Avril 1994. Kigali. Unité d’hospitalisation de l’hôpital MSF-CICR installé dans un orphelinat tenu par des sœurs.

Book Review: Jean-Hervé Bradol and Marc Le Pape, Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontières, the Rwandan Experience, 1982–97


Myfanwy is a lecturer in Development Studies at the University of Oxford. She holds a DPhil from the Oxford Department of International Development, a master degree in International Development and Humanitarian Emergencies from the London School of Economics as well as a bachelor degree in History from the University of Bristol. Her work focuses on humanitarianism, conflict and the Democratic Republic of the Congo. 

Book review in Journal of Contemporary History, January 11, 2019

Jean-Hervé Bradol and Marc Le Pape, Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontières, the Rwandan Experience, 1982–97, Manchester, Manchester University Press, 2017; ix + 144 pp.; £19.99; ISBN 9781526115515

This book describes and analyses the work of Médecins Sans Frontières (MSF) in the Great Lakes Region between 1982 and 1997. It explores the everyday, operational and political dilemmas faced by MSF staff in the field and the debates that followed, as they asked themselves: ‘how should we react and what action should we take’ in the wake of mass violence (p. 4). In effect, the authors ask: (how) could MSF prevent itself being manipulated or becoming complicit in the everyday atrocities in the field?

The book explores several historical phases by drawing on first-hand accounts from contemporary MSF project sites: MSF’s provision of aid to Rwandan exiles in Uganda (1980–94), and during the Rwandan conflict (1990–4); MSF’s operations in the Zairian refugee camps controlled by genocidaires; the violence committed against refugee populations in the RPF’s ‘new Rwanda’; and the fate of refugees who fled across Zaire as they were systematically hunted by Rwandan and Alliance of Democratic Forces for the Liberation of Congo-Zaire (AFDL) forces.

Bradol – a member of MSF France who worked in the region at the time and is currently a member of MSF France’s internal think-tank, Centre de réflexion sur l’action et les savoirs humanitaires (CRASH) – and Le Pape – a sociologist and a former MSF board member – do not focus solely on the ‘macro’ historical picture, but explore the individual experiences, disagreements and negotiations of MSF workers through a ‘close-up observation’ of internal archival documents (p. 2). Essentially, the authors delve into the ethical and political dilemmas of humanitarian action by examining the everyday experiences of MSF’s teams – the organization’s social history. In doing so, the study sits at the intersection between the historical literature on humanitarianism and a growing body of literature that calls for a focus on humanitarian practice.

Despite the benefits of this methodology, the reader is left with the impression that the authors could have developed their analysis further through the inclusion of oral histories – in particular, those of national MSF workers, whose voices are not found in the archives. It becomes evident that while the book is a production of a partnership between CRASH and Le Pape, and draws on intersectional archives, it retains much of its MSF France voice, with the occasional appearance of Bradol’s first person narrative (p. 29). As such, it acts as a historical assessment of MSF’s action in the region, while also providing an analytical reader with an insight into the organization’s understanding of its own work.

Several theoretical insights can be drawn from the detailed descriptions of MSF’s experience. Firstly, the authors describe a number of instances when ‘humanitarian spaces’ are not only inherently politicized, but become theatres of violence. For instance, in Kigali, MSF withdrew from a hospital that was being used as a ‘slaughterhouse’ (p. 28). In Zaire, refugee camps were sites of repression and violence. Subsequently, it became evident that MSF’s assistance was instrumentalized to lure refugees out of hiding, only for them to be massacred. Yet, the authors do not just re-iterate the need for humanitarian principles or denounce their violation as exceptional. Instead, they explore the everyday political conditions that enable humanitarian projects to become the epicentre of violence, putting those who work and are treated within them at risk. By tracking MSF’s repeated struggle with humanitarian spaces as sites of violence over a 15-year period, the authors illustrate how humanitarian principles and medical ethics are not selfevident, but continually negotiated through interaction with alternative political authorities and logics.

Secondly, the authors shed some light on the often-underexplored experience of local humanitarians who are not ‘blank-slates,’ but politically and socially situated in the local conflict. Anecdotes illustrate the ambiguity of their humanitarian identity: the overlapping personal and humanitarian identities, and the disastrous effects in contexts of mass violence. For instance, in Rwanda, the MSF team became a reflection of the conflict. In a hospital in Kigali, some Rwandan staff were ‘suspected of drawing up lists of patients and colleagues’ for ‘the killers’ (p. 31). In an MSF base, Tutsi staff were murdered, despite the efforts of expatriates who ‘yelled’ that they were MSF employees (p. 26). In effect, the ‘humanitarian identity’ of national staff could not neutralize their politicized personal identity, or act as a form of protection – they were ‘victims or sometimes accomplices’ of the violence (p. 126).

Thirdly, the book provides an insight into MSF’s political vision. The authors illustrate how MSF’s principles and its insistence on the value of all human life becomes a political position in itself when in opposition to political regimes that wish to dictate who can live and die based on alternative political logics – such as ‘ethnic’ identity. By repeatedly taking the side of the most vulnerable in the Great Lakes, MSF’s political imagination is portrayed as a solidarity with the victimized, rather than a mere maintenance of biological life. Additionally, the authors demonstrate the nuanced political cultures within the MSF movement by describing the inter-sectional disagreements about whether to continue operating in the genocidaire-controlled camps in Zaire (p. 136). Finally, the authors reflect on MSF’s calls for international military intervention in the region between 1994–7 (p. 137), and historicize it as an outdated phase of the organization’s political evolution: ‘in this post-Cold War period so productive of utopian thinking, MSF hoped that the ‘new international order’ might . . . reach an understanding on the urgent need to contain the violence . . . against non-combatants’ (p. 130). In short, the organization argued that political actors needed to intervene, rather than using humanitarians as an ‘alibi’: ‘you can’t stop genocide with doctors’ (p. 131). Instead, today, the authors finish by asking: ‘what could a humanitarian agency do?’ (p. 138). In the end, MSF continues to explore the recurrent problem of how to act in the face of mass violence with internal self-reflection and a refreshing honesty that has become an identity marker of the organization itself.

To cite this content :
Myfanwy James, “Book Review: Jean-Hervé Bradol and Marc Le Pape, Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontières, the Rwandan Experience, 1982–97”, 5 février 2019, URL : https://msf-crash.org/en/book-review-jean-herve-bradol-and-marc-le-pape-humanitarian-aid-genocide-and-mass-killings-medecins

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