International Activity Report 2004
The struggle to reach people in need
By Kenny Gluck,
MSF Director of Operations, Amsterdam

The decision to withdraw from Afghanistan following the killings of five of our colleagues was sad and painful because it represented a rupture in a quarter century of commitment and engagement with victims of this crisis. It was jarring to lose the ability to provide health care in a spirit of human solidarity in a place which has absorbed so much passion and dedication in the history of MSF. We are forced to ask if this foreshadows the loss everywhere – the beginning of our irrelevance as humanitarians and as a movement.

An MSF health worker discusses problems with a soldier in Angola. © Hans Jurgen Burkard

The murders in Afghanistan highlight the fundamental vulnerability of our work and remind us of the frailty of the humanitarian position. Our allegiance to a humanitarian ideal demands that we go unarmed into areas of crisis to provide assistance where it is most needed. We are not willing to turn into an armed agency of medical providers. We believe that going unarmed into an area of conf lict, trying to save lives, trying to alleviate suffering, is a reaffirmation of human dignity.

The only protection we carry is hope, sometimes a naïve one – that we will be recognized as people outside of the framework of violence and therefore will not be seen as a legitimate target for it. When we talk with faction leaders about gaining access to victims and respect for the safety of aid workers, our key arguments are the content of our aid and our humanitarian identity, that is, our independence from political and military forces and agendas. However, during the last ten years, many governments have sought to rob us of this identity and undermine our argument.

More importantly, most other United Nations and private aid agencies seem to have given up on the very idea of a limited humanitarian mandate. Today even UN relief agencies uphold the notion that their assistance has to be coherent with their political strategies. Many NGOs explicitly mix the promotion of democracy and human rights with their humanitarian agenda. In Iraq, NGOs sought to use humanitarian arguments to advance their political positions against the United States invasion of Iraq. In Afghanistan, many of the larger NGOs even called for NATO deployment throughout the country in order to improve the security situation. The promotion of a partisan military advance is a clear breach of the humanitarian ethic of neutrality. These groups freely depart from humanitarian principles but still seek to be covered by protections associated with humanitarian action. Sharing the same institutional form, their rejection of humanitarian principles erodes the protections for all and undermines the entire field of humanitarian aid.

When aid is blocked

In many countries where we work our access to populations in crisis continues to be threatened in other ways. We have seen it in Darfur. Starting in the middle of 2003, villagers in Darfur, western Sudan, have faced a violent campaign of terror, in which their villages have been burned and their livelihoods destroyed. Thousands have died and hundreds of thousands more have been forced to f lee across the border into Chad or into overcrowded, makeshift camps in Darfur itself where they have sought, but never found, safety in numbers.

In addition to the massacres and campaign of rape which occurred during attacks, hundreds of thousands of displaced people soon started a slow slide into malnutrition and death. In spite of the enormity of the abuse and urgent needs, it would take months before MSF could mount interventions of any scale. Although we had small teams on the ground back in November 2003, the large-scale intervention demanded by the situation would not become a reality until April and May 2004. For months, the displaced lived in destitution and misery with little aid from MSF or anyone else. MSF watched with frustration as the Sudanese government blocked volunteers' visas and cargo shipments while we were torn between the desire to denounce their delay tactics and the hope that we could still negotiate our way in. It was only months later that international pressure forced the government to lower the barriers, allowing MSF and other agencies to provide some of the massive amount of assistance required.

While such situations conjure up a feeling of frustration, it would be wrong to assume that this is a new phenomenon. Access to people in need has always been blocked and manipulated by those who control the violence against them Humanitarians have had to continuously struggle to ensure that aid is provided in a way that allows dignity and does not get turned against the very victims we seek to assist. But to be honest, it is not difficult for governments or military forces to keep us out. The humanitarian aid worker is not a powerful negotiating partner. We come to the table with no force of arms. We offer practical assistance to those in need, but the survival of those abused and neglected in crisis often holds little interest for the powerful. In the negotiation for access, we offer little else but a clear and compelling position on caring for those in need.

There are other ways in which our ability to reach people in crisis is blocked. For many years, we have been unable to provide the levels of assistance in Somalia which the crisis demands. Ravaged by 15 years of war, massive levels of malnutrition periodically plague much of the country. Armed clashes between warring militias continue to leave hundreds or even thousands of wounded who receive little or no care. In spite of the clear needs, neither MSF nor other agencies has been able to negotiate safe and secure arrangements which allow us to work fully and openly in the country. The armed groups are too fractious and numerous to allow a stable negotiation of access. The blurred lines between humanitarian assistance and the international military takeover in the early 1990s as well as the UN's use of aid to advance its military strategy has crippled the respect which humanitarians could have enjoyed as neutral and independent caregivers.

In Chechnya, where civilians have endured a brutal bombing campaign and waves of oppression, MSF and other humanitarian aid groups have likewise been forced to reduce, if not completely stop, assistance. As in Somalia, MSF has found it impossible to negotiate a protected space to work amid the intertwined mix of criminal and military endeavors in the region. More insidiously, the Russian government and some Chechen rebel groups have tolerated and even encouraged attacks on humanitarian actors. After dozens of kidnappings, assassinations and other abuses, the powers that be do not need to construct administrative obstacles to bar our entry which we can publicize and denounce. We are no longer willing to take the risk of sending our volunteers there. We want our work to be a gesture of solidarity with those who suffer in crisis, but we do not want to martyr ourselves on the suffering of others. It is simple for totalitarian regimes to keep out humanitarians. North Korea has, for years, denied any possibility for independent humanitarian action. MSF left the country when we saw that our assistance was controlled by the government which would not allow us to reach those most in need or ensure that the aid was not diverted by those in power, contributing to further oppression of the most vulnerable. Denied access to the vast misery in the country, MSF has, for years only been able to provide limited assistance to the lucky few who manage to escape its borders. Knowing the suffering of millions inside the country, the denial of the ability to provide aid to all but these few refugees, who have risked forced repatriation, imprisonment and execution, should be a constant provocation to our conscience.

Overcoming suspicion in communities

As humanitarian workers, we always seek to negotiate our presence with the armed actors that rule an area. However, the degree of respect and understanding that we generate in the communities where we work is even more crucial. Our acceptance by aid recipients and their communities keeps us safe too. In some countries, a loss of acceptance and even the demonstration of mistrust or suspicion due to changes in global political contexts are a great threat to our relations with the communities we seek to serve. In a time of Western political and economic domination, many communities find it hard to imagine that our activities represent individual action with a separate set of ethics and objectives. Instead of health care and human solidarity, they fear that we bring unwanted Western inf luences or carry hidden motives. While we cannot force our help on those who do not want it, we also cannot passively abandon our ambition to ignore boundaries in our increasingly polarized world.

The struggle to reach populations living in crisis is not new. Providing care to those who are abused and neglected inevitably brings humanitarian aid workers into conflict with those who conduct this violence. This is a confrontation we should not avoid. The greater tragedy would be if our daily, hands-on work with individuals and communities fails to create an understanding and tolerance that overrides the fears and suspicions generated by an increasing global divide.