David Rieff

There was never any room for compromise in the myth of the “French doctors”. Aid was a moral imperative, full stop. Like all doctrines founded on such an absolute (not to say absolutely self-righteous) conception, moral ambiguity was taboo, and the need for negotiation seen as, at best, a necessary evil. To be sure, most international relief groups, and certainly MSF, have moved beyond this kind of vulgar Kantianism which Bernard Kouchner once championed so insistently. Nonetheless, in the collective memory of modern humanitarianism, the comforting illusion endures that there was a time when relief NGOs were largely free to act as they saw fit, taking into account only the needs of the populations they sought to help, and the limits imposed by their own charters. Populations in danger, to use an expression that MSF made into a commonplace of the humanitarian lexicon more than a decade ago, were assumed to have the right to be helped but, just as saliently, international relief groups took it as read that they had an absolute right to help. In reality, humanitarian action cannot afford to be absolutist in, say, the manner of the human rights movement, which, because it is law based, is absolutist, at least in principle, or it is nothing. All effective humanitarian action is based on negotiating compromises with the relevant political actors, including of course insurgent groups, donors, and with other stakeholders (including beneficiaries, themselves never monolithic in their viewpoints or requirements), and trying to reconcile competing agendas, not only between NGOs but within NGOs as well. For a humanitarian organisation to believe and, far more importantly, to behave as if this were not the case is to court disaster, as a number of the case studies in this book painfully illustrate.

The need for compromise in almost every situation in which an organisation like MSF operates or is likely to operate emphatically does not imply that, where the compromises on offer are unacceptable from a relief NGO’s perspective, it is imperative to act anyway.

That would not be compromise, but rather a supine capitulation. Instead, as Fiona Terry puts it in her chapter on Myanmar, what is essential is for there to be an emphasis on internal discussions “of [the] parameters or benchmarks against which to judge acceptable from unacceptable compromises”. The French title of this book is Agir à tout prix? (Acting at any price?). It is posed as a question, but in fact it is only a rhetorical one, since MSF’s answer to it is an emphatic “No”. It is difficult to see how any other answer could be acceptable. There are times where it may appear to an outsider that MSF as an institution wished that it could make such a claim, but the legal mandate that provides the moral, as well as the operational, rationale for the International Committee of the Red Cross’ practice of operating everywhere that security constraints do not preclude it from doing so without subjecting its delegates to intolerable risk is simply unavailable to the association. But following in the footsteps of the caritative arms of the United Nations system and never withdrawing whatever the negative effects of their relief efforts may be (the genocidaire controlled Hutu refugee camps in eastern Zaire in the aftermath of the Rwandan genocide are the emblematic example of this) is available, but is rightly viewed as being unacceptable. Faced with such a dilemma, MSF has little choice but to jealously guard what Rony Brauman has called its “right of abstention”, for given the fact that compromise is a far greater imperative in humanitarian action than the “droit d’ingérence”, not acting at any price and in all circumstances, no matter how unfavourable, becomes the sine qua non for an international aid organisation to maintain its autonomy.

That is why, however paradoxical it may appear to be at first glance, the connection between compromise and autonomy actually is a central one. It is true that impartiality and neutrality have figured more prominently in the collective imagination of the humanitarian international (and nowhere more so than within MSF), but if there has been one idea that has been invaluable in practice, at the practical level, it has been autonomy. This should not be surprising. Neutrality and impartiality are important as ideas, but they beg as many questions as they illuminate, and even when understood as contingent rather than unvarying concepts, leave much to be desired. Impartiality in humanitarian action is one of those concepts that, like objectivity in journalism, is a goal rather than a reality, rather like the horizon in ocean navigation before the advent of GPS. As for neutrality, well, the political contradictions and moral and ethical limitations of that idea are both too obvious and too well rehearsed to need much further elaboration. In contrast, as an American Supreme Court judge once famously said of pornography, we all know autonomy when we see it. It is commonplace for moral philosophers to identify the so-called objective correlatives of a given word or idea. But these are far easier to grasp when the subject is humanitarian autonomy than they are when it is impartiality or neutrality that are being discussed.

Caveat lector: One cannot speak about absolute autonomy here. That is no more an attainable goal for MSF, or any other humanitarian association, than absolute anything else. But whatever else has changed in the four decades since MSF’s founding, experience has shown that often always and in all circumstances, a reasonable degree of autonomy can be obtained and maintained provided that a particular action or programme is coherent in its understanding of the condi-tions in which the association will work (above all in the sense of the limitations that governments and insurgent groups are likely to put on these efforts); realistic in its acknowledgment of the ever shifting and inevitably contingent nature of the conditions on the ground that must determine whether a humanitarian relief organisation continues to operate; or if the crossing of too many deontological red lines forces the group to give serious thought to withdrawing—caveats that apply to all the understandings made by the NGO with local actors as well. As every practitioner knows, these are treacherous waters in which to swim. The solution certainly does not lie in securing enough humanitarian space (a parlous concept in any case, and one that whatever its past utility should be definitively retired for any number of reasons, including those Marie-Pierre Allié adduces in her introduction to this book), let alone of falling for the fantasy that humanitarian action can ever exist in some sort of splendid isolation from the contexts in which it is undertaken. The relevance of the idea of autonomy derives from its essentially transactional nature—at least when applied to the humanitarian context. One does not simply assert one’s autonomy, one defends it. In contrast, humanitarian space is a sentimental idea, neutrality a bogus one, and impartiality an abstraction, however necessary, and it is a lost cause to try to defend any of them. The sooner they are given a decent burial, the sooner we can all move on.

If the answer to one of the key questions posed by this book in a number of different ways, sometimes explicit, sometimes implicit, is that there can be no true autonomy for humanitarian actors without the right of abstention, the ghost at the banquet is whether maintaining even a tenuous autonomy for humanitarian action is still a realistic possibility in the battle spaces of the so-called Long War (or Global War on Terrorism, or whatever it is being called this week), from Afghanistan and Pakistan, through the Yemen to the Horn, and then on to the Sahelian countries. Xavier Crombé and Michiel Hofman’s essay on MSF in Afghanistan and Jonathan Whittall’s essay on the association’s work in Pakistan in this book answer with a qualified yes. They acknowledge that in both places there have been systematic efforts to enlist humanitarian relief efforts in the service of winning the hearts and minds of the population. To be sure, humanitarian action in one form or another has frequently been an integral part of counterinsurgency strategy going back to the British in Malaya. Though obviously much distinguishes the two cases, one element of France’s failure to retain control of Algeria during roughly the same period was its over-emphasis on the military and intelligence aspects of the fight—as set out by Col. Trinquier and other French officers of the period—and its neglect of the “hearts and minds” element.

 What is different in Afghanistan and Pakistan has been the centrality of human-itarian action in the broadest sense of the term. To paraphrase Clausewitz, humanitarianism, not just war, has now become the continuation of politics by other means. Nonetheless, Crombé, Hofman, and Whit-tall argue strongly that MSF has had some success in resisting these attempts at co-optation by US-led ISAF forces in Afghanistan, and the government in Islamabad and the US Agency for International Development in Pakistan, and, instead, convincing both the government and the insurgent side that MSF’s medical assistance could be useful enough to both to be allowed to continue, at least for the time being. In the Pakistani case, MSF’s ability to draw a distinction between its own conception of humanitarian assistance and those of most other mainline NGOs, pursuing programmes more in sync with the regime’s (and Washington’s) counter-insurgency goals, has led to a measure of acceptance by the insurgency.

How long this can continue is an open question. There are already laws on the books in the United States that criminalise any aid provided to terrorist groups. On some readings of this law, setting up a hospital, or even providing support for a medical programme in an area controlled by the Taliban or similar groups could leave MSF open to prosecution for “supporting” terrorism. But even assuming, as seems most likely at the present moment at least, that no such charges are ever brought, it is not clear that Washington would tolerate a significant expansion of MSF or any other relief NGO’s efforts in Taliban controlled areas. After all, if success in counter-insurgency is more contingent on winning hearts and minds than on killing the enemy (and today, the near universal consensus is that it is), then aid distributed in insurgent areas with the accord of the guerrillas will presumably have the opposite effect. Were that effect to start to be seen in Kabul or Islamabad as significant, it seems doubtful that it would be allowed to continue without sanction as it has been so far. For the moment, however, the fact that MSF can negotiate with all sides, and secure their assent if not their approval to act with some autonomy in government and insurgent dominated areas alike—thus separating itself to what to an outsider seems like a remarkable degree from the humanitarianism in the service of the state that is the reigning ethos of the battle space— is a testimony to the transactional basis of humanitarian autonomy in the present moment.

Because MSF mostly relies on private funds, it has been better able to resist being “integrated” into so-called post-conflict reconstruction efforts than most of the other important mainline relief NGOs. Nonetheless, if the MSF position on these matters has a weakness, it is in the association’s confidence, which at times well and truly crosses the line and tumbles over into vanity, that it can somehow stand apart from the humanitarian system—and, like it or not, there is only that one system, for all the important divergences and ethical standpoints between the actors within it—whilst simultaneously participating in it. Surely, legitimate questions can be asked about both the operational and the moral and political significance of a right of abstention if, in exercising it, MSF does so in the full knowledge that another organisation will rush in to carry out the role it declined to play, or decided no longer to fulfill. It was this perception that lay at the heart of the criticism, notably by Sergio Vieira de Mello when he was still assistant high commissioner of UNHCR, of MSF’s decision to withdraw from the refugee camps of eastern Zaire. In his article on Sri Lanka, Fabrice Weissman bravely acknowledges the extent to which MSF has fallen victim to its own tendency to think of itself as an “NGO apart”. “Having returned to Sri Lanka thinking itself the beneficiary of a special status in the world of international solidarity”, he writes, “MSF found itself in an extremely fragile negotiating position, which in the end was comparable to that of other NGOs”. Trying to predict the future is rarely a very useful exercise, but it seems entirely safe to predict that the dilemmas it faced in the last period of the war in Sri Lanka and in the immediate aftermath of the crushing of the Tamil LTTE insurgency will confront it time and again in the years to come, and that this is not the last time it will feel obliged to bow to the “diktats”, to use Weissman’s terms, of the government of a country in which it is trying to work.

The consequences of this are considerable. Not only should MSF and groups choosing to follow its “independentist” (as opposed to “statist”) humanitarian line not delude themselves that the only question that needs to be asked is “Faut-il agir à tout prix?”, they should also leave the mental space for what they all know to be the essentially tragic nature of their action—once described by Philippe Gaillard of the ICRC as “injecting a measure of humanity, always insufficient, into situations that should not exist”. MSF-France, with its history of scepticism (never fully shared by the other sections of the association, let alone by other mainline relief NGOs, and now unfortunately weakened even in Paris…) about all grandiose claims, whether in the mould of a Kouchner or of Oxfam, for what humanitarian action can accomplish, should be particularly alert to the limitations of their own agency. While the authors of this book are absolutely correct when they insist that, as Marie-Pierre Allié puts it, rather than speaking of a defined and immutable humanitarian space (shrinking or otherwise), it is more truthful to speak of humanitarian actors having a “space for negotiations [in the context of the] relations of force and of interest between aid groups and the authorities”, it is not mere declinism to ask whether those relations of force are likely to grow ever more unfavourable to MSF and like-minded organisations. Speaking of MSF’s initial attempts to resist playing the role that the Ethiopian government wanted to assign it in Ogaden, Laurence Binet, in her contribution to the book, writes sardonically of MSF having “resisted the first waltz”, but in the end having “bent to the tempo that permitted it to stay at the dance”.

These examples—and, to Sri Lanka and Ethiopia, one could reasonably add the Sudanese government’s behaviour toward the humanitarian NGOs in Darfur—should make it clear that while the limitations put on humanitarian autonomy by the political and military goals of the global war on terrorism are real enough, they are scarcely the only challenge faced by humanitarian actors in the second decade of the twenty-first century. Indeed, if the contributors to this book are correct, then MSF has been more successful in securing a measure of autonomy for itself from the Americans, the Pakistanis, and the Tali-ban, than they have from strong states in the Global South where the conflicts that are occurring have little or nothing to do with Jihadism. Of course, this may not last, but if it doesn’t that will not be because the authorities in Colombo, Addis Ababa, and Khartoum, following a trend that began in Rwanda after the Rwandan Patriotic Front took power in 1994, have grown less exigent, but rather because ISAF or the Quetta Shura have grown more so. But the increasingly unfavourable relations of force between these governments and MSF can be seen in the association’s developing reluctance to make public state-ments—above all, those that involved generalising about the humanitarian situation, a demarche whose repercussions, once it has been undertaken are usually very difficult to control—lest it provoke retaliation from the regimes concerned. These concerns were entirely warranted, as is evidenced by MSF’s experience of having been expelled from Darfur and Niger, and threatened with expulsion from Sri Lanka, Ethiopia, and Yemen (in this last case not least for having dared to put Yemen on the list of what, in any case, was MSF’s extremely ill-judged annual “Top Ten Humanitarian Crises” media campaign).The use of MSF’s reports about Darfur by Luis Moreno Ocampo, the chief prosecutor of the International Criminal Court, in preparing his indictment against President Al Bashir of Sudan, also contributed to the association’s increasing public reticence, since it had the effect of making MSF a “witness” against Al Bashir, which was the last thing that these reports had been meant to achieve.

 And they bode ill for the future, since there is every reason for other states wishing to bring humanitarian groups to heel, and having observed how effective such measures are, from taking similar steps.

Having said all that, the situation is scarcely hopeless. As several contributors to this book point out, there are very few governments or insurgent groups (even among the most militant Jihadis) who challenge the basic premise of international humanitarian aid or challenge its claim to at least some degree of political autonomy. Instead, as the Afghan case illustrates, the debate is over whether relief groups are, in fact, taking sides. The insistence of US government officials, from Colin Powell and Andrew Natsios during the Bush administration to Hillary Clinton and Samantha Power under Barack Obama, that relief NGOs not try to distance themselves but rather develop closer links to US and other ISAF forces has done a great deal of harm to the efforts of MSF and other humanitarian organisations seeking to work wherever the needs were most urgent, rather than where they would do the most good for the Coalition’s war effort. Nevertheless, MSF has succeeded to a remarkable extent in distancing itself from that project with the result that it has been able to operate in at least some Taliban areas. Surely the same approach can bear fruit in the future in other theatres of war. Is this enough? Self-evidently, it is anything but enough. But in a time when fanatics on all sides seem willing to accept nothing less than the total defeat and unconditional surrender of their foes, it may be as much as we have any right to expect. Sometimes just holding the line for one’s values as best one can, making the compromises that one must, and playing the long game in the full knowledge that relations of force are always changing, and not always for the worse, is no small victory.