40 years helping the disregarded

Founded on 21 December 1971 by a group of doctors with the support of the medical journal Tonus, MSF is currently celebrating its 40th anniversary. It is a time for both emotion, which is much needed, and for questioning, which is no less necessary. Created in France, structured in Europe, present in more than 60 countries and awarded a Nobel Peace Prize in 1999, MSF is now recognised as a flagship organisation in the world of international aid in the areas of healthcare and emergency relief. As a member of this organisation for 33 years – I had joined initially for only a few months – I'm certainly not the best person to view MSF with the cool eye of an analyst. But let me take the perspective of a player, as subjective as that may be and which is not necessarily that of a propagandist. And let me first point out that during these militaristic times the “right to intervene” – associated with the name of MSF's best-known founder, Bernard Kouchner, and adopted in 2005 under the name "responsibility to protect" – was put into effect in Libya by NATO. Some MSF founders can celebrate this anniversary as a victory.

In a previous column, I wrote what I thought about "humanitarian neo-Leninism", a remedy that causes more harm than good1 . I'm only bringing this up to highlight one of the most problematic aspects of humanitarian work in the multimedia age, namely the reduction of politics to the conflict between the light of democratic compassion and the darkness of despotic violence. Manichaeism, a religious doctrine dating to the 3rd century, was certainly able to exist without waiting for modern humanitarianism, but it seems to be enjoying a renewed vigour that is not unfamiliar to us humanitarians. That drones and jet fighters have become the instruments of contemporary humanitarian aid is a strange anniversary gift for an association that has long made advocacy and denunciation a cornerstone of its work.

Let me be clear that it is not my aim to exclusively attack any one example of Western neoimperialism. Sri Lanka, for example, skilfully exploited "rescuer" rhetoric during the deadly assault against the LTTE guerrillas' last remaining bases two years ago. The government presented it as a humanitarian operation, the largest ever conducted to liberate and rescue a civilian population held hostage by the LTTE. MSF's silence in the face of such butchery, which, by the way, was denounced by the United Nations, prompted intense debate within the organisation. For some, the risk of expulsion had to be avoided at all costs while others felt the need to confront the issue head on.

Many questions are raised, many objections come up as we review the history of an association which has made violence and suffering the focus of its work. How can we talk about success when we are so involved in the world's misfortunes? It is not cynical, however, to view our history from the perspective of success. Neither certain parties' opportunistic use of rhetoric and humanitarian imagery, nor our own errors and blindness, should obscure what our teams manage to accomplish day after day at their various sites in the grip of war, disease and poverty. The ambiguity of humanitarian work and the mistakes they give rise to are not failings but the fog and uncertainty of the real world. Free to choose and also to refuse thanks to its financial independence, MSF can answer for both its actions and failures. And it does so, at the risk of tarnishing its image by revealing the compromises and prevarications that are the rule in our work2 – not only to avoid the false consciousness of a blameless rescuer but especially because we believe this is an essential condition if we are to identify with our work.