Emerging in the aftermath of Biafra, a foundation recounted in mythical terms (support for a people resisting oppression, a break with the tradition of silence maintained by the Red Cross), MSF was immersed from the beginning in a field of multiple references linked to the issues of the dayFor a retrospective critique of the early days of MSF, see R. Brauman, “Les relations dangereuses du témoignage humanitaire et des propagandes politiques” in M. Le Pape, J. Siméant and C. Vidal (eds.), Crises extrêmes, La Découverte, 2006, pp. 188-204..The 1960s and 1970s were marked by decolonisation and wars of national liberation, as well as by the Cold War and the abuses of totalitarian regimes. These realities, and the various ways in which they were represented, dominated the world into which MSF had thrust itself. Moreover, the founders of the organization originated from a society where the seductive power of ‘progressive’ ideologies such as communism and Maoism started crumbling, and where new debates on the Holocaust emerged. It is, thus, both in reaction to the evils of distant worlds (evils rather than violence, the use of which is more recent) and in accordance with certain western modes of thought that MSF defined its role up to the 1980s. – a role which consisted in the presence of the doctor-witnesses supporting oppressed peoples and acting as their voice.

“WE ARE PROTECTING PEOPLE”

Presence, the core of the commitment accepted by MSF doctors, was far more than a neutral fact. In a “closed” world, it was an act, and an act regarded as protective (in the commonly accepted sense of preventing violence) by virtue of its twofold aim: to “stand alongside” the vulnerable and to act as a witness:

“… A handful of comrades decided to found a medical organization, hoping to provide aid and consolation in situations of war and disasters in those places where other organizations, prisoners of their own status and conformity, could not go … As doctors, we are protecting human beings” (AR 1980)Throughout this document, the abbreviation “AR” will stand for “President’s Annual Report”.. “… the people of Afghanistan were beginning to forget the meaning of the word SOLIDARITY when it applied to western countries” (AR 1981). In Nigeria, there was a need to stress “the nature of our intervention, derisory perhaps, but still meaningful: it conveys a certain sense of fraternity with these people, who are trapped in misery and humiliation.” In Iraq: “Behind this wall, the result of fanaticism on the one hand and reasons of state on the other, a population is suffocating. We are seeking, and we shall find, a way to breach the ramparts.” “Afghanistan’s invaders cannot tolerate our presence because it provides the population with material and moral support and because we are troublesome witnesses” (AR 1983). Honduras: “The safety of these refugees, which the military regards as single mass of suspects, will continue to require a permanent international presence” (AR 1986). Refugees: “Our medical action aside, our physical presence in the camps is also a militant act, a constantly renewed affirmation of this fundamental humanitarian principle” (AR 1988).

The reference to violated rights – human rights, the rights of peoples and refugees’ rights (but not international humanitarian law) – was an expression of this committed vision. It was essential to the identity of the doctor-witness until the early 1980s, and was fully endorsed until the end of that decade:

“MSF personnel back from mission will report any human rights violations and unacceptable facts they may have witnessed” (AR 1978). “Because we are doctors and nurses, because we apply Pasteur’s sublime words – ‘I do not ask what is your race or religion, I ask what is your pain’ – we have taken on a considerable burden of responsibility by acting as witnesses” (AR 1980). “Everyone will join me so that we can make a dream come true … the crazy dream of giving our skills but also our hearts and our enthusiasm so that nobody is ever forgotten … and sometimes also to testify to these attacks on peoples rights, like famines, deportations and massacres …” (AR 1981). “We must denounce the attacks on peoples’ rights to which we are the only witnesses” (AR 1982). MSF decides to create a “centre for research into issues of development, human rights and the rights of peoples” (AR 1984). As a “human rights practitioner”, MSF is thinking of participating in the drafting of a new universal declaration (Board meeting May 1988).

The denunciation of violence therefore appeared as the act which gave substance to the image of the witness standing in the way of its perpetration, as opposed to the complicit silence the world had maintained during previous genocides. As we know, the stance adopted by the Red Cross during the Second World War was a seminal reference in this respect, as the following extract makes clear:

“My dear friends, let us not forget! From the time of the Nazi concentration camps, some organizations have been willing to visit such camps … we will not tolerate bars or genocides … and we will make every effort … to alert the public and tell them that while we are being offered the balm of statistics, peoples are being murdered” (AR 1980).

Like the birth of ‘sans-frontierism’ in Biafra ten years earlier, the promotion of a “march for the survival of Cambodia” in 1980 stemmed from the same logic and points of referenceMSF was working in refugee camps in Thailand and had witnessed the influx of starving refugees. Not unreasonably, this provoked fears of a famine in Cambodia. Without confirming its existence, the organization interpreted it as a case of organized ‘famine-genocide’; the lack of access reinforced the idea of intentionality. At that point it was decided to launch the “march for the survival of Cambodia”.. The march, organized in the hope of “demolishing the barriers that prevent us from aiding a people faced with death”Extract from the MSF appeal published in various newspapers. Quoted by R. Brauman on page 200 of the text referred to in footnote 6. Its inclusion here is not for the purpose of highlighting past errors; it simply illustrates the extent to which implicit references structure and shape existing reality and the desire for action. , was perceived as a way of refusing to be complicit in genocide: “We have acted responsibly – and we spoke out when confronted with the holocaust – we were almost alone in doing so” (AR 1980). A historical reference and the perceived need for denunciation were also at work in the “Little Hitler” affair in Sudan eight years later. In March 1988, an MSFHolland team produced a confidential report claiming that Abdu Gurun, a Southern leader whose brutality had earned him the nickname Little Hitler, was responsible for a series of atrocities. Believing that it was a matter of urgency to denounce the atrocities (which were probably regarded as evidence of an ongoing genocide), MSF-France decided to “alert the press” (Board meeting May 1988), although MSF-Holland, the source of this alarming (and second-hand) information, advised against it. Raising awareness of such incidents was not the only goal: “The aim? To encourage the French government to begin an international demarche resulting in the dispatch of a neutral intervention force to central Sudan” (AR 1988). A force to “protect civilians”, as we would now say.11. However, the era of the witness was not necessarily the age of témoignage. To begin with, defining oneself as a witness should not disguise the fact that in most cases MSF was working on the margins of conflicts. The first doctors without borders thought of themselves more as committed observers of the disastrous consequences of totalitarianism (particularly the Soviet version) than as eyewitnesses. By their very presence in refugee camps on the borders of communist countries and at the edges of bipolar conflicts (and, more rarely, alongside combatants, as in Afghanistan and Chad), they attested to the atrocities being inflicted on populations or the political effects they were being forced to flee. Furthermore, neither the founders – who had not inscribed témoignage in the charter – nor those who led the organization during the 1980s saw the provision of testimony relating to violence as a systematic practice:

“The office alone will decide to inform the public if it is the case that MSF was the only witness to intolerable atrocities and if it is the case that silence would render every member of MSF complicit. In no case should the provision of testimony be systematic” (AR 1978). “…sometimes also in order to bear witness to these attacks …” (AR 1981). “We would like the means to make our voice heard when it becomes necessary to denounce the attacks on people’s rights that we alone have witnessed” (AR 1982). (Author’s italics.)

The theorisation of denunciation gradually disappeared from policy framework documents after the presidency passed to Rony Brauman, who put more emphasis on the role of MSF doctors as “troublesome witnesses” (AR 1983). They were there to “challenge injustice and violence” (AR 1984); to act as “troublemakers, stand in the way of wholesale slaughter” (AR 1987); to contribute to “protection against external threats” (AR 1988). This was the “substance of [the] commitment” (AR 1984) that bound MSF. While definitions of the role contained fewer references to the witness as a voice of denunciation, the protective virtues of presence (obstacle, prevention or attenuation of violence) were still held in high regard. When faced with war and oppression, MSF continued to act as a “human rights sentinel”.It should be noted that during this period MSF was also developing purely medical and technical missions which were neither motivated by nor designed to deal with situations of war and oppression. We shall not discuss them here, but it is important to avoid conveying the impression that MSF acted exclusively as a human rights sentinel at this stage in its history.

“AID WAS USED TO PREPARE A TRAP”

However, the complexity of the protective role became increasingly apparent during the second half of the 1980s, principally through events in Ethiopia in 1984-85 and the long experience in the Salvadoran refugee camps in Honduras that culminated in withdrawal in 1988. In both contexts, MSF found itself in direct confrontation with politically motivated violenceSee L. Binet, Famine and forced relocations in Ethiopia, 1984-1986 (2005), and Salvadorian refugee camps in Honduras 1988 (2004), both published by Crash/MSF in the ‘MSF Speaking Out’ series.. The mission in Ethiopia began in early 1984 and continued until the end of 1985, when it was expelled by the authorities. Some months later, Rony Brauman offered a forthright summary of the history of this crisis: “In other words, international aid was used to prepare a trap designed to capture more than a million people; organizations were unwittingly acting as bait in this lethal arrangement”. MSF was expelled because it “refused to turn a blind eye to the 16 unacceptable” (AR 1986). The diversion of aid to further a criminal policy grew intolerableAs used here, the term “intolerable” implies no moral judgement and is simply a direct reference to the notion as it is developed in D. Fassin and P. Bourdelais (eds.), Les constructions de l’intolérable, La Découverte, 2005: “It is always a matter of a historically constituted norm and limit.” The authors’ approach is not intended to “defend values … but rather to identify the existence of a common threshold in our moral universe – a threshold developed at specific times and in specific places.” (p. 8.) . From then onwards, “dilemmas” coloured MSF’s view of the world.

As it was chiefly concerned with relief work, the Ethiopian episode may appear to have little to do with the subject under discussion. In fact, the intervention was an instance of a medical organization responding to a government’s request for assistance when faced with a famine. In short, while MSF had no sympathy for the Mengistu regime, its intervention was not designed to support oppressed populations or defend their human rights – a role which would have justifiably required the team to watch out for atrocities and pay close attention to the context, in other words to combine the roles of witness and doctor from the outset. It was more than a year before MSF became aware that aid was being diverted in Ethiopia. Attention to the context, which at the beginning was no more than a “shadow play”“Working day and night as we were, the atrocities and roundups seemed like a shadow play of which we understood nothing.” (Rony Brauman, “L’humanitarisme contre la politique?”, interview, Le Banquet, no.2, CERAP, April 1993).for the hard-pressed volunteers, was slow to develop. It grew from their experience of the obstacles placed in their way, which (re-)established the link between action and a context of violenceAs the crisis developed, MSF was chiefly concerned by the permanent obstacles to the presence and activities of humanitarian organizations and the feeling of impotence this induced. The brutality with which the “resettlement” process was implemented gave rise to terrible scenes, some of which were witnessed by the teams, but it was not central to the issues as they were perceived. There is a reference to a “limit to what is tolerable that has largely been exceeded” (Board meeting, May 1985), but this primarily applies to the obstacles to action, which MSF was trying to overcome. By the end of 1985, discouragement was total: “For four months, the medical team at Kelala has been forced to watch, hands tied, the death of hundreds of children, most of whom could have been saved in a feeding centre” (Board meeting October 1985). In this context, various elements combined to create a coherent picture of the way aid was being used as bait: on this occasion, the “limit … that has largely been exceeded” justified “going right up to the wire, at the risk of being expelled” (Board meeting November 1985).. Indeed, MSF regarded the impediments as a classic sign of oppression. In these circumstances, the organization became aware firstly of the violence and thereafter of the role its own presence was playing. The figure of the complicit witness who remains silent in the face of violence was joined by another – the doctor-participant who is blind to the crimes being committed around him. In this sense, the Ethiopian dilemma helped to tighten up the previously slack connection between assistance and attention to violence. We were forced to acknowledge that our action took place in a dynamic field characterized by relations of political power, and that it was but one ingredient among many: given the context, its positive effects on the recipients could no longer be taken for granted. In other words, assistance and protection (or témoignage, or attention to violence) had to be linked, a lesson MSF would not forget.

The loss of innocence, so important for the future of the organization, resonates in the tone of the president’s annual report which discusses the dilemma: “What standard should we use to assess the interests of the men and women we mean to assist?” While the “finality” of MSF action remained “the human being” whose “physical integrity and right to freedom” have been attacked, we would in future have to “think about our action and its significance” (AR 1986). Besides continuing to pursue our chosen role as a defender of rights, our responsibilities when faced with violence would henceforth require us to examine the consequences of our own actions. This idea became increasingly important as time went on: “If we are to improve our action’s integration, it is essential that we strive to understand the nature of the problems forming the context of our intervention; we must look at the solutions proposed in the light of the outcomes. In effect, purity of intentions has all too often served as a convenient screen to shut out the harsh reality of the facts” (AR 1987).

The harsh reality extended to refugees: in the autumn 1988, MSF took the difficult decision to withdraw from the Salvadoran refugee camps in Honduras after years of conflict with the committees that claimed to represent the inmates’ interests. The committees had maintained an iron grip on the refugees, treated them brutally, used them in their guerrilla warfare against the Salvadoran dictatorship, attempted to commandeer aid for the war effort and made increasing demands. The leaders of MSF gradually became convinced that we were dealing with an authoritarian, or ‘Albanian’, tendency (while the teams on site, many of whose members found the guerrillas’ cause seductive, tended to tolerate these practices). Given their aversion to totalitarianism and authoritarianism, they concluded that the committees’ demands had to be resisted – a stance which resulted in a drastic deterioration of relations and culminated in withdrawal from the camps in 1988. While MSF had long been aware that most refugee camps were far from being pure “sanctuaries” See J.-C. Rufin, Le piège humanitaire , Paris, J-C Lattès, 1986., the Honduran experience complicated its perception of the situation of refugees and of the role it should play in response to the abuses to which they were subjected:

“The perpetuation of refugee camps in the Third World is a source of tensions which themselves raise serious protection problems … Like everyone else, we have no ready-made solution to this problem, and it cannot be summarised in terms of idealistic oppositions such as ‘human rights/reasons of state’ or ‘refugees good/government bad’. Nevertheless … our humanitarian vocation puts us unequivocally on the side of the refugees; their rights, theoretically guaranteed by international conventions, must be defended every inch of the way … As I have said, we have an important part to play in the field of protection against external aggression. We have played it by maintaining an uninterrupted presence in Honduras for eight years … When it comes to external threats there is something we can do. But we are powerless when faced with an internal system of oppression … when law founders on the reef of force” (AR, 1988, shortly before the withdrawal).

The above extract tells us something about the protective role MSF had taken on in refugee camps in general – it was not necessarily linked to specific actions, but was primarily a matter of maintaining a presence and, once again, of acting as an outside observer. Some months earlier, when violence broke out in the Honduran camps, it had been noted that “UNHCR, which has a mandate to protect refugees, is in a very difficult position. It is trying to protect the refugees from the committees and the Honduran army” (Board meeting July 1988). Two forms of protection, one elective and the other with a mandate, meant that a small French organization and a UN agency were working side by side, a convergence which would surprise anyone today, and which would in fact be called into question a few years later.

On the eve of the collapse of the Berlin Wall, MSF was no longer the minor and marginal actor noted for conducting symbolic actions on the edges of bipolar conflicts. It had organized itself along professional lines during the 1980s and had gone through the experience of Ethiopia. It certainly envisaged a role that extended “beyond [its] medical action” (AR 1988), and acknowledged the complexity that would arise from that. The 1990s would usher in another kind of complexity – the linking of its own responsibilities to those of the other actors working in the field of post-Cold War conflicts.