Q & A: MSF author Fiona Terry talks about her new book Condemned to Repeat? The Paradox of Humanitarian Action

Terry is Director of Research at Doctors Without Borders/Médecins Sans Frontières (MSF) in Paris. Questions By Mary Sexton

Q: Why do you feel that there is a need for this book?

For a couple of reasons. First, I think that it is important to remind aid organizations that the difficulties they face today in assisting populations are not new or original. We have precedents from the past that can help us to analyze contemporary situations and help us consider what might be the most appropriate way to respond in order to avoid the mistakes made in the past.

Second, I think there is a serious lack of consideration of the responsibility of aid organizations for the consequences of their actions. Few aid organizations even pose questions about their intervention beyond funding concerns, let alone consider under which circumstances the most responsible decision might be to withdraw. We need more ethical analysis of aid operations.

At the moment there is considerable emphasis on improving the technical standards of aid, but if aid is really benefiting the oppressor rather than the victim, then such improvements are actually counterproductive. We need to focus on the bigger picture and conduct some hard-headed analysis, rather than just assuming that aid is intrinsically "good".

Q: What was your first experience in witnessing the manipulation or abuse of humanitarian operations?

At a political level, it was in Iraqi Kurdistan in 1991 when humanitarian action was deployed as the response to the terrible predicament of the Kurds at the hands of Saddam Hussein. The United States and its allies had encouraged the Kurds to rise up during the Gulf War but only offered them wheat flour as compensation for the violent repression that followed. Fearful that a massive influx of Kurds would destabilize Turkey, an important US ally, the would-be refugees were refused asylum and were lured back to their villages with humanitarian aid. Thus humanitarian action served as an alibi, giving governments an image of doing something to address the problem when in reality they did little to help the Kurds.

At a more direct level, it was in Somalia during the 1991-92 famine. While men, women and children starved to death, certain Somalis went to great lengths to steal food for their own use, including registering fictitious villages for distribution. Aid agencies were struggling to find the resources needed to feed hundreds of thousands of starving people, yet had to pay exorbitant fees to armed militias to protect them and their supplies.

But even at its worst, the abuse of humanitarian action in Somalia was not as bad as in the Rwandan refugee camps in Zaire (now the Democratic Republic of Congo) when it was the aid - and only the aid - that sustained a regime and army responsible for perpetrating genocide.

Q: Would you please define what you describe as the "refugee-warrior" phenomenon in your book?

Refugees are generally fleeing some violence or oppression in their home country and seek asylum in a neighboring country. There some of them take up arms and use the refugee camps as rear-bases for guerrilla incursions against their home government. Although the notion of a refugee-warrior is a contradiction because combatants are not entitled to refugee status unless they put down their arms, in practice the refugee-warrior phenomenon has been widespread during the last 50 years. Refugee camps provide a good pool of potential recruits, many of who are understandably willing to take their future into their hands and try to return to their homeland by any means necessary. The camps provide protection against enemy reprisals as an attack on a refugee camp usually receives condemnation from the UN and its member states, and camps provide a whole host of resources such as food, money and medical supplies. The aid structures in the camps also provide mechanisms through which control can be exerted on the refugee population. And, by acting as interlocutors between the refugees and the aid organizations, combatants can gain legitimacy with the refugees as well as internationally by acting as the supposed representatives of the refugees.

Q: In your book you state that "do no harm," the common dictum among aid organizations, is an illusion. Why?

Because humanitarian assistance will always have some negative consequences even if these are not immediately visible to aid organizations. Aid will always generate some winners and some losers; in order to reach victims it is often necessary to work with and through rebel leaders or government officials who have blood all over their hands. Pretending that aid can actually be given without causing any harm is utopian. Moreover, it is counterproductive if we are to make hard-headed assessments about the relative good and harm of our actions and act accordingly.

Q: The 1990s term "complex emergency" with its implicit notion that humanitarian work is more complicated now than during the Cold War era is something that you discuss at length in your book. You feel that some humanitarian workers use this concept as an excuse for not learning (or wanting to learn) from past experiences, or more specifically, experiences that happened during the Cold War period. Why do you think that this is a mistake?

I think that too much emphasis has been placed on perceived changes in the context to explain the difficulties encountered in assisting victims of conflict, and not enough on the role of aid actors themselves. There are genuine changes in the nature of conflict in the post-Cold War world but these have coincided with the massive growth of the international aid regime, and the expansion of the field of intervention from the periphery of conflicts during the Cold War to the heart of conflicts in the 1990s. Aid is implicated in the dynamics of conflicts in most places but this is not a new phenomenon, and the dilemmas we face today are not more difficult than those of the past. I think that the choices aid organizations faced when trying to assist Cambodians along the Thai-Cambodian border and inside Cambodia in the 1980s were more difficult than most choices we have to make today. I think aid organizations too readily assume that what occurred in the "simple" past is not relevant to today's "complexities," and lament the complexities of contemporary crises as an excuse for their failings.

Q: In your book, you focus on four contexts where aid was manipulated to the benefit of combatants: the Afghan refugee camp in Pakistan (1980s), the Nicaraguan and Salvadoran refugee camps in Honduras, the Cambodian refugee camps in Thailand, and the Rwandan refugee camps in Zaire (DRC). Do you think that there are similar situations happening now?

Absolutely. The Liberian refugee camps in Guinea are used as a base for opponents of Charles Taylor's government in Monrovia, and the Burundian refugee camps in Tanzania have long hosted rebel fighters.

But the worst case of the manipulation of humanitarian assistance in the world today is not taking place in a refugee camp but in a huge open prison that is called North Korea. Refugees who have managed to flee the country and hide in China say that food aid meant for famine victims is not getting to those who need it but is going to citizens deemed to be loyal to Kim Jong-il's regime. Refugee testimonies suggest that three million people died from starvation and related illnesses in 1995-1998 alone, and many continue to die today. I think it is scandalous that aid organizations continue to work in North Korea when the government does not allow them to conduct an independent needs assessment, freely distribute their aid or monitor and evaluate the impact of the aid. These are the minimum conditions necessary to assure that aid is reaching those in need and not those chosen by the regime. To participate in such discrimination opposes the fundamental idea of humanitarian action. It is terrible to think that North Koreans are starving to death while North Korea is the second largest recipient of food aid after Afghanistan. Until last year, it was the largest recipient. Aid organizations have a responsibility to know what is happening to their aid for the sake of the people in whose name they intervene. In North Korea they are collaborating with the regime, channeling aid through the same regime that is responsible for causing and perpetuating the famine.