community is on shaky ground. However, a community can be in crisis, divided, and fragmented, as the international community is today (Cassere 1999, 162), and still be a community. Some people argue that the global citizenship movement, in the form of the network of rights-based NGOs, constitutes a powerful realm of non-state actors in the international community. Galtung suggests that “clearly, without the civil society, the NGOs, human rights as an institution would be vacuous in many countries, perhaps most, perhaps all” (Galtung 1994, 149). While influence does not equal membership, the use of the term “international community” often seems to include state and non-state actors, including not only NGOs but also the powerful International Financial Institutions (The IMF, the World Bank, the World Trade Organization) as well as the more influential transnational corporations. For our purposes, it is the community of states, held to account or undermined, as they are, by a multitude of institutions.

Human Rights in Philosophy and Law

The Western tradition of humanism has given us the discourse of human rights, with the relief of suffering as a supreme value (Taylor 1999, 116). Human rights, as Habermas says, have a dual nature like Janus, looking simultaneously toward morality and the law (Habermas 2001, 118). In the evolution of human rights philosophy, it is useful to think in terms of three generations of human rights (Weston, 1990). Human rights are commonly understood to mean civil and political rights of individuals, and this is the way that both Western governments and humanitarian NGOs such as MSF tend to use the term. This is the first generation of rights, which evolved in the West out of natural law doctrines from ancient Greece, through the Renaissance and the shift of emphasis from natural duties to natural rights. It came to fruition through the English, French and American revolutions, with their emphasis on protecting individual liberties, formulated in its modern form in the Universal Declaration of Human Rights (UDHR) in 1948 as a direct response to the Nazi Holocaust. The second generation is economic and social rights, defined by the UN in 1966 which, in contrast to civil liberties, require the intervention of the state in allocation of resources to fulfill the goal of social equality. The third generation of rights are solidarity rights, which can also be understood as collective rights, although each of them can be defended as individual rights as well. These include the right to peace, the right to a healthy and balanced environment, and the right to humanitarian disaster relief. These “rights” are not reflected in international treaty law as collective or group rights, with the exception of some developments in the 1990s concerning environmental protection (Rundle 2001, 5). Both the second and the third generations of rights, dealing with collective issues of equality and protection of quality of life for all peoples, are sharply at odds with the forces of neo-liberalism and corporate globalization which define human rights narrowly, as the right to individual liberty , what the current US administration refers to as “freedom”. In the minds of many lawyers, the three generations of rights as defined in the UN conventions collectively known as the International Bill of Human Rights are not normally recognized as binding international law. Lawyers can interpret them as merely declarations or pronouncements of principles (Rundle 2001, 5). Henry Shue contends that the narrowly individualistic, legalistic approach to human rights privileging basic civil rights over all second and third generation rights, entrenched in American domestic and foreign policy, entails a form of “intellectual bankruptcy”.

The common simple dichotomy between economic rights and political rights is misleading in several respects. Some rights seem to be neither economic nor political in any very strict sense. This includes not only the cultural and social rights that the partisans of political rights are inclined, in any case, to assign to the same limbo as economic rights, but also firmly entrenched rights like the right not to be tortured (Shue 1980, 7).

Beyond the intra-Western debate about the hierarchy of rights, the rights norms have undergone multiple challenges from formerly subjugated cultures around the world. It is worth recalling, as Edward Said has pointed out in his study of cultural imperialism, Orientalism, that by the end of World War I, 85% of the earth was subject to European colonial conquest and exploitation (Said 1978, 123). Galtung demonstrates through a cosmology analysis of Western civilization, looking at seven dimensions of culture of space, time, knowledge, nature, person, societies and the transpersonal, that the whole package of human rights is an unmistakably Western, a cultural export package. “Propagation of human rights, consequently, is also propagation of Western civilization, and partly intended as such” (Galtung 1994, 18). For example, tracing the Western rights tradition of rights from the notion of natural rights that are God-given, Galtung compares the understanding of rights/ethics in a culture that has a tradition of the divine as immanent (Buddhism, indigenous cultures), which gives one a recognition of the symbiosis of self and other, in contrast with top-down understandings of rights/ethics in a culture that takes moral authority from a transcendent god (Judeo-Christianity, Islam) in which the unity of life does not imply symbiosis or interdependency. “The commandments are our duty to God as a vertical, transcendental ethics as opposed to horizontal, immanent ethics” (Galtung 1994, 4).
Galtung’s response to this massive Western structural/cultural export is to be optimistic – it can evolve, with input from other cultures, groups. “Many aspects of the Western formula will probably remain for a long time.” But new norms can be formulated and applied by actors other than states and the norms can apply to more than just individuals. “Indeed, if we play on the full richness of civil society there is enough work to do, deepening and broadening the human rights tradition for generations to come” (Galtung 1994, 25).
For all their bias and limitations, the existing layers of human rights norms offer a profound humanistic promise: “An important part of the Western consciousness of human rights lies in the awareness of an historical achievement. They define norms of respect for human beings, more radical and more exigent than have ever existed in the past. They offer in principle greater freedom, greater security from violence, from arbitrary treatment, from discrimination and oppression than humans have enjoyed at least in most major civilizations in history. In a sense they involve taking the rather exceptional treatment accorded to privileged people in the past, and extending it to everyone” (Taylor 1999, 112).

It is true, as David Rieff contends, that “revolution of moral concern” does not stop the world from going to hell, but this is not a persuasive argument against the defense of human rights, especially within the context of humanitarian action. Taylor speaks of the need for cultural conversations to bridge the vast gulf of misunderstanding that separates Western and other cultural traditions with respect to human rights, and of the potential for achieving sufficient common ground about human dignity (Taylor, 1999) to approach the global ethic that Hans Küng has so fervently imagined for us (cited in Aldunate 1994, 297). Habermas suggests that it is what we have to work with, and we should not shy away from the challenge. “…the conflict of cultures takes place today in the framework of a world society in which the collective actors must, regardless of their different cultural traditions, agree for better or for worse on norms of coexistence” (Habermas 2001, 128).

While Henry Shue can argue plausibly that the moral norms called basic rights—of subsistence, security, and liberty—are “everyone’s minimal reasonable demands on the rest of humanity” (Shue 1980, 19), humanitarians tend to argue that, as one gets closer to the barbarity of war, one pays less attention to the details of human rights discourse. Confronted with the victims of naked cruelty—the irreducible crime against humanity in most, but perhaps not all, cultures—the humanitarian imperative is to defend individual human dignity. The humanitarian impulse, at its best, is the motivation of what Richard Rorty calls the “liberal ironists,” those who harbor the ungroundable desire “that suffering will be diminished, that the humiliation of human beings by other human beings may cease” (Rorty 1989, xv). As Russell Hardin warns in the epigraph, however, noble motivations can often precipitate unintended consequences, when coupled with inadequate (or “perverse”) understanding of the real social ecology of the context in which the humanitarian presumes to interfere. Abdullahi An-Na’im suggests that Sufi wisdom teaches us to beware of “the conceit of righteousness and the arrogance of charity” (Bedell 1999, 2).

With respect to human rights, many humanitarians harbor a purely legalistic, and therefore inadequate, understanding of how human rights norms need to inform their actions. Many would say, with David Rieff, that “because it is law-based, the human rights movement must be absolutist or it is nothing. By definition, its demands are maximalist, its standards inflexible” (Rieff 2002, 286). This may be true of much of the advocacy practiced by human rights NGOs, but the human rights construct is open to change and evolution. It is alive, not fixed and dead (Galtung 1994. 3). Recognizing the dangers of philanthropic imperialism, both Galtung and de Waal call for more flexibility and cultural sensitivity in the efforts to promote basic rights in other people’s back yards.

There’s a danger that the institutional practice of international human rights combined with a number of other factors, such as the way in which human rights discourse is converging with humanitarian discourse so that the archetype of the human rights victim is now the innocent victim, someone without moral agency, and so on, this is actually beginning to stand in the way of the mass civic mobilization that is required. There is an imperative of searching for an idiom and method of work that is much more suited to the realities of each particular country. It is peculiarly difficult to do this because of the universalizing idiom of the discourse of human rights which tends to very easily transfer from the universality of human rights to the universality of the methods to promote human rights. That is an easily made transfer, but not, I think, a legitimate one (de Waal 2000, 2).

Galtung counsels NGOs not to be too concerned about each country’s ratification of each human right, but rather to understand human rights as an unfolding agenda, which plays out differently in countries that are on different historical trajectories. The job of the broadly defined international community is to “make available a vast array of human rights programs, with a hard core that could be seen as more universal, expanding that core as civilizations learn through genuine dialogue to accept one another’s rights” (Galtung 1994, 98).

History and Habits of Humanitarianism

Modern international humanitarian assistance has three sets of historical roots – the history of private charity, the history of the ICRC, and the historical pursuit of realpolitik and Cold War geopolitical interests (de Waal 1997, 67). Overarching all of these is the history of Western colonialism, to which humanitarianism has always been an alter-ego, whether as a facilitator of conquest, like the missionaries who accompanied the Conquistadores, or as a compassionate response from within the camp of the conquerors, like the ICRC—often both at once as, for example, when Britain abolished the slave trade in 1807, and then moved against its rivals on “humanitarian” grounds (Rieff 2002, 58). Rony Brauman of MSF believes that this history has defined the limits of humanitarian action. “The ambiguous position of the humanitarian movement in the face of power is a structural problem. It came into being along with the humanitarian impulse, it is enshrined in the first Geneva Convention, it is enshrined in the very first texts, whether we refer to Saint Vincent de Paul, Henry Dunant, the Quakers or the British anti-slavery movement” (Brauman 2002, 75).

Brauman talks about how the anti-slavery movement served to consolidate the power of the British empire, and how this pattern of complicity is shared by the entire “colonial left”—the child savers, the anti-slavers, and the doctor-missionaries epitomized by Albert Schweitzer. People fight courageously for humanitarian causes, whether to protect street kids and give them support, to abolish slavery, or to protect civilians from armed conflict, perhaps without knowing that these apparently emancipatory projects serve the strategic agendas of the Western powers (to gain domestic moral approval for colonization and to make the world safe for commerce). Otherwise states would interfere, as they sometimes do. This is not to deny that these efforts have value, says Brauman, “but it is right to be aware that at the same time they also shared the perspective of the dominant power” (Brauman 2002, 75). Edward Said goes much further than Brauman, suggesting that this socialization is ongoing, and it tends to incline NGOs (and MSF is no exception) to view the rest of the world with an eye to the interests of one’s own homeland. “…because Britain, France, and recently the United States are imperial powers, their political societies impart to their civil societies a sense of urgency, a direct political infusion as it were, where and whenever matters pertaining to imperial interests abroad are concerned” (Said 1978, 11).

Indeed, it can be argued that every humanitarian is a carrier of his or her nation’s political and cultural agenda , as each has been socialized since childhood with notions of the Other, for example of the Gallic for the Anglo peoples, and of each for the non-Europeans in the rest of the world. These cultural prejudices are deeply imbedded in educational systems so that all the founders of all the operational sections of MSF, indeed all of us educated in the West, struggle with the same range of post-imperialist guilt and the latent potential to enact a new form of moral imperialism in the name of relief and/or development. In our philanthropic imperialism toward so-called “failed states,” perhaps we in the West are not so far as we imagine from the assumptions of John Westlake in his turn-of-the-century work, Chapters on the Principles of International Law (1894) who said that “uncivilized” regions of the world should be annexed or occupied by advanced powers (quoted in Said 1978, 206-07). Edward Said comments dryly, “Along with all other peoples variously designated as backward, degenerate, uncivilized, and retarded, the Orientals were viewed in a framework constructed out of biological determinism and moral-political admonishment” (Said 1978, 207). White Westerners of European descent (the vast majority of humanitarian workers) who are in their 40s today may have parents who loved Kipling best of all poets, who thought that Negroes “even smell different,” and grandparents still alive who, on discovering that one is engaged in international relief work might ask, sotto voce, “why is he so interested in helping little brown children?” Each humanitarian, of whatever racial background, has his or her own version of the White Man’s Burden to bear, and we are scarred by it in ways we do not realize, as Frantz Fanon revealed so vividly in Black Skin, White Mask (first published in France in 1952).

In the New American Century, as it was in the 20th, globalization is another name for imperialism (Petras and Veltmeyer, 2001). Raised in late 20th century rights culture, which has not displaced but has added moral dimensions to 19th century cultural habits, today’s senior humanitarians are those “liberal ironists” who transform inherited prejudices and the will to dominate into a sense of moral outrage and obligation, as if our relief efforts can make up for the sins of our fathers and the guilty comforts of our culture, which thrives on wealth built up in the last century with the blood and sweat and resources of the colonized peoples and lands.
Several of the countries of Europe colonized the rest of the world, but the ambitions of England and France were the most widespread of all in Africa, the Middle East, Asia and the Americas. In Orientalism, Said chooses to focus on the French and British empires to expose the deep structures of imperialism. Similarly, it is instructive to compare and contrast the history and cultural roots of British and French humanitarian practice. British and Nordic NGOs such as Oxfam and Save the Children have embraced a rights-based approach to relief and development, whereas French-based NGOs such as MSF have held to a version of humanitarianism which, as Rony Brauman said, “denies any possibility of social linkage, of social construction” (Brauman 2004, 1). Braving the troubled waters of political incorrectness, Johan Galtung has speculated about how cultural habits may affect efforts to actualize human rights norms in the post-colonial period. Galtung contends that “the Anglo-Saxons/Nordics would tend to save the normative culture by changing it, being essentially flexible, case-oriented, experimental in their attitude. The Latins would tend to save the normative culture by retaining and embellishing it, giving it the status of a piece of culture rather than a really prescriptive, not to mention predictive, not to mention descriptive, guide to behavior” (Galtung 1994, 45). There is a dissonance and lack of respect from other cultures when infractions of human rights are evaluated and adjudicated according to Anglo-Saxon/Nordic standards which others may not agree with. Reading the texts of the French and Belgian intellectuals who are part of the MSF movement, one can detect more than a hint of truth to Galtung’s assertion that “Latin normative culture may regard the human rights tradition as beautiful, but perhaps too beautiful for this world” (Galtung 1994, 49). Keep this in mind later when we look at the identity and practices of MSF-France in more detail.

MSF and Human Rights in Practice

MSF defines itself as a humanitarian organization with a mandate to provide emergency medical relief, and operates alongside but independent of various other humanitarian agencies such as ICRC, Oxfam, CARE, Save The Children, and governmental agencies such as the UN High Commission for Refugees, as well as so-called military humanitarian actors. Unlike the Red Cross, however, MSF does not simply care for the victims of war within the laws of war. It also reserves the right to conduct advocacy (témoignage, “bearing witness”) on human rights issues with reference to international human rights legislation. MSF draws strength from a unique founding vision born in the crisis of witnessing the Nigerian military’s atrocities against the Biafrans, and the travesty of humanitarian (Red Cross) neutrality, in the Nigerian Civil War (1967-70) . MSF was founded by Red Cross doctors led by Bernard Kouchner who were frustrated by the politicized constraints against action inherent in the ICRC’s strict mandate to respect sovereignty and the laws of war. MSF’s founding myth is the vision of a witness who is part doctor, part journalist, the “marriage of the stethoscope and the camera” (Rackley/MSF Belgium 2001, 6). The international human rights Covenants “serve as the legal basis to guide MSF medical operations and advocacy messages in various circumstances. At the same time, they are the minimum standards that MSF must promote and defend when operating on the ground or advocating” (Biquet/MSF, 2000 PAGE).

The roots of témoignage are undoubtedly deep in the French soul. The moral challenge was articulated by Albert Camus, whose novel The Plague was a seminal influence on the social conscience of a generation of post-war intellectuals in Europe—the teachers and mentors of those who founded MSF. In Camus’ novel, the doctor asks the journalist if he would be capable of pronouncing a total condemnation of an injustice, that is, could he publish an unqualified testimony? This is the question posed to the one who presumes to approach, to alleviate, and to describe, the pain of others (Camus 1972, 11). It would be interesting to know how many of the doctors who have joined the MSF movement would credit Camus as an influence in their decision to practice medicine, or to be a humanitarian volunteer.

For MSF, advocacy can be defined as speaking out, in public or in private, about the plight of populations in danger for whom MSF works in order to “improve their basic living conditions and to protect their fundamental human rights” [italics added] (MSF-Netherlands, 1996). Based on its understanding that the humanitarian act is not simply the Red Cross 19th century charity ideal to care for the wounded and to visit prisoners, but also to bear witness to suffering, MSF has often, in many contexts over its thirty-three year history, witnessed, documented and spoken publicly about human rights abuses. However, MSF has always had a deep, yet ambivalent investment in denying that it is a human rights organization, which goes hand in hand with its claim to neutrality, similar to the Red Cross claim of neutrality. MSF’s mission is to bear witness through advocacy activity while providing medical relief. The organization contains its advocacy within a medical framework for valid strategic reasons, carefully avoiding any direct political critique in order to maintain maximum access to the populations in danger by insisting on its political neutrality. This containment is porous, so that both in the western MSF offices and in the field MSF personnel do make critical statements about human rights abuses, sometimes with political consequences that necessitate PR and diplomatic damage control . This is controversial within MSF, as MSF’s practice of humanitarianism is sometimes actually a hybrid of humanitarian action and human rights advocacy. “It is important to acknowledge the fact that by definition humanitarian and human rights work is political; organizations cannot continue to hide behind the fact that they only help populations in danger” (MSF-Holland, 1996).

Témoignage can mean speaking out either in public or in private, so the witness does not always wear a journalist’s hat. Witnessing, particularly using the media, is seen by MSF as a way to influence the ethical conscience of the western and/or local public. “Intelligent protest succeeds because it transforms indignation into a force of positive change” (Rackley/MSF Belgium 2001, 13). Despite its ambivalence about human rights protection, over the last 30 years MSF has helped to establish the centrality of media in the human rights movement.

The core of MSF activities is defined as medical action, direct assistance or proximity, témoignage and war/emergency. However, while MSF is perceived by the public and by its own workers as an agency focused on war/emergency, upwards of 70% of MSF operations worldwide are in longer-term contexts, whether due to chronic low intensity conflict or ongoing circumstances of acute danger (e.g. refugees, internally displaced) or social exclusion (e.g. urban health projects ). The result of this tendency to remain in contexts after the initial emergency impulse has passed is that, over time, MSF acquires deep field experience of the rights dimensions of its work that can be used for potent advocacy. In recent years there have been examples of excellent advocacy documentation emerging from chronic contexts such as the MSF-Holland report on the health impacts of the civil war in the Upper West Nile of the Sudan, where MSF has been present for many years.
The inevitable human rights dimensions of MSF’s work are brought into stark relief in its limited efforts to deliver mental health programming in regions where the population in danger is experiencing gross human rights violations. It can be argued that, to some extent, MSF finds mental health work problematic not just because of the traditional tension between psychology and biomedicine, but also because it draws the field workers directly into witnessing human rights testimony and can be extremely dangerous.

By committing a major proportion of its resources to address HIV/AIDS in field programming as well as in the Access to Essential Medicines and the Neglected Diseases campaigns, the MSF movement is choosing to engage in human rights advocacy and design programming to address the rights of the population in danger, the people affected by HIV/AIDS. MSF is advocating for the rights of people affected by AIDS, particularly with respect to the issue of access of destitute Africans to artificially expensive US-patented HIV/AIDS medications, for example the anti-retroviral therapies. This is a combined medical and social approach, and it is an area where MSF finds itself fully engaged in operationalizing the link between health and human rights.
When MSF speaks of human rights, it generally seems to be referring to first generation rights, the rights of individuals that are routinely violated in war. However, MSF works in the field of third generation rights, ensuring the right to humanitarian relief, while vigorously denying that it is engaged in defending the right to peace or any other group rights. MSF struggles to keep its work focused on its core mandate in an international context of growing recognition of the synergy between health and human rights. NGOs such as the Centre for Health and Human Rights at Harvard University proliferate, with annual conferences on the subject. This also manifests from within MSF, as when Richard Bedell organized a symposium on human rights, humanitarianism and culture in Holland in 1999, in which the philosopher Charles Taylor was a guest speaker. Meanwhile, some MSF sections such as MSF Spain lend major advocacy efforts to participate in anti-war coalitions with development (Oxfam), human rights (Amnesty International) and environmental (Greenpeace) organizations on the international campaigns to ban landmines, against the small arms trade, and most recently to protest the invasion of Iraq (www.antelaguerraactua.org).

Indeed, MSF reserves the option of invoking second generation rights, the social and economic rights, in some contexts. The Humanitarian Affairs Department (HAD) of MSF published a background paper in 2003 that encourages MSF personnel to invoke the right to health on behalf of populations in danger, citing Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). MSF field personnel are encouraged to use their medical data and témoignage to advocate for a population’s right to health with local governments and international bodies, to share information with international human rights NGOs, and to provide information to the UN Special Rapporteur on the Right to Health (MSF 2003, 6).

It is instructive to compare the evolution of Amnesty International (AI), a human rights organization with a clear mandate to promote internationally recognized human rights through research and action. In its early years it focussed on preventing and ending grave abuses of the rights to physical and mental integrity, freedom of conscience and expression, and freedom from discrimination, and it is famous for its campaigns for the release of political prisoners. In recent years, however, it has expanded its mandate to address social and economic rights, the poor neglected cousins in the human rights canon. It is now explicitly advocating for the full gamut of all three generations of rights as defined by the UN, including social, economic, and solidarity rights. At the 2002 World Social Forum in Porto Alegre, Brazil, the Chair of AI’s International Executive Committee, Paul Hoffman, said “All human rights for all means challenging the notion that some rights can be enjoyed in isolation, that the right to life can be separated from the right to food, water, work and medical care, or the right to freedom of expression from that to receive an education. It also means countering the argument that the rights of certain groups, individuals, or states can be sacrificed in the name of the security, rights or interests of others” (Hoffman/AI, 2002). Is AI, a quintessential human rights organization, becoming watered down by social justice advocacy? One might think that this would open AI up to a potential loss of identity which is comparable to MSF’s fears described above. More likely, however, this demonstrates a maturing and evolution of AI to embrace and fight for all aspects of the International Bill of Human Rights.

The problem of being co-opted by political agendas is not the same for non-operational human rights agencies like Amnesty International and Human Rights Watch. Their problem is that their critiques are too predictable, therefore their impact is much less than they would like. The heyday of human rights advocacy was, for example, during the Argentinian dictatorship, when letter-writing campaigns were able to move governments and rescue prisoners of conscience. In the age of the War on Terror, state violence is masked by variations on “Homeland Security”, and litanies of rights violations gather dust on shelves. This problem is mitigated, however, by the proactive rights-based policies of operational NGOs such as such as Oxfam in Britain and Save the Children in Scandinavia and Britain, which have evolved to include advocacy of the full range of rights in their mandate in both their development and their humanitarian operations.

Humanitarian Law, For What It’s Worth

Both humanitarian law and human rights law have long histories, the former having to do with upholding the rules of war, the latter with the just treatment of people at all times. In its modern form, humanitarianism dates from the Geneva Convention of 1864 and the founding of the mother of all humanitarian organizations, the International Red Cross (ICRC) by agreement of twelve European nations. Compassionate action based on concern for the alleviation of suffering goes back much further, of course. Two centuries ago the anti-slavery movement first highlighted the inherent links between human rights (the idea that human beings have intrinsic rights) and humanitarianism (the idea that human beings should receive assistance) (O’Neill, 1999).

Though many of us assume that the first Geneva Convention of 1864 established the first real laws of war, all cultural and religious traditions imposed limitations on the conduct of war, and most of those different traditions articulated and enforced penal sanctions for violations of their particular limitations on the conduct of warfare. The Geneva Convention was different, however, in that it forged multilateral obligations and founded the ICRC as a neutral, independent, humanitarian actor (McCormack, 2000). International humanitarian law (IHL) provided the groundwork for human rights law (HRL) by establishing “the general acceptance of the need for international legal protection for individuals and … the promotion of the concept of individual criminal liability for violations of international law” (McCormack, 2000, 8).

The main difference between IHL and HRL is in their definition of the scope of protection required for the individual. They sometimes overlap: both agree that murder, torture, cruel and inhuman treatment and punishment are prohibited at all times, that individuals have the right to judicial guarantees, to a fair trial, to humane treatment (there are virtually unlimited exceptions, however, as we shall see below). But IHL makes no reference to free speech, freedom of the press, elections, representative government, the right to peace, or the so-called solidarity rights. “While people and governments might disagree on what constitutes a human right, and the international treaties do disagree, all the world’s nations have solemnly agreed on the provisions of the Geneva Conventions… the most basic human rights in times of armed conflict… Let’s call IHL the ‘least common denominator’ where notions of human rights are concerned” (Boll, 2000, 5).

Although human rights norms are supposed to be respected in peacetime, the narrower range of humanitarian law is deemed to be applicable in war. The core legal protection for all people in all circumstances, common to both IHL and HRL, are the so-called fundamental human rights—the right to life, freedom of conscience, prohibition of torture, prohibition of slavery, prohibition of retroactivity of criminal law, and the application of nondiscrimination. While human rights treaties usually have derogation clauses that allow states to suspend human rights obligations in emergencies, these fundamental rights are exempt from derogation and are also part of humanitarian law.

In the 1980s there were efforts by human rights lawyers and advocates inside and outside the UN to establish the recognition that human rights continue to apply in armed conflicts, and to spell out basic norms for their protection. Despite several substantial instruments and declarations produced in the 1980s to place limits on use of organized violence by states, the UN General Assembly did not reach a clear consensus affirming that human rights continue to apply in warfare. Instead, there were a series of statements regarding specific countries in crisis, calling for observance of both humanitarian and human rights norms (Tomasevski 1994, 74).
International jurisprudence distinguishes between the laws governing the use of force, just war theory, jus ad bellum, and laws of conduct in war, jus in bello. Jus in bello is divided into the Geneva laws, known as the “humanitarian laws,” which pertain to the treatment of victims of war such as prisoners and others not in combat (hors de combat), and the Hague laws, the “laws of war,” which regulate the means and methods of combat. The Hague laws, which are most crucial in limiting the war’s potential for barbaric excess and abuse of civilians and nature, actually enshrine military necessity as the dominant value of the laws of war. According to legal historians Chris af Jochnick and Roger Normand, the Hague laws are “vaguely worded and permissive, enabling powerful states to use the latest military technology with little regard for the humanitarian [or ecological] consequences.” (Jochnick and Normand, 1994, 53) Contrary to the assumption of legal limits that informs most of the discourse on the laws of war among the other authors cited in this paper, Jochnick and Normand propose the radical insight that the current regime of jus in bello is not meant to restrain the dogs of war, but is rather a carefully woven web of “structured impotence” (Jochnick and Normand, 1994, 56) that legitimize all state-sponsored organized violence under the defense of military necessity.

While the laws of war impose no substantive restraints on pre-existing customary military practices, they nevertheless have an impact on war. The mere belief that law places humane limits on war, even if factually mistaken, has profound consequences for the way people view war, and therefore the way that war is conducted. The credibility of the laws of war lends unwarranted legitimacy to customary military practices. Acts sanctioned by law enjoy a humanitarian cover that helps shield them from criticism (Jochnick and Normand, 1994, 56).

Law shapes discourse and makes existing arrangements seem credible, even inevitable. In times of war, the fact that nations claim to respect the rule of law helps protect the entire structure of war-making from more criticism (Jochnick and Normand, 1994, 58).

From ancient times, efforts have been made to establish legal codes to limit human suffering caused by war, and invariably these efforts coincide with the bitter regret that follows major armed conflicts. The coexistence of law and atrocities is common to all the laws of war through history, including the chivalric practices of Medieval Christian Europe and further back to ancient Greece and Egypt. Far from being evidence of a modern age of legal restraint, the laws of war are part a history of unsuccessful efforts to limit wartime conduct. “Notwithstanding public pressure to limit the horrors of war, the diplomats who negotiated the laws and the soldiers who implemented them structured a permissive legal regime. Despite humanitarian rhetoric, military concerns have dictated the substantive content of the laws of war” (Jochnick and Normand, 1994, 56).
With the carte blanche of military necessity, belligerents are free to target non-combatants directly, and they all do it; but they do not have to. Most of their impact is achieved beyond combat. Of the minimum 8 million people killed by war in Africa between 1980 and 1994, starvation and lack of medical services, along with the stress of flight, killed about twenty times as many people [in African conflicts] as did weapons. As Reginald Herbold Green reminds us, “the Four Horsemen of the Apocalypse—Famine, Pestilence, Death and War—ride out together” (Green 1994, 38).

While there are many detailed norms of international humanitarian law prohibiting governments from killing, torturing or starving their populations, the international supervision needed to monitor compliance with norms is intergovernmental and lacks any enforcement mechanisms (Tomasevski 73), and as Normand and Jochnick convincingly demonstrate in their study of the first Gulf War, “the most legalistic war of all time,” military necessity allows for virtually unlimited violence to civilian populations and defeated opponents. An infamous example was the slaughter of the Iraqi peasant conscripts in retreat on the highway from Kuwait to Basra at the end of that war (at the time, one of the US pilots said it was “like shooting fish in a barrel”).

There have been efforts to establish formal links between humanitarian affairs and human rights at the UN, notably in the 1991 study that led to the creation of the UN Department of Humanitarian Affairs. The report recommended the creation of a Department of Humanitarian Affairs and Human Rights, based on the substantial connection between humanitarian emergencies and human rights. However, when the General Assembly resolved to create the agency in 1992, it dropped the reference to human rights (de Waal 1997, 156). Member states could not agree, resisting the reiteration of Western human rights norms which authoritarian states equate with political subversion. When the Geneva Conventions of 1948 were drafted, too, there was an attempt to include a preamble to the IV Geneva Convention that would have defined it as a human rights instrument to protect basic, minimal human rights (Best, quoted in Slim 2000, 493). An argument erupted when the Vatican insisted on adding a reference to God, the divine source of human charity, and the communist bloc objected. The preamble was dropped, at a moment in history when a window opened up to preempt the false separation of human rights advocacy from humanitarian action (Slim 2000, 493).

If we accept the lack of protection of rights and the license to cause suffering that is masked by the so-called laws of war, the question is, What do humanitarians mean when they say they defend human rights? In armed conflict settings, they rarely refer to rights as defined in the Universal Declaration, but rather labor under the illusion that IHL covers basic human rights. It is a recipe for cynicism, bitterness, and grief.

The Last Humanitarian

There are those, like former MSF International president James Orbinski, who believe that the public idea of humanitarianism as they knew it is dead. Orbinski argues that humanitarianism has become what Ivan Ilych called an “amoeba word,” a term that is now shapeless and protean, lacking coherent public meaning. The new humanitarianism (humanitarian military intervention) has cast NGOs as character actors in TV shows about the War on Terror. It has all-but killed the public possibility of an independent humanitarianism, and nothing substantive has emerged to counter this. As noted previously, he argues that there is acute urgency to struggle to reclaim the ethos and language of humanitarianism, to radically transform, redefine, and find new language or else shut down.

Representing MSF-France, Rony Brauman deplores the misuse of the word ‘humanitarian’ by the Anglo-American coalition to describe the invasion of Iraq and its aftermath. His views, expressed to an American audience in 2004, are very cogent, and he deserves to be quoted at length: “The confusion caused by the misplaced use of this all-purpose word did not disappear with the end of military operations, far from it. The chaotic situation created by the war – looting, score settling, general insecurity – was also described as a “humanitarian crisis”. It is a curious term, applied exclusively to a context of misfortune (always exotic) to denote a disorder that rescuers (always Western) are supposed to remedy. Given the advantages such a convenient expression affords, it is hardly surprising that the spin doctors employed by heads of state and high commands are so fond of it: in one context it permits the response to be confined purely to relief like during the genocide in Rwanda; in another it justifies military intervention, as in Kosovo. …It is more surprising to see the term figuring so prominently in the vocabulary of NGOs for its use reflects the basic communicative strategy – propaganda, in other words – of political power. Some humanitarian NGOs have doubtless adopted it for the sake of convenience, seeing it as an immediately intelligible way of designating their natural place and of legitimising their actions even before they are carried out. In this sense, the use of it serves their interests. But they reap short-term benefit because the first to profit from the confusion to which they thus contribute are those who use humanitarianism for other ends” (Brauman and Salignon 2004, 1).

Fiona Terry is one of those who, like David Rieff, thinks that a rededication to a simple vision of human solidarity and political independence will put the MSF movement, and humanitarianism, back on track. In 2002 she published a study of humanitarianism through the lens of MSF, focusing on the problem of how humanitarian assistance often helps refugee warriors and criminals. She offers a very strict, narrow synopsis of what humanitarianism is. In her definition she gives glancing mention to human rights and includes it within her notions of the term ‘humanitarian’ (Terry 2002, 17-18). Her unexamined, unexplained positioning of human rights within a discussion of the 7 principles governing the ICRC— humanity, impartiality, neutrality, independence, universality, voluntary service and unity—indicate that she aligns MSF with the problematic notion that human rights are covered by the laws of war.

David Rieff equates the mandate appropriate to humanitarianism with charity (Rieff 2002, 57), and calls for a “back to basics” solution. He fails to see that if one is a citizen of a Western democracy, the shadow of the simple kindness of charity is the simple failure to address the political and social causes that make a person need charity. “Pity would be no more,” wrote William Blake in 1793, “if we did not make somebody Poor” (Perkins 1967, 67). Alex de Waal accuses the humanitarian international of being politically regressive in its pretense that charity is neutral, and he deplores its self-justification which mitigates against reform. “It may even be the paradigm of a secular human enterprise that does not need to succeed in order to justify itself. Humanitarianism works, by definition” (de Waal 1997, 4). While Rony Brauman is often brilliant and is deeply committed to the humanitarian cause, he always seems to talk around the tough questions that de Waal and others raise about the self-justifications of humanitarian action that fails to address the conditions for local social mobilization. For de Waal, the problem is “an entire political tradition, one manifestation of which is contemporary international humanitarianism” (de Waal 1997, 1), a tradition that gains realpolitik flexibility by maintaining a false dichotomy between charity and politics. Interestingly, Brauman is the first to admit that “neutrality ratifies the law of the strongest” (quoted in Terry 2002, 22), a point which Mark Duffield makes in arguing that political neutrality is a humanitarian fiction: “The internationalization of public welfare means that an internal emergency and its external response are organically linked. In the past, attempts to maintain political distance or neutrality have hidden this relationship. In practice, the linkage has meant that relief operations have usually provided indirect or tacit support to the politically strong. Humanitarian aid has never been, and will never be, neutral. The challenge to the international community, therefore, is consciously to direct the wide-ranging effects that its assistance has to support the emergence of alternative and popular political structures” (Duffield 1994, 66).

Neutrality—Policy and Reality

In her essay about Albert Camus’ The Plague as a testimonial allegory of the struggle against Nazism, Shoshona Felman describes why the doctor is the archetypal witness to the tragedy. In so doing she provides a brilliant illumination of the ethos of MSF: “Camus’ choice of the physician as the privileged narrator and the designated witness might suggest that the capacity to witness and the act of bearing witness in themselves embody some remedial quality and belong already, in obscure ways, to the healing process. But the presence of the doctor as key-witness also tells us, on the other hand, that what there is to witness urgently in the human world, what alerts and mobilizes the attention of the witness and what necessitates the testimony is always fundamentally, in one way or another, the scandal of an illness, of a metaphorical or literal disease; and that the imperative of bearing witness, which here proceeds from the contagion of the plague—from the eruption of an evil that is radically incurable—is itself somehow a philosophical and ethical correlative of a situation with no cure, and a radical human condition of exposure and vulnerability” (Felman and Laub 1992, 4-5).

The early leaders of MSF such as Kouchner and Brauman, undoubtedly inspired by Camus as well as Marx and Lenin, were radical student activists and veterans of the great leftist disillusionment of May 1968. MSF harnessed the “demobilized militancy of the post-May 1968 period” (Jean-Christophe Rufin, quoted in Rieff 2002, 105). Everyone channels disillusionment in their own way. Kouchner thought that, claims of neutrality notwithstanding, MSF’s work was always political, and its rigorous independence gave it room to take independent political positions, with the moral authority of the witness. He has gone on to enjoy a high profile life in French politics, and also served as humanitarian czar for the UN in Kosovo.

There are two different forms of neutrality that are often conflated by MSF and other agencies, operational neutrality and neutrality of principle. MSF tries to practice both. Operational neutrality means non-partisan aid and communications, refusing to take sides in a conflict. Neutrality of principle means objectively assessing parties to a conflict according to the same standards. This often means that one party is criticized far more than the other, reflecting the reality that some governments and armies are far more abusive than others… a human rights organization that failed to follow this principle, and instead preferred to ‘balance’ its criticism…would in fact be partisan towards the more abusive party (de Waal 1994, 8).

MSF advocates “active neutrality”, arguing that “by providing both sides of a conflict with equal access to relief aid the security of humanitarian operations can be enhanced, potential conflicts between opposing parties over access to relief resources can be mitigated, and civilian populations can be equitably provided with assistance irrespective of their location” (Macrae and Zwi, 1994, 29).

In 1989 MSF held an international conference in Toulouse, France. The MSF Charter was on the agenda. It was clear that interpretations diverged among the sections, and parts of the charter were no longer consistent with MSF advocacy practices. In MSF’s original charter, volunteers were not allowed to interfere in a country’s internal affairs or publicly state their opinions. In practice, none of the sections adhered to these rules. The French section had always been particularly outspoken, and regarded advocacy activities as essential to its mandate. The charter was amended at the conference to remove the text referring to the ban on advocacy activities. While there was concern that this move might infringe on the neutrality principle, the Dutch section at the time concluded that it was a good decision, recognizing that in some situations that “the failure to engage in advocacy was tantamount to condoning human rights violations” (MSF-Holland, 1994). Times had changed, MSF-Holland co-founder Jacques de Milliano explained. In the 80s “aid workers used to monitor the combatants from a distance and were given access to the civilian population, with ‘neutrality’ as the password….human rights activism was seen as an insurmountable threat to field operations.” But since the fall of the Berlin wall, humanitarian aid has become one of the political instruments, along with peacekeeping, peace enforcement and organizing elections, that both governments and the UN use to respond to a crisis. “Neutrality has lost its magic” (MSF-Holland, 1994). “Humanitarian action and human rights advocacy are more than ever two sides of the same coin: the concern for human dignity. If, by joining forces, the plight of populations in danger can be improved, cooperation should no longer be considered an option but a necessity” (MSF-Holland, 1996).

MSF is an organization that thrives on internal debate, and in 2001 the question of the principle of neutrality was again discussed in the series of regional Annual General Meetings (called Mini A-G’s). While in 1989 the ban on advocacy was debated and dropped from the Charter, and a few years later the word ‘strict’ was debated and dropped from the phrase ‘”MSF observes strict neutrality and impartiality”, in 2001 the perennial debate about dropping “neutrality” from the Charter was opened again without resolution. The issue for critics was inconsistency and hypocrisy. In one of the discussion papers prepared for these meetings, Fiona Terry (MSF Australia president at the time) wrote, “Many aid organizations invoke their ‘neutrality’ as a reason for not reacting to human rights abuses and criminal behavior, whether in Ethiopia in the mid-1980s when aid was used as a tool of deportations, or in the mid-1990s in the Rwandan refugee camps. Within MSF, this argument, coupled with the fear of expulsion, has also been used to oppose public témoignage” (Terry, MSF-France, 2001).

This question of whether MSF can honestly claim to be neutral, and to claim that it is not, and cannot be described as, a human rights organization, is a problem that MSF struggles with through continuous internal discussion. Some in the MSF movement promote a ‘back to basics’ approach, claiming that the policy mapped out by the ICRC in the 19th century is the “correct ideology” of humanitarian action. “The realism behind the ideology of humanitarian action is that if it is allowed, it must have very low political significance. It should not challenge authority by offering hopes of democracy, peace, or freedom—because the form of peace or democracy or freedom is an intensely political question” (Davis/MSF-Holland, 2002). Others in the movement suggest that it is too late for this approach and MSF needs to accept the implications of its own evolution. Indeed, the notion of doing mere charity work without crying out for justice, as has occurred when military humanitarianism coopts the humanitarian space (Afghanistan, Iraq) is repugnant to many in MSF: “The role assigned to the humanitarian community draws the attention of the general public to the charitable aspect, thereby appealing to people’s emotions. This means feelings of compassion take precedence over any call for justice” (Dachy/MSF-Belgium, 2001).

Doctors Without Politics?

To approach the question of rights-based action, MSF calls it protection of “humanitarian rights” (Biquet/MSF Belgium, 2000), an interesting linguistic marriage of convenience not found in humanitarian law. For some people in MSF, the recording and reporting of violations of human rights and international humanitarian law, committing to enforce the ethical norms of rights “protection,” could serve to “re-politicize human suffering in precisely the way that charity fails to do. …Charity has never altered unequal power relations, but only reinforces them” (Rackley/MSF Belgium 2001, 27). This can, and usually should, be done through discreet cooperation with human rights organizations (MSF-Holland, 1996). It is argued that MSF’s humanitarian identity, and its dedication to medical relief, is not threatened by explicitly acknowledging that MSF volunteers will record and report violations of human rights and humanitarian law encountered in the field. However, this response to the problem of de-politicized charity is only proposed, and hotly debated within the MSF movement. As we have seen from the versions of the truth as described by MSF intellectuals such as Terry and Brauman, and MSF’s champion journalist in the English-speaking world, David Rieff (who describes Brauman as his most important mentor), there is no consensus approaching Rackley’s position. Fearing that a commitment to human rights norms of protection would entail a loss of identity, a compromise of independence, and a quagmire of unrealized good intentions, the MSF movement has not committed itself to this course of action.
It is important to understand that those who call for a rededication to neutrality do recognize, at the same time, that aid has always been politicized. They see this as an inevitable dilemma of the humanitarian calling, to which MSF’s traditional approach is the only viable response. They speak with unconcealed disgust of the “collective historical amnesia” of the new humanitarians who insists that aid has become politicized, as if it wasn’t in the past (Terry 2002, 10-11).

Critics of the protection agenda within MSF question the relevance of this work to MSF’s mission. They insist that protection is in the realm of the social, and should be left to social development agencies such as UNICEF. In some contexts, perhaps. But what about the times and places, the communities and shanties beyond the CNN spotlight where MSF is alone, sometimes for years, where other agencies are not active for one reason or another, or where no one is assisting with rights protection, justice issues, and social regeneration? In these contexts the dilemmas of claiming to bring aid that is “modestly” pre-social and supra-political become most visible. It is a kind of charity, but is it sufficient?

You may recall Rony Brauman’s version of the humanitarian paradox: that it is based on gifts without any counter-gift. This, he suggested, means that humanitarian gestures deny any possibility of social linkage, or of social construction. He continues, “This internal contradiction should be seen as a limitation of humanitarian aid. It is one of the many reasons why humanitarianism should be restricted to a very limited space of human action generally. Politics is about constructing social links. Humanitarianism is about relieving individual suffering” (Brauman 2004, 1).

Elegant as this statement is, it arguably presents a false disconnect that depoliticizes the systemic relation of the humanitarian worker and agency with the structural violence that generates the humanitarian crisis. It also rings a false note in its insistence that there is no counter-gift. This would seem to deny what the humanitarian, the agency, the agency’s donors, and its public supporters receive in return for their help. This may be many things to many people, but it is never ‘nothing’. One way of thinking about the counter-gift is through the ideal of service that is articulated in the riddle that Parsifal seeks to solve in the Grail cycle of stories. Whom does the Grail serve? It serves the Divine (whatever you conceive the Holy to be). What does that mean? By gestures toward the other, toward life, we are fully alive to ourselves. We may not realize that this is what we receive when we give humanitarian assistance, but it comes to us whether we are aware of it or not, whether we are Rony Brauman or eager young volunteers on our first mission.

The politics that MSF does practice is the option of refusal to be complicit in a morally compromised situation, where aid is supporting injustice, as in the Ethiopia famine and in the Tanzanian refugee camps after the Rwanda genocide, or where MSF is unable to remain independent of the interests of belligerents or state powers in a context such as Iraq. MSF has a culture that vigorously debates the political implications of its actions, and the organization often finds itself isolated from other NGOs that close ranks and carry on in what MSF considers to be morally untenable situations (Terry 2002, 238). Fiona Terry seems to be speaking to both MSF traditionalists and to the ICRC when she writes that “…remaining silent about atrocities and abusive policies can also lend countenance to them: as organizations professing to uphold certain principles of humanity, international aid agencies just by their presence and participation can be a strong propaganda tool in the service of governments or insurgents. This is particularly true of ICRC, whose mandate, reputation, and discretion imbue its presence with a particularly affirming quality” (Terry 2002, 45),

As noted earlier, the critiques of human rights as a Western construction help us to see why traditional humanitarians choose to stand apart from human rights agencies. They reject the dictats of human rights conditionality for aid and relief partly because they recognize the cultural imperialism, born of Christian cosmology, that informs the Western rights tradition. Humanitarianism claims for itself the narrow space in which we can practice ethics based on human compassion, on immanence, rather than based on ethics from above, from a distant transcendent authority.

It is crucial to recognize that these Western humanist presumptions of moral authority inform both the human rights activists and the apologists for the new humanitarianism, the adversaries that confront MSF from within the humanitarian international, both in their face and at their back, as it were. In 1997 the ICRC, along with a broad coalition of IHA organizations, from which MSF is conspicuously absent, launched the Sphere project to improve the effectiveness and accountability of disaster response. The concrete product of Sphere is a handbook called The Humanitarian Charter and Minimum Standards for Disaster Response (revised edition, 2004). Sphere claims that the Humanitarian Charter is informed and “underpinned” by all of the key legal instruments of international human rights, humanitarian and refugee law of the 20th century (Sphere, 313). Sphere defines well the noble values claimed by humanitarians, under the leadership of the ICRC: “first, that all possible steps should be taken to alleviate human suffering arising out of calamity and conflict, and second, that all those affected by disaster have a right to life with dignity and therefore a right to assistance” (Sphere, 5).
Respected critics of aid such as Mark Duffield, Joanna Macrae, and Anthony Zwi assert that humanitarian aid is always political. “Aid, far from being politically neutral, is a political and economic resource” (Macrae and Zwi, 1994, 27). In this light, the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief—a centrepiece of the Sphere Handbook—rings hollow when it protests that “when we give humanitarian aid it is not a partisan or political act and should not be viewed as such” (Sphere, 317).

The reasons that MSF has not signed on the Sphere have more to do with the technocratic nature of it than with any dispute over the ICRC’s Code of Conduct. Fiona Terry charges that “Sphere reduces humanitarian action to its technical components for the sake of proving efficiency to donors” (Terry 2002, 52-3), and she argues for the importance of evaluating the overall impact of the aid, in order to ensure that aid is serving the best interests of the victims. Sphere, in the view of MSF, does little to reverse the debasement of humanitarian action.

According to David Rieff’s account, which is consistent with Fiona Terry’s, the consolidation of the new, politically compromised, humanitarianism (or the death of the last humanitarian, depending on your point of view) occurred in Bosnia in the early 90s. “It was in the interaction in Bosnia between donor governments, the UN relief and refugee agencies, and the NGOs that the new humanitarianism was born” (Rieff 2002, 134). Before that time, MSF coexisted among other charitable relief agencies that all, in theory, are required to be non-political by the rules of charitable status of home countries such as England, Canada and the United States, and in the countries where they worked the local government could also kick them out for taking any political position. Typically NGOs make reference to political neutrality in their charter or mission statement when they apply for tax exempt charitable status. “One consequence of the depoliticization of relief was that a ‘natural disaster’ model of human suffering prevailed. Repeatedly, when a government reduced its own citizens to a state of acute hunger and desperation, through corruption, ineptitude or brutal counterinsurgency warfare, the blame was put on the weather” (de Waal, 1994, p.1).

‘Humanitarian space’ in war is supposed to be detached from the political stakes of the conflict. Fiona Terry shows how problematic this is in practice when she claims that political independence is “an indispensable condition”, and then goes on to say that “the term ‘humanitarian space’ has been used to invoke a space ‘separate from the political’, but…such as separation is seldom possible in practice” (Terry 2002, 19). So how can humanitarian actors remain, and be perceived by belligerents to be, scrupulously independent, “free of all political, religious or other extraneous influences” when they intervene in the political miasmas of armed conflicts?

In light of the deeply problematic nature of MSF’s claims to neutrality, the words of MSF-Canada director David Morley in the aftermath of the slaughter of five MSF workers in northern Afghanistan on June 2, 2004 are particularly poignant. Lamenting the militarization of humanitarian action and the disappearance of “humanitarian space,” he speaks of the present but sounds like he is recalling a bygone Camelot, now out of reach: “MSF works in highly polarized situations, and our impartiality, independence and neutrality make it possible for us to rise above the conflict, and to be in Colombia, Congo, Ivory Coast and, until last week, Afghanistan” (Morley 2004, 1). Assertions of neutrality were dismissed by the local warriors in the north-west province of Badghis, Afghanistan, both before and after they targeted the MSF vehicle for destruction. In a statement released after the killings, the Taliban declared that the MSF volunteers were “working for the policy of America” (Morley 2004, 1). To the locals, that is what it looks like; and in this new, post-humanitarian world, perception is nine-tenths of reality. Fiona Terry, writing two years earlier, was among those in MSF who raised the alarm about the collapse of humanitarian space in Afghanistan. “Will aid organizations consider the negative repercussions of their past role as adjuncts of Western foreign policy and assert their independence, so that they can act solely in the interests of victims of this conflict? Or will they consider that this ‘war against terrorism’ justifies advancing US interests through their aid?” (Terry 2002, 82). Everyone in the MSF movement knew that this unholy integration of aid with the War on Terror would place humanitarians in peril on the ground. Many predicted that it was only a matter of time before some enraged Afghans would punish aid workers for their perceived collaboration with the US military.

War Talk

Diversity of opinion is seen as a strength (or an inevitable aspect) of the MSF movement among the 17 sections (5 operational based in Europe, 12 other national partners), and within the leadership of each section. The five MSF Operational Centres express a range of positions on these matters. In the 2001 Annual Report of MSF-France, president Jean-Hervé Bradol attempted to clarify MSF’s philosophy on war, and by implication, the human right to peace. “Our volunteers often feel confused about this issue. They forget whether they are there to provide the best possible assistance to the victims of war or whether their role is to participate in reconciliation and peacekeeping. We must be very clear about this. We have to accept the existence of war. We are here to help alleviate its consequences on civilians. That is our primary responsibility. We are not responsible for peacekeeping, much less for peacemaking. That is beyond our scope, understanding and authority… The confusion between pacifists and humanitarian workers has led some of our volunteers… to lose faith” (Bradol/MSF-France, 2001).

In his effort to address the volunteers’ faltering faith, Bradol strikes a fatalistic chord reminiscent of Camus, as if the MSF workers’ fate is to accept the tragic limits of humanitarian action. Recall that in La Peste, Camus’ doctor chooses to bear witness and remain in solidarity with the plague’s victims in response to “a situation with no cure, and a radical human condition of exposure and vulnerability” (Felman and Laub 1992, 4-5). This version of the truth, so relevant to medical relief, seems to be shared by many within the MSF movement, and may lead to the kind of humble acceptance of the status quo that Bradol recommends. The internal newsletters of MSF serve as a forum for debate, but also as a platform for MSF leaders to shape and manage the discourse on controversial issues. In his effort to clarify the modest limitations of what MSF considers to be in the realm of the possible, Bradol implies that an MSF worker’s commitment to conflict transformation and the rule of international law is a naïve failure to “accept the existence of war.” This seemingly wise, paternalistic advice pre-empts any reasoned debate on jus ad bellum or jus in bello, and like the permissive laws of war themselves, helps protect the entire structure of war-making from criticism. Like so many “realists” who wearily insist that war is a perennial human pastime, Bradol fails to distinguish the human appetite for aggression from the potential social and legal limitations that can prevent acting on instinct, individually and collectively.
Of course the medical tasks are huge (there will be poor always) and it takes so much courage and compassion to just do that. It is true, the plate is full. So full with its limited yet ambitious work, that some feel, particularly in MSF-France, that its integrity is compromised by the tendency to combine humanitarian and human rights practice. It has even been proposed that MSF should break away from the humanitarian movement.
The volunteers can be forgiven for harboring pacifist illusions. De Waal laments that while many humanitarian NGOs give lip-service to peace building, none has any clearly defined set of principles for operation in a war zone. He thinks that many NGOs are implicitly pacifist by conviction (de Waal, 1994 p. 6). Hugo Slim, on the other hand, interprets the lack of explicit policy statements as tacit acceptance of the war system, although he seems unsure about it. “Reading between the lines and without explicit policies to go on, it seems fair to say that almost all humanitarian agencies, whether single-mandate or multi-mandate, are not pacifist organizations” (Slim 2001, 9). While I agree with Slim that most humanitarian agencies are not overtly pacifist, I think it is despite the convictions of many humanitarians, which de Waal rightly identifies as anti-war. By upholding the laws of war, the NGOs are complicit in the structure of legitimated violence, the war system.
An oft-repeated mantra within MSF is that the organization role is not to denounce war itself, but only to denounce attacks carried out by armed forces on civilians. But our understanding of war has changed dramatically in recent years. In a world where 90% of the casualties of war are civilians, due to the permanent transformation of the nature of war in terms of both weapons and tactics, the notion of creating humanitarian space to shield civilians from harm without defending their right to peace seems to be at best deluded, and at worst an apology for slaughter.

It can be argued that providing services to alleviate the suffering of war and claiming the authority of the full spectrum of human rights covenants without denouncing armed conflict itself has become an untenable position. The fact that some MSF sections now take part in anti-war activist coalitions demonstrates a refusal to be complicit in a charade, a refusal to respect the old rules of “just war” that no longer apply.
In the imaginable future, if we are ever able to realize the legislative and normative changes that are needed to make international humanitarian laws enforceable (by revoking the license of military necessity), it may still be necessary to allow for the possibility of armed rebellion against tyranny. While the signatories to the UN Charter explicitly abandoned the right to make war, there was no mention of the need to make allowance for the overthrow of tyrants. The words of archbishop Oscar Romero, assassinated by death squads for his stand against the regime in El Salvador, could serve as the basis for such a provision. “When a dictator seriously violates human rights and attacks the common good of the nation, when it becomes unbearable and closes all channels to dialogue, of understanding, of rationality—when this happens, the church speaks of the legitimate right to insurrectional violence” (quoted in Terry 2002, 108).

Who Needs Mercy Without Justice?

In our time, the most eloquent voices of dissenting vision come from the South, from the parts of the world where the oppressed and exploited majority of people live. Where people have little to lose and so much to gain, their leaders have the courage to say that they don’t care much for mercy without justice. This radical perspective suggests that, in order to intervene abroad in a way that they would not accept in their own country, MSF claims a fictitious non-partisan stance and privileges the right to life over the right to justice, despite the fact that most of the people they are assisting have declared that for them, justice is on a par with life. On this view, traditional humanitarian doctrine is simply inadequate to define the appropriate role of aid in many contexts.

Alex de Waal’s emphasis on the necessity of engaging oppressed people in Africa in political processes to address their suffering is consistent with the thinking of one of the original champions of liberation theology in Latin America, Gustavo Gutiérrez. Gutiérrez promoted radical reform in the Catholic church and in state governance, suggesting that change could only come from below, from “the underside of history”, that is, through sub-version—radical change or overthrow (vertir) from below (sub). This involves the claiming of rights and dignity by the oppressed, and claiming a “share in the decisions that affect their lives and their future” (McAfee Brown, in the preface to Gutiérrez 1983, xii).

Liberation theology insists on coming from below, from the poor, the most oppressed and exploited. Because it is bearing witness at that level, it insists that it has to look at political, social and economic structures of society as the context in which the humanitarian issue is embedded. Arguably, this is also necessary for a fully engaged humanitarianism. “Attention must certainly be called to the suppression of the right of dissent, of freedom of expression, of the holding of unpopular opinions, but such attentions run the danger of leaving untouched the further issue of what can be called social human rights, i.e. the right of people to food, clothing, education, shelter, health care, employment. In the northern hemisphere, such ‘rights’ are usually defined as privileges, available to those who can pay for them. But the whole discussion of human rights aborts, Gutiérrez feels, if the latter ‘rights’ are not center stage. Doing away with torture, admirable and important as a goal in itself, need not affect the denial of the other rights just mentioned, and when torture is abolished a government is likely to assert that the human rights problem has been ‘solved.’” (McAfee Brown, in the preface to Gutiérrez 1983, xiv).

Like Brauman and Kouchner, Gutiérrez was also a young activist in May of 1968. But for him the hopes of social transformation, of a new society, of genuine social change, that were the zietgeist of ‘68 were not light-minded illusions but powerful visions encouraging an uneasy hope. For Gutiérrez the increases in injustice, repression, and barbarism that we have seen in Latin America in the last 36 years do nothing to discredit or invalidate the clear awareness, since the late 60s, “that something new was afoot, something no repression could ever again quell or crush: a people’s will to self-affirmation and to life” (Gutiérrez 1983, 81).

Unlike Guittiérez and those who have gone on to articulate the global citizenship movement described earlier, the founders of MSF seemed to have committed themselves early on to the ideological shift of the 70s and 80s described in the later works of French philosophers such as Lyotard and Foucault, which Edward Said laments as a loss of faith in “the great legitimizing narratives of emancipation and enlightenment” (Said 1993, 26).
After years of support for anti-colonial struggles in Algeria, Cuba, Vietnam, Paletine, Iran, which came to represent for many Western intellectuals their deepest engagement in the politics and philosophy of ant-imperialist decolonization, a moment of exhaustion and disappointment was reached (Said 1993, 27).

Consider the possibility that what Gutiérrez says of the poor is equally true of all beneficiaries of humanitarian assistance: The person in danger (in a population in danger) “does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a byproduct of the system in which we live and for which we are responsible.” Hence their suffering “is not a call to generous relief action, but a demand that we go and build a different social order” (Gutiérrez 1983, 40). [italics added]. This would have serious implications for public education, advocacy and humanitarian action in all crises. For example, it is easy to say that the suffering of children in northern Uganda at the hands of the Lord’s Resistance Army is due to the psychopathology of that army’s leaders, and the peculiar local sociopolitical circumstances out of which that extremist group has come. But depoliticized humanitarian action, complicit with the geopolitical actions of our states in the past and present, can and does contribute systemically to the sociopathogenic conditions that breed and feed the LRA and its atrocities. Alex de Waal would say that the choice that emerges from this kind of consciousness is either to be the technical service contractor type of agency, or to be an agency that works in an explicitly political way to promote local citizens’ movements. “Agencies that are wedded to an ethos based on drama and self-publicity have no serious contribution to make. Those embedded in more thoughtful and politically progressive constituencies, ready to act without publicity from a sense of solidarity, can do a great deal” (de Waal 1997, 219).

The possibility to support local citizens’ movements is limited by the degree to which there is a political contract, and is problematic in the so-called failed states, where the simpler, more ‘modest’ or pure form of humanitarian action seems like the only way to go. It is important to acknowledge that MSF is among the best of the agencies that are able to deliver humanitarian assistance in these contexts.

Toward a Rights-Based Approach

Discussing the humanitarian debacles after the Rwanda genocide, David Rieff plunges to the heart of the matter that humanitarians need to struggle with, not just in that particular hell, but in all circumstances where humanitarian assistance may be justified. “Could the humanitarians themselves have carried on with what they were doing while really assimilating the somber sense of moral ambiguity that an accurate account of their effort in eastern Congo [providing assistance to genocide perpetrators] would have evoked? …They had not given up lives and jobs in the West to save the families of the 1990s Central Africa’s equivalent of the Nazi SS. Or had they?” (Rieff 2002, 56). This is a very good question, although Rieff fails to do justice to it. It can be argued that the complicity of Western TV viewers and Western humanitarians in these tragedies, the political dimensions of our relations with it all through the geopolitical actions and failures of our governments, are essential aspects of an “accurate account” of what was (and is) going on in Rwanda and Zaire. This level of understanding may be essential for the renewal of humanitarian integrity. A rights-based approach is all about the micro and macro dimensions of the question “Why?” —Why are they poor, why are they suffering, why are they fighting, why does the power in control of the military lack popular support, why are the Western powers responding in this or that active or passive way?

Rony Brauman argues that these questions cannot legitimately be asked by outsiders. “The humanitarian’s position is much more humble and restricted than that assumed by the development aid community. Even though both kinds of aid spring from the same philanthropic source, in practical and philosophical terms they differ greatly” (Brauman 2004, 1). Why is it that insistence on the “smallness and realism of the humanitarian ideology” (Davis, MSF-Holland, 2002) continues to be vigorously questioned by humanitarians who recognize the social implications of humanitarian assistance, and who strive to be consistent with what moral philosopher Richard Rorty calls our human rights culture (Rorty, 1993, 134)? Drawing on the work of Argentinian jurist and philosopher Eduardo Rabossi, Rorty suggests that the human rights culture has become not just an ideology espoused by some liberals in some places, but plausible as a “fact of the world,” a contemporary cultural fact for all people. For Rorty, this is a result of the evolution of human moral capacity, not simply the recognition and entrenchment in law of universal ahistorical notions about human nature. This view is compatible with a respect for diverse culture-specific interpretations of rights, and is not dependent on a Western universalist bias. Perhaps MSF needs more voices from within, such as De Milliano, Rackley, Terry, and Richard Bedell, who are committed to the world-making task that Rorty describes, to make the human rights culture “more self-conscious and more powerful” (Rorty, 1993, 117). Given that MSF workers serve populations whose health problems are always physical manifestations of rights violations with political implications, this may be a coherent approach that can strengthen MSF’s integrity and effectiveness rather than a quixotic and ill-advised idealism.

But at the heart of MSF’s culture, particularly MSF France, is skepticism about human rights discourse, dismissing it as rhetoric too beautiful for the real world. “The more that is said about the progress made on the human rights front and the moral dimension of international and humanitarian relations, the less this is reflected in the world and the more human beings suffer” (Dachy, MSF-Belgium, 2001). MSF’s international legal expert, Françoise Bouchet-Saulnier speaks of rights norms with bitter irony. On one hand, she sees the rights advocates’ impotent insistence on norms in face of brutal facts, and on the other the military humanitarian’s imposition of brutality (war making) in the name of the rules: “Reference to law is always strongest at precisely the moments when respect for the rules disappears” (quoted in Reiff, 1994, 244). One hears the honest voice of Rorty’s liberal ironist in this kind of reasoning, but there is also a dry skepticism that dismisses the claim of actual advances of the moral capacity that Rorty describes.

And yet perhaps the sentimental affinity of humanitarian workers for human rights ideals, beyond the narrow confines of working within the deadly laws of war, is to be expected. For many in MSF, the act of standing alongside the people in danger, touching them and listening to them, (proximity) is the essence of the work. They learn from frontline experience the answer to the question, “Why should I care about a stranger?” They hear first-hand “the long, sad, sentimental story which begins ‘Because this is what it is like to be in her situation—to be far from home, among strangers,’ or ‘Because she might become your daughter-in-law,’ or ‘Because her mother would grieve for her.’” (Rorty, 1993, 133). This empathy, based on sentiment rather than cool reason, is what causes an individual to internalize the human rights culture, and this is why it resonates so deeply for many within MSF despite the best efforts to define the active defense of human rights set apart from humanitarian practice.

The excitement of MSF culture, “always on the move, daring to take the initiative, high-spirited and averse to compromise, trying to achieve the impossible” (de Milliano, MSF-Holland, 1994) inspires fierce loyalty. On the other hand, MSF has a high turnover of field volunteers and operational staff, and new, young volunteers ask the same old questions. This is reason for hope, in that there is a potential flow of fresh perspective. It is also a source of frustration, because the learning curve is steep, the field assignments are often short-term, and the imperative to act efficiently is paramount. So: When is a humanitarian worker a human rights worker? We have looked at MSF’s answers, which offer a variety of perspectives, and we have noted how some other NGOs have addressed the question. For many agencies, the answer is, always—actively or passively, part of the problem or part of the solution. It is up to the humanitarian organization to provide the worker with a clear understanding of the inevitable rights dimensions of the work, and to establish institutional mechanisms to take on the full political implications of its engagement from a rights-based perspective.

Conclusion

The Nazi Holocaust provided the catalyst not only for the writing of The Plague, but also for the development of international human rights norms. Human rights law-making was the global response to those horrors; new international legal norms emerged out of sustained global outrage. This gives us a clue as to why the separation of humanitarianism from human rights work is not universal, fixed, or immutable. The experience of repeatedly confronting the rights implications of the work provokes incremental experiences of outrage among humanitarian workers. This outrage builds up, and the purist humanitarian armor begins to crack, unable to withstand the reality of genuine feeling, what Jonathan Swift called savage indignation.

Those who promote a new synthesis of international humanitarian and human rights law and practice are engaged in the early, dark period of a long effort of peoples to reach consensus and mutual understanding about human rights norms, knowing how little the international community today demonstrates the characteristics of balanced relations—“relations of mutual recognition, mutual role-taking, a shared willingness to consider one’s own tradition with the eyes of the stranger and to learn from one another, and so forth” (Habermas, 2001, 129) In our scrutiny of human rights in practice, which should be a prerequisite for any humanitarian actor or agency to defend human rights in the midst of contests among enemies and warriors, we can criticize “not only selective readings, tendentious interpretations, and narrow-minded applications of human rights, but also that shameless instrumentalization of human rights that conceals particular interests behind a universalistic mask.” However, we must come through the other side of this critical de-centering and eye-opening without being tricked into losing our commitment to the value of the rights themselves. The challenge is not to succumb to the “the false assumption that the meaning of human rights is exhausted by their misuse” (Habermas 2001, 129).

Many of the MSF-focused intellectuals cited, such as Terry, Brauman and Rieff build their arguments on the assertion that “the dilemmas confronting aid organizations today are essentially the same as in the past” (Terry 2004, 5). However, it may be that increased rights consciousness has fundamentally changed the moral ground of humanitarian assistance. The dilemmas are not exactly the same as in the past because our perception of them has changed. We have lost our innocence, and we now know too much about what it means to take responsibility for bearing witness.

A final note on the bleak image of the last humanitarian:
Certainly, there are both individuals and organizations out there in the field now who are forging a new language and a new way of working that addresses the dilemmas and integrates the insights that have been discussed in this paper. Uncomfortable with the current debasement of the old term ‘humanitarian,’ and rejecting the 19th century fable of de-politicized compassion that animates the humanitarian idea, they may not know what else to call themselves yet. Perhaps a metamorphosis is underway, from the humble, compassionate, heroic, resilient and agile humanitarian caterpillar into a quite different creature
Or should I speak of evolution instead?

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