Coursive extérieure de l’hôpital de campagne MSF-CICR à Kigali au Rwanda

Humanitarian Aid, Genocide and Mass Killings. MSF, The Rwandan Experience, 1982-97

Jean-Hervé Bradol

Medical doctor, specialized in tropical medicine, emergency medicine and epidemiology. In 1989 he went on mission with Médecins sans Frontières for the first time, and undertook long-term missions in Uganda, Somalia and Thailand. He returned to the Paris headquarters in 1994 as a programs director. Between 1996 and 1998, he served as the director of communications, and later as director of operations until May 2000 when he was elected president of the French section of Médecins sans Frontières. He was re-elected in May 2003 and in May 2006. From 2000 to 2008, he was a member of the International Council of MSF and a member of the Board of MSF USA. He is the co-editor of "Medical innovations in humanitarian situations" (MSF, 2009) and Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontiéres, The Rwandan Experience, 1982–97 (Manchester University Press, 2017).

Portrait de Marc Le Pape
Le Pape

Marc Le Pape has been a researcher at the CNRS and then at the EHESS. He is currently a member of the scientific committee of the CRASH. Formerly with the CNRS, Marc Le Pape is currently a researcher at the l'Ehess (Centre d'études africaines). He has carried out research in Algeria, Côte d'Ivoire and Central Africa. His recent studies have focused on the Great Lakes region in Africa. He has co-directed several publications: Côte d'Ivoire, l'année terrible 1999-2000 (2003), Crises extrêmes (2006) et dans le cadre de MSF : Une guerre contre les civils. Réflexions sur les pratiques humanitaires au Congo-Brazzaville, 1998-2000 (2001) and Génocide et crimes de masse. L'expérience rwandaise de MSF 1982-1997 (2016). 

Interview with Jean-Hervé Bradol and Marc Le Pape. The book is published by Manchester University Press and will be out in January 2017.
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Where did the idea for the book come from?

Marc Le Pape (ML): Jean-Hervé and I travelled to Rwanda and neighbouring countries in the 1990s and beyond, to work in our respective areas - sociology for me and humanitarian medicine for him. We began working together in 1995 in response to the genocide of the Rwandan Tutsi and the inertia of the international community observed at the time. Since then, we've never stopped debating the issue and, in a way, the book's origins date back to that time.

As the 20th anniversary of the genocide approached in 2014, we thought it likely that questions would come up about the role and humanitarian response of an international NGO like Médecins Sans Frontières both before, but also during and after, the 1994 genocide in Rwanda.

Thinking about it, we realised we didn't have all the information we'd need to answer certain questions accurately. And so we decided to write a book, bringing together our experiences as a humanitarian doctor and a sociologist.

Jean-Hervé Bradol (JHB): As Marc has said, we had the conviction that pairing our disciplines would present the facts in a particularly interesting light. We would associate sociology, which adopts a distant viewpoint and uses very specific analytical tools, with on-the-ground experience of the field, of the events as they happened and of the humanitarian practices of the time.

So we reviewed the existing literature on Rwanda, the genocide of the Tutsi, population displacements across the borders into neighbouring countries and the mass violence that was committed. Most of the books that look both at Rwanda and at the humanitarian operations conducted in the Great Lakes region tend to be political analyses of the relationships between military and humanitarian actors, studies of the international response to the genocide and the workings of the International Criminal Tribunal for Rwanda (ICTR), assessments of the emergency response or similar. There are also macro - and micro - level analyses, medical publications, and the memories and testimonies of the medical staff that were part of the response.

No emergency organisation, however, has published an account of its interventions, based on internal archives and documents. Our account answers several questions. Where were the teams working, at what moment and under what conditions? What difficulties did they face? What lessons did they learn?

Our research covered several MSF mission countries in which Rwandophone populations were living. We did not, however, attempt to look at all the humanitarian programmes in the region. We wanted to focus on the work of the teams in the field, and it was based on this criterion that we consulted the MSF archives in Paris - they contain documents originating from all the operational sections in the MSF movement working in the Great Lakes region at the time.

The archives had already been used by Laurence Binet, journalist and Crash director of studies at the time, in a series of publications on the most important dilemmas when speaking out publically in the history of the MSF movement. The first four were published in 2004 and looked at the Great Lakes region before and after the genocide. Her work helped us enormously.

As well as the archives and testimonies, we used research which introduced previously unknown sources, and reports and public statements issued by international NGOs on the Great Lakes region between 1990 and 1997.

This book is an original account, and unique in its genre. No other organisation that worked in the region has ever publically decided to produce anything similar.

You asked yourselves three specific questions. Where was MSF working? What did the work involve? What difficulties were raised at the time, in some cases publically, about the work the organisation was trying to do?
Why did you decide on that particular methodology?

ML: I had asked myself these questions personally. I had patchy knowledge of the medical operations in Rwanda and in neighbouring countries, but a global account of the work undertaken by the MSF movement was lacking. With the archives, we could get a complete picture of all the work done in the Great Lakes region because it was not only in Rwanda, but also in Burundi, Uganda, Tanzania and Zaire (the Democratic Republic of Congo).

JHB: Exactly. We had fragmented knowledge, but nobody had put all the pieces together to give the whole picture.
The book starts with MSF's first intervention in Rwanda in 1982 and runs right up to the end of 1997, the last year in which the scale of the massacres of Rwandophone peoples set them apart from other populations in the region.

What does the book teach us about the events of the time? What did you learn?

JHB: It's striking to see the extent to which aid workers, repeatedly from 1994 onwards, became eyewitnesses to violence, murder and massacre on a large scale in Rwanda and the surrounding countries. Aid organisations usually work a certain distance from the scenes of such events, and their staff rarely witness these kinds of atrocities directly. The identity of the perpetrators most often remains unknown, which wasn't the case here. It was therefore a violent experience for MSF and one unlike anything the organisation had experienced before: \"the presence of humanitarian aid workers as people were sorted into those who would die and those to be spared." Extract from the book

Rwandan staff were also among the victims; sometimes they colluded in or co-authored the killings. More than two hundred Rwandan MSF staff members were executed in this period - in fact, the organisation has never lost as many staff as it did during this time.

ML: In fact, aid workers continued to pay the price of working in such close proximity to the violence far beyond 1994. Don't forget that three expatriates from Médecins du Monde were assassinated in Rwanda in January 1997.

JHB: In Burundi in the same period, more than 20 expatriate staff from international organisations were assassinated. The levels of violence and of exposure to violence observed were extremely high. We had believed this was the case, but the archives, in which we found a certain number of quotes from direct testimonies, confirmed our intuition. And particularly from the MSF teams, people who were trying to save their own lives, their colleagues' lives, and who were being forced by the militia to massacre their Tutsi colleagues, under the orders of the architects of the genocide. The organisation was entirely immersed in intense, extreme violence.

ML: Another significant observation was the difficulties and tensions brought about by working in such high-risk situations, in situations where the authorities were constantly imposing restrictions and where the risks, given the proximity and scale of the massacres, were acute.

It raised many questions. How were the teams to work in these conditions? How were they to work in camps in which hundreds of thousands of people had taken refuge and violent organised groups (military and militia) were also present? Reading the archives gave us some insight into the very high levels of tension on the ground.

An extract from the book: "The repetition of mass atrocities in the presence of teams of humanitarian workers sparked two non-mutually exclusive reactions within MSF. The first was to try and maintain operations as political violence sent needs through the roof and the capacity of aid workers to take action was reduced. (...)"

JHB: Indeed. The teams on the ground, given what they were facing, did what they could to continue working despite the danger, often to provide assistance to the displaced or refugees, and often in horrific conditions. There was a desire to keep providing an effective response. Teams worked in camps with several hundred thousand people, almost on the scale of a city, which went up and came down in just a few days.

Between 1990 and 1994, MSF was providing assistance to the displaced Rwandans who were fleeing the military advances of the Tutsi exiles - organised into the Rwandan Patriotic Front (RPF) - and, from October 1993, to refugees arriving in Rwanda from Burundi. Then, from 1994, the organisation witnessed the arrival of several million Rwandans, who were concentrated in huge camps in Tanzania, Zaire and Burundi. The population movements were massive, refugee camps opened and closed at a frenetic rhythm, leaving aid workers with the feeling that they were permanently starting from scratch.

The teams were also aware that some of the emergency measures, for example food distributions, were inadequate. From an operational and technical point of view, we didn't have the equipment or infrastructure to handle situations like Rwanda. And we found evidence of this in conversations that took place between the headquarters and field teams who, at times, were so consumed by technical and operational questions that they were no longer able to take stock of the political and social contexts.

It is not the first time that we have seen the limitations of emergency assistance. Our limited operational capacity to respond to the severe acute malnutrition in Somalia in 1992, for example, was already an indicator. The shortfall in the skills and capacities of emergency organisations that was observed in the 1990s, which were dominated by a multiplication of humanitarian catastrophes, is largely acknowledged.

What happened in Rwanda had an important impact on the development of policy and technical practices for the international response to armed conflicts and serious crisis situations. It resulted in an aid reform both in terms of political codes of conduct, with the adoption of a common code initiated by the Red Cross, and of the minimum technical standards to be attained in each sector.

"The second [reaction] was to try and resist attempts by the perpetrators of political violence to instrumentalise humanitarian aid at the risk of being treated as undesirables by the authorities (legal and rebel), prevented from working, expelled or even executed."

JHB: We realised pretty quickly that those behind the mass violence had infiltrated the aid system. The militia, the most criminal political groups present at the time, had people at every level of the aid system, and were misdirecting part of the food supplies that were destined for the Rwandan IDPs and refugees. The aid that was misdirected was serving the political violence directly, particularly when it was used to purchase weapons to reward militia taking part in acts of violence. Some of the food was used to feed the machine that was behind the mass killings.

The situation would cause tensions in the humanitarian community. The French section of MSF stopped working in the refugee camps in December 1994 and the other sections during 1995. They no longer wanted to contribute to strengthening and legitimising those responsible for the genocide. The organisations working in the region at the time had to choose between withdrawing from the camps or assuming their medical responsibility, "they either had to abandon their relief to avoid supporting those responsible for the genocide, or carry on providing assistance to civilians." Extract from the book

ML: There were major tensions within the MSF movement over this question, but there were also tensions with other institutions, the United Nations, the United Nations High Commissioner for Refugees (UNHCR) and the World Food Programme (WFP) in particular. In November 1994, MSF appealed to the United Nations Security Council to deploy an international security force to protect the Rwandan refugees from the violence and threats being perpetrated in the camps by those responsible for the genocide. The request was never approved.

JHB: Relationships between the different sections weren't always contentious. They all agreed, for example, that the extermination of the Tutsi people qualified as genocide, and they lobbied together for it to be recognised as such, while also criticising the responsibilities of the French government.

MSF called for an international military intervention on three occasions between 1994 and 1997. This was exceptional for the organisation. Can we talk about them?

JHB: When MSF denounced the genocide at the end of April 1994, it created huge tensions with the authorities in place in Rwanda. The organisation replaced its medical team in Kigali and worked with the ICRC to help the perpetrators' victims and those that they were threatening. The massacres continued, and MSF declared "Genocide calls for a radical, immediate response. [...] But genocide cannot be stopped by doctors".

Two further MSF declarations were published in November 1994 and in November 1996. They called for an emergency deployment in Eastern Zaire of "an armed intervention force to set up safe areas and ensure access to assistance for civilians".MSF-France, MSF-Holland, "Call for immediate dispatch of an armed intervention force to protect civilians",MSF-France, MSF-Holland, "Call for immediate dispatch of an armed intervention force to protect civilians "MSF-France, MSF-Holland, "Call for immediate dispatch of an armed intervention force to protect civilians", 15 November 1996. Their appeals fell on deaf ears, there was no such deployment.

Tensions arose between MSF and the RPF. Our teams witnessed the first massacres they committed in the zones they now controlled. Two sections (Switzerland and France) were expelled from Rwanda, mainly because they refused not to speak out about the new regime's crimes, and particularly the Kibeho massacre in April 1995, which was committed by the RPF in front of MSF staff and the United Nations armed forces. MSF refused not to speak out, condoning by its silence the Rwandan authorities' rhetoric which played down the massacre. Some actors present at the time believe that at least 4,000 people were killed in the Kibeho camp.

To cite this content :
Jean-Hervé Bradol, Marc Le Pape, “Humanitarian Aid, Genocide and Mass Killings. MSF, The Rwandan Experience, 1982-97”, 28 novembre 2016, URL :

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