MSF distribue du matériel en Afghanistan
Judith Soussan

Graduated in International relations (Institut d'Etudes Politiques de Paris), Logistics in humanitarian settings (Bioforce-Développement) and Anthropology (University Paris I), Judith Soussan joined MSF in 1999. After missions in Sri Lanka, Ethiopia, Sudan and the Palestinian territories, she worked in Paris, in particular on protection of civilians. Following a few years break from MSF working as a radio reporter, she has come back to Crash in 2015. She contributed to the book "Saving lives and staying alive. Humanitarian Security in the Age of Risk Management" (chapter "Security Issues and Practices in an MSF Mission in the Land of Jihad" - London: Hurst and Co, 2016).

Date de publication


The end of the Cold War, that oft-quoted caesura, was a turning point for MSF in that it marked the transition to the age of the “international community” and the spread of the discourse of democracy and human rights. It also marked the emergence of humanitarian action as a distinct field, for many previously inaccessible areas now provided MSF with the opportunity to work amidst conflict instead of remaining on the margins. The rapidly changing environment obliged MSF to reposition itself, make adjustments and discard some of its badges of identity. First, the way it referred to its own responsibilities was reformulated in a somewhat clouded critique of the role the international community adopted in response to violence. The organization was then faced with a series of particularly acute crises, from Bosnia to the Great Lakes. These missions brought back to its role in a situation of war and work in the midst of the violence. As these crises have become established as key moments in the history of MSF, as they constantly surface in explanations of what we are today, and as they are often recalled in simplified or formulaic terms, we shall examine each of them in some detail, for they successively raised every one of the issues linked to protection.


During the 1970s, the discourse of human rights had become an increasingly prominent component of international relations as the West applied pressure on the Soviet camp. With the advent of the post-Cold War order, states began involvement in the “humanitarian field” by developing a form of governmental humanitarianism. Significantly, the word “field” first appeared in MSF documents shortly after the fall of the Berlin Wall, at the precise moment when the organization had begun to experience a sense of intrusion – the existence of the field being in some way produced by this intrusion: “It is a widespread problem. It is the price to pay for the human rights impact of humanitarian action. States are becoming involved in the humanitarian field”The remark illustrates the extent to which human rights and humanitarian law were still intermingled. Subsequently, the “field” was shaped by the proliferation of humanitarian NGOs as distinct from human rights NGOs (which were also on the increase), the allocation of funds, the organization of operations, and also by the creation of governmental coordination bodies, etc. ; “… We must regain our identity” (Board meeting discussion, December 1989). There was a growing perception of “confusion”; was this just a “passing phase”? (AR 1989-90). The Kurdistan crisis in 1991 provided an answer of sorts to this question. In the meantime, MSF had begun directing questions at the new “international community” embodied by a UN which had recovered its ability to act. The positions the organization adopted during this period were consistent with the role of warning system and obstacle it had considered appropriate in a world where its appeals did not have much impact (i.e. during the Cold War). For example the “Cambodia Operation”, with its threefold purpose “to denounce the misappropriation of international aid in the camps situated on the Cambodia-Thailand border, to denounce Khmer Rouge representation at the UN and to call for the creation of a neutral camp.” Aversion to the Khmer Rouge (which embodied the worst excesses totalitarian power), coupled with the fear of further violence, were at the root of this initiative which, like the appeals to the international community during the 1980s, was viewed as a Utopian gesture: “Although fully aware that the idea is Utopian, we call on the United Nations to create a neutral camp. Neither the Thai government nor the Khmer factions will tolerate it, but it is a good battle to conduct” (Board meeting, December 1989). Another Utopian idea had been advanced a month earlier, a few days before the collapse of the Berlin Wall: “The constitution of an international body to be known as ‘white helmets’, with a mission to create access corridors to disaster areas and protected perimeters, thus enabling relief teams and materials to reach these sites” (AR 1989). This “Utopian” proposal expressed the possibility for the UN to implement the civilian protection measures contained in the Geneva Conventions, particularly the free passage of aid and the creation of safe havens. In subsequent years the idea became a reality, but its complexity was almost immediately apparent to MSF. Whereas our role in war was reaffirmed as the major component of our ‘identity’, and war itself as our field of legitimacy par excellence“The question of the continuation of wartime missions was raised – necessarily so – and the response was positive. Everyone considered such work to be a constitutive and fundamental characteristic of MSF” (AR 1989-90). , that field had to be shared with the new actors who had become involved in it; cohabitation thus meant direct confrontation with the acts and discourse of others.

Each of the major crises of 1991-1993, Kurdistan, Somalia and the former Yugoslavia, involved a military intervention with a variety of goals, although all three made use of the humanitarian argument. MSF revised its stance accordingly, but critiqued each intervention as either an excuse or a failure of political will and attacked it on the grounds of “protection”.

In Kurdistan and Somalia, it appears that MSF’s use of the protection argument was primarily a matter of defending the field, a means of discrediting interventions by drawing public attention to the duplicity and partiality of the states which undertook them. Our retrospective analysis of the famous “right to intervene” in Kurdistan thus argued that “it would be wrong in theory and imprudent in practice to imagine that the international community’s mobilisation in support of the Kurds could lead to an international mechanism to protect populations in their own countries”. It also argued that the intervention was an “entirely conventional” operation, its purpose being to avoid regional destabilization by ensuring that the Kurds remained within the borders of IraqF. Jean (ed.), Populations en danger, Paris, Pluriel, 1992, p.84 (in English : Populations in Danger, London, John Libbey, 1992 ) . By doing so, MSF disputed the claim that the right to intervene rested on humanitarian concerns. It switched its focus from the (massive) sphere of aid to the (nonexistent) sphere of “protection”, which became the object of the criticism directed at the allies as the crisis developedAt the beginning of April 1991, MSF called for protection measures including “the establishment of safe areas to provide provisional asylum on the Turkish and Iranian borders”. When the United States announced plans to set up new sites, the organization called upon the international community to ensure that “these people are sheltered from reprisals and can return to their homes” (AR 1990-91). At the end of April, it was noted that the problem with current operations was not one of “assistance, but of providing protection for people under threat” (Board meeting April l991).. The US-UN intervention in Somalia provoked further criticism based on the issue of protection, or rather on the paradox arising from the fact that aid protection was actually putting the population at risk. The brutal suppression of riots by blue helmets in the spring of 1993 prompted an internal question: “What logic governs the fact that soldiers who were originally deployed to help Somalis are now turning them into victims?” (Board meeting June 1993). Public statements were uncompromisingly harsh: “In Somalia, for the first time, people were killed under the banner of humanitarian relief” R. Brauman, Le crime humanitaire, Paris, Arléa, 1993. Available in English on (Somalia, A Humanitarian Crime); the quotation is page 13 of the pdf file.. The killing of civilians in the name of humanitarianism was an aberrant and unacceptable reversal of moral principles: “Under the banner of solidarity, human rights and humanitarian aid, we have seen combat helicopters attacking demonstrations … Are peacekeeping forces, military-humanitarian forces, obliged to respect humanitarian principles or not?” (AR 1993-94). The reference to the “humanitarian principles” was one of the first occurrences of “protection of civilians” in its legal sense. Significantly, it arose from the specific context of a Western-led intervention, and would arise repeatedly from such a context in the years to come.

In short, these two attempts on the part of MSF to defend the impartiality of the humanitarian field took the form of criticising humanitarian aid action which ignored the need for protection (understood here as concern for peoples’ safety, for their vulnerability), and of redefining “military-humanitarian” forces as belligerents (with an obligation to respect IHL). These episodes drove MSF to (re)assert that humanitarian action was enshrined in humanitarian law (“protection of civilians” being part of IHL) at a time when (given the reigning confusion) the need for clarification was urgent: “Should we distinguish between humanitarianism, the general interest, social utility and defence of human rights? I think we should … in the concern for coherence, for minimum clarification”. Unlike states, which have their own interests to defend, “ethics is the foundation of our approach” (AR 1990-91).


The reference to protection to defend the humanitarian field, identified in the cases of Kurdistan and Somalia, was also apparent in the criticism of the “humanitarian alibi” adopted by the international community in Bosnia. It was not the driving force, however, for in this instance the primary consideration was the perceived lack of political will (and the need to denounce it). Faced with a war of “ethnic cleansing” on European soil, MSF began working with displaced persons and interned Bosnian civilians. The decision to intervene had initially been delayed by a variety of problems, notably the reluctance to act as a kind of “after-sales service for ethnic cleansing” by distributing aid after people had been displaced (although this was seen as preferable to assisting on sites of violence beforehand). Abetting the internment of civilians by working in camps which should not have been necessary in the first place was another thorny issue. In short, we were faced with the classic difficulty: coping with the aftermath of violence that could have been prevented by others. But the greatest reluctance to become engaged stemmed from the way that states were hijacking the humanitarian argument “All year long, we prevaricated over our commitment in Bosnia” because of “the misgivings we felt over the manipulation of humanitarianism” (AR 1992-93).. Once MSF had established a presence (and had, unlike the states involved, fulfilled its responsibilities), its initial reluctance gave way to indignation. This in turn generated the relentless calls on political actors and the multiple denunciations of the “humanitarian alibi”, dual aspects of the responsibility MSF felt when confronted with the plight of the Bosnian Muslims.

The public stance adopted during this period was openly a call to protection; as such, it was a call to political action. Several press releases called on “governments to shoulder their responsibilities” (Board meeting, October 1992), while a report compiled from the testimony of deportees (published in late 1992) denounced “ethnic cleansing” and suggested that the process amounted to a “crime against humanity”. The organization stepped up the pressure through articles in the press, mounting scathing attacks on the “inaction”, “lack of will” and “impotence” of the international community See F. Jean (ed.), Face aux crises, Paris, Pluriel, 1993, p. 129-132 (in English: Life, Death and Aid: The Médecins Sans Frontières Report on World Crisis Intervention, London, Routledge, 1993) , and redefining the “so-called” protection force: “If words mean anything at all, the ‘United Nations protection force’ should be renamed the ‘ethnic cleansing observation force’”Rony Brauman, “Un général au balcon”, Le Monde, 3 April 1993.. The “humanitarian sideshow” threatened to become the new way of allowing crime to flourish in the age of the international community. Internally, the sharpest criticism revolved around the hypocrisy of humanitarian alibi and the absurdities to which it led: the plight of interned civilians, who could not be released because no country was prepared to take them, was “unacceptable and absurd” (Board meeting October 1992). “State humanitarianism simply misrepresents the fact of ethnic cleansing and acts as a substitute for political responsibility.” Thus MSF-France’s absence in Bosnia was to be read as a “criticism of the provision of humanitarian aid to populations facing death” (Board debate, January 1993). The view that action was meaningless and derisory in this particular context seems connected to the perception that the violence was intentional The view that it was a deliberate policy probably exacerbated the feeling that we had come face to face with the ‘intolerable’, although other crises were in fact more lethal. The widespread use of the term “ethnic cleansing” might have contributed to this perception. As A. Krieg-Planque has shown, the foregrounding and ‘success’ of the term are themselves linked to the intentionality it implies. See A. Krieg-Planque, ‘L’intentionnalité de l’action mise en discours ’, Crises extrêmes, op.cit., pp. 88-102. 23 indifference”.. Significantly, the word “limits” surfaced in several debates. Some claimed that humanitarianism had “reached its limits”, or had lost its meaning and no longer represented a genuine response to the demands of the situation. Others took the opposite view, agreeing with the president, Rony Brauman, that the problem of humanitarian action being “confronted with its limits” was not confined to Bosnia (Board meeting August and December 1992). When considering the context and meaning of our action, the notion of limit (limits MSF should give itself, accept, or push further) would henceforth be omnipresent in the minds of MSF’s leaders.

So it appears that several years after the collapse of the Berlin Wall and shortly before the genocide in Rwanda in 1994, our discourse concerning the international community’s response to the fact of violence had already adopted a tone of disillusionment, or at least of scepticism: “These paradoxical interventions which employ military means to achieve humanitarian ends do not announce the advent of a new world order in which the international community mobilises to stop atrocities and aid the victims … The time when an intervention to support the Kurds, accepted as a promise that atrocities … would no longer be tolerated, has passed.” The criticism advanced by MSF was also based on the observation that most of the countries in which it intervened were “abandoned to murderous conflicts, while the massive acts of violence atrocities inflicted on their populations are greeted with general. The role of the witness, the guarantee of a vigilant presence in situations of conflict, was therefore still very much in evidence – in fact it had gained in importance as the field of action expanded to encompass Sudan, Afghanistan, Liberia, Angola and other countries. The “maintenance of the intervention framework and priorities, i.e. the emphasis on crises and emergencies” (AR 1992-93), placed MSF even more firmly at the heart of the issues surrounding access to aid and témoignage when faced with violence. Apart from the “strongest card of the year” – the “public denunciations” (Bosnia being one example) – the campaign against the atrocities in Sudan and the “advocacy behind closed doors” concerning the Rohingyas in Burma provide further examples of MSF’s persistent attempts to alert the world to violence that in most cases was simply being ignored.

The striking conjunction of a critique of indifference and a critique of intervention – in which scepticism did not exclude the belief that the international community could take ‘pure’ action – probably seems incoherent today. However, it is apparent that both approaches derived from the same logic, that of a tense and close interaction with political bodies (individual states and the UN) in order to influence their agendas, to persuade them to address previously neglected crises, or to direct policy towards a greater acknowledgement of the plight of the populations MSF had identified as being “in danger”. In short, they represent a kind of “non-governmental politics” See Vacarme no. 34, winter 2006. This issue, entitled ‘Politique non gouvernementale’ [Non-Governmental Politics], contains a particularly interesting discussion of the concept by M. Feher (‘Les gouvernés en politique’, pp. 1-3), and an interview with Rony Brauman, (‘L’école des dilemmes’) notably addressing the position adopted by MSF at the time of the Bosnian crisis.or, in the parlance of the day, a form of humanitarian “diplomacy” (AR 1993-94).

A number of exceptionally severe crises broke out between 1994 and 1997 (particularly the genocide in Rwanda and the hunting down of Rwandan refugees in Zaire). Many of those present at the time will never forget what they saw; events such as Kibeho and Srebrenica are often described as “traumatic”. These experiences had a profound effect on the way in which MSF defined its own responsibilities when faced with violence, stamping it with the seal of impotence, illusion and disillusionment.


“It is customary to say that MSF was created not to stop wars but to alleviate suffering. Faced with the genocide in Rwanda, we felt a responsibility to try to influence the course of events” (P. Biberson, AR 1994-95). This was how the president of MSF explained the call for armed intervention (“doctors can’t stop genocide”) that went out in June 1994. The appeal – “unusual for a humanitarian organization, to say the least” (AR 1994-95) – and now regarded as a key moment in the institution’s history, stemmed from the internal reversal generated by a situation of genocide. However, it should be noted that the situation was not defined as such until a (relatively) late hour: the reversal was not immediate. Faced with what appeared to be widespread massacres in the days following 6 April, MSF decided to try and remain present. After a brief evacuation, a surgical team began working in Kigali hospital under the aegis of the ICRC. The team would remain there until the end: “We decided to stay on for the sake of the sick and the Rwandan staff – we could not abandon them and leave them to their fate –  and because we felt it essential that there remain a presence of foreign organisations in the country” (Board meeting May 1994). A combination of elements encouraged the shift to a “media offensive”: the continuation and scale of the slaughter, the fact that it was organized and systematic (and especially the fact that MSF personnel had been murdered after the various sections had evacuated their expatriate staff); the silence of France and the near absence of the international community (the UN maintained a much-reduced contingent of blue helmets). The media interventions were principally designed to re-politicise a situation which was frequently being described as a “humanitarian crisis”The description of the situation as genocide was not central at this point. The term was used (by a journalist) in the televised interview with J-H Bradol on 16 May, but did not appear in the open letter to the French President or during J-H Bradol’s interview for Libération on 18 May. For a review of media treatment of the Rwandan genocide, see J. Siméant, ‘Qu’a-t-on vu quand ‘on ne voyait rien ’?’ in Crises extrêmes, op.cit., pp. 36-56.. MSF called upon the international community, particularly France, to “shoulder its political responsibilities and take immediate action to stop the massacres, protect civilian populations and bring war criminals to justice” (open letter to the French president, Le Monde, 18 May 1994). The term ‘genocide’ received internal approval at the beginning of June, on the basis of a document which concluded that “given it’s genocide, we can’t just say it’s ‘business as usual’”. Quoted in L. Binet, Genocide of Rwandan Tutsis 1994, Crash/MSF International, ‘MSF Speaking Out’ series, 2004, p. 41. The decision to call for an international intervention was ratified a few days later. The formal appeal, initially delayed for “fear of endangering the MSF team on site and pinpointing the hospital”, finally went out on 18 June (Board meeting June 1994).

We can therefore see how different sets of responsibilities came into play as both the situation and the perception of it evolved: maintain a presence, do not put the hospital at risk, denounce the refusal of states to deal with wholesale violence – these are all familiar registers. They illustrate the hierarchy of responsibilities binding MSF first to its “staff”, then to its patients, and then – through the call for “protection” – to populations. But the explicit call for an armed intervention broke new ground. Everyone knew it was a truly exceptional move, a kind of ‘quantum leap’. Given this “fundamental and symbolic break”, the media had to be harnessed in order to get across the message that it was “vitally important to do whatever is necessary to stop [the genocide]” (R. Brauman, Board meeting June 1994). “Nobody could see any alternative; only armed intervention would stop the massacres” (Board meeting, June 1994). The decision to express this publicly was based on the reasoning mentioned above, the need to re-politicise the language of crisis and to put an end to states using the “humanitarian alibi” when faced with a policy of extermination.

Hence, while the genocide was widely acknowledged as a symbolic break with other situations of violence, it was not the only trigger for the institutional break with regular practice – i.e. the call for military action. This call to arms can also be interpreted as a reaction to the international community’s ‘humanitarian’ response – the cynical mask overlaying a deliberate policy of inaction that MSF had already seen in Bosnia. Put another way, it seems that in Rwanda, as in Bosnia, there was another form of complicity at stake, the acceptance that political situations could be dressed up as “humanitarian crises” and should be treated as such. The refusal to be an accomplice (an auxiliary, to use the current term), thus fostered the urgency to redefine the situation. In a post-Cold War environment in which “modern censure” (AR 1992-93) did not always need closed doors but could sometimes be implemented through drowning out issues in a ‘waffle’, the compulsion to reveal the political nature of violence was to some extent a synthesis of the two foundational rejections of complicity – that through “silence” in the 1970s and 1980s, and that through the manipulation of humanitarian action since Ethiopia.


Vast Hutu refugee camps began forming on the borders of Rwanda before the genocide had run its course. The fact that they sheltered leaders of the genocide as well as innocent people was a major cause of concern from the outset. By June 1994, it was feared that “the leaders would seize control of the camp and international aid” (Board meeting, June 1994). The uneasiness engendered by intervening in these camps was obvious. The very core of the legal framework of protection appeared to be at risk, the acknowledgement of a particular form of vulnerability and the establishment of categories of innocent people who had become victims – ‘good victims’ as it wereThe basis of the 1951 Convention Relating to the Status of Refugees is vulnerability, but it also takes into account the ‘political quality’ of a refugee: his right to protection resides in the fact of his flight from persecution. The text explicitly states that such provision does not apply to a person who has committed criminal acts.. But the fact remains that UNHCR responded to the massive influx – a million people – by classing them all as refugees. MSF then entered into a trial of strength with the UN agency; after calling for specific measures to distinguish between ‘genuine’ and false refugees (to exclude the leaders, in other words), it issued a series of denunciations and questions. The problem faded into the background in July; cholera had broken out and an emergency operation was mounted to deal with it, the priority being to save lives. However, “as the situation improved, there was a resurgence of the abomination that had given rise to the camps” (AR 1994-95). The situation had become “unacceptable” – the leaders of the genocide were using aid to strengthen their grip. It is likely that MSF-France drew upon the powerful precedents of Ethiopia and Cambodia as it attempted to resolve the moral qualms it had felt from the outset: the decision to withdraw was taken at the end of 1994. The situation was later summarized succinctly: “Aid was turned against the refugees, for it strengthened their oppressors” (AR 1994-95). This appears to be a rhetorical use of the Ethiopian paradigm in order to justify a decision which had clearly not been easy to take, and which would have been much harder had the other MSF sections not chosen to remain and continue to work with the refugees (they eventually pulled out by late 1995). The degree of importance the various sections placed on the Ethiopian episode (and particularly its seminal influence on MSFFrance), may help to explain the arguments over the correct position. There would be further disagreements during later crises as MSF-France turned to politically-based analysis which, besides including the possibility of withdrawal, frequently led to denunciation. MSF-Holland, for example, was seen as favouring “the very Anglo-Saxon concept of individual aid to the victim” (Board meeting November 1994).


Shortly before MSF-France withdrew from the camps and urged the international community to concentrate on returning refugees (which, according to the Board meeting of November 1994, was regarded as the only solution), it became aware of the violence raging in Rwanda itself HCR stopped repatriating refugees in September. At the time, the decision was interpreted by MSF as another sign that it had lost its neutrality, that it was taking a soft line on the leaders of the genocide, and confining its denunciations to the atrocities committed by the new Rwandan regime (Board meeting September 1994). It was not until October that MSF began discussing the difficulties it experienced in thinking and talking about the atrocities in Rwanda because it was “trapped in the logic of genocide” (Board meeting, October 1994). . Atrocities and disappearances were proliferating in a post-genocidal context 29. 30.26 sapped by the issue of justice. In April 1995, the Rwandan government decided to close the last of the displaced persons camps. Despite the presence of an MSF team and UN troops, several thousand refugees were slaughtered in the Kibeho camp. The teams “… attempted the impossible to come to the aid of the refugees and restrict the slaughter and have given accounts of what they saw and lived through during those hellish days” (AR 1994-95). Some months later, the enclave of Srebrenica fell to the Serbs. The team witnessed the selection of those destined for execution: “We can say this: it was ethnic cleansing, promises were broken” (Board meeting, July 1995).

These unique, targeted events were each time already over: all that remained was the possibility of a public statement, a means of alerting the world (which was done in both cases), so that they would not be shrouded in a veil of secrecy. These atrocities have become engraved on the institutional memory because the teams were present on site, and were reduced to “impotent witnesses”. They were later contextualised in terms of illusions (on our part) and false promises (on the part of others): “We no longer have many illusions concerning the dissuasive aspect of our presence; the talk is more of solidarity and témoignage” (J.-H. BradolNames are sometimes included when it seems useful to indicate, within institutional discourse, how individuals and their personal experiences leave their imprint. , Board meeting, June 1995). “In Srebrenica, populations were betrayed by being offered the fictional concept of a safe area” (AR 1995-96). Was the fictional concept just an illusion on the part of MSF (MSF believing in it) ? There is nothing in the institutional discourse to suggest that this was so. According to Face aux crises (1993), “the message the population received from the besieging forces is clear: the protection of ‘safe areas’ is an illusion. In reality, the inhabitants have been sentenced to death and are benefiting from a stay of execution; humanitarian organizations are helping them to survive in their prisonFace aux crises, op.cit, p. 135..”. The presence of MSF was not thought to have contributed to the illusion: “In Srebrenica, the aid provided by MSF was not some gadget in the humanitarian fancy dress used to disguise this war” (AR 1995-96). We shall see later how hindsight led to this episode being depicted in terms of illusions.

After the camps, after Srebrenica and Kibeho, MSF began a period of self-examination. It wanted to review its action and responsibilities and re-clarify their markers. An assessment of its own powers (non-existent or considerable) and abilities would form the basis of the review:

“Contrary to what the public may think, humanitarian action, as fine and indispensable as it may be, is not in a position to provide solutions to the problem it tackles … When humanitarianism becomes a way of assuaging a ‘citizenship without borders’, confusing and supplanting the initial aim – relief –, we are forced to reflect … Opting for the defence of humanitarian ‘causes’ means we move away from people in danger; it risks not just the instrumentalisation of the victim, but his dehumanization, and ultimately the relegation of relief to a secondary consideration” (AR 1995-96).

In this assertion that aid is more important than appeals towards politicians, that proximity to the vulnerable takes priority over adherence to some abstract collective cause, we can detect the beginning of a shift in the centre of gravity at MSF. The displacement is related to a reappraisal of the kind of criticism it had been directing at political actors, which reflected a certain belief in its own purity – as the following extract suggests:

“The systematic appeal to politics, its paradoxical demonization and the observation that in 25years MSF has given France three ministers … leave me perplexed … Let us accept that the humanitarian works in the political sphere, but in a way that highlights our separation from it … Let us not lapse into the humanitarian activism that constantly reminds politicians of their responsibilities while setting sufficiently high standards that it can vent its spleen until the end of time …” (ibid).

This ‘critique of the critic’ provided an opportunity to re-examine the status of témoignage, supposedly the MSF trademark and an inseparable element of its action:

“Far more than ‘témoignage in action’, it was the demolition of the myth of neutrality that formed the founding principle of the modern humanitarian movement that emerged 25 years ago. It was not its communicative version, témoignage, which is now on everybody’s lips and permeates our principles of action. MSF provides information about the situations in which it acts, primarily because it is the only way we can muster support for our action … MSF warns of manipulation and denounces what it has witnessed, the violations of the Geneva Conventions and other declarations to which all, or almost all, states are signatories. We do this not to pass the responsibility onto someone else or bemoan our lack of power, but to remind them of their respective obligations. Let us not become bogged down in the endless repetition of words which prevent us from thinking, expressions like ‘témoignage is part of MSF’s mission’ …” (ibid).

The repeated assertion that témoignage was not a systematic practice, together with the acceptance of humanitarian law as the bedrock (as opposed to the set of references previously employed) and the paramount importance placed on aid, indicated the direction that MSF was to take in the years to come. In the ‘era of appeals’ therefore, the practice of appeal was itself called into question.


The crisis known as the “hunting of Rwandan refugees” in eastern Zaire between 1996 and 1997 raised many further questions, for it contained all the issues concerning responsibility in situations of violence that MSF had experienced so far.

This exceptionally severe crisis represented a long period of powerlessness for MSF – and also generated considerable inter-sectional strife. It arose following the deterioration of the situation in the Rwandan refugee camps (the same camps from which MSF had withdrawn). As the Rwandan army and Kabila’s rebels swept through eastern Zaire, they attacked each camp they came to. It was difficult throughout the crisis to access the refugees. This led from the onset to the second call for a military intervention in the organization’s history, an appeal for troops to “protect the refugees and guarantee access to aid” (November 1996). This intervention did not take place; the international community refused to commit itself and used the return of some refugees to Rwanda as an excuse to bring the chapter to an end. But hundreds of thousands had not returned. Many attempts were made to reach the refugees, but even when they succeeded they seemed to do more harm than good. If the teams located people who were hiding in the forest, rebel forces or the Rwandan army would then move in and kill them. Large groups of refugees would band together and form de facto camps in which MSF teams worked to “patch them up”, but these were also eventually attacked. In every case, aid was used as bait – not in order to displace people, as in Ethiopia, but to kill them. In these circumstances, the very concern to save as many people as possible provoked heated arguments between sections, the principal bone of contention being the importance placed on 28 a medical presence and the need to denounce the violence. MSF-France believed that ‘something besides care’ was urgently required and indeed ignored the “security veto” the other sections had set on public communication. The sense of urgency seems to have been fostered by the existence of two unacceptable phenomena: ‘humanitarian bait’ and the logic of extermination. The criticism of MSF-Holland’s strategy at a Board meeting expressed this view: “If we are convinced that every effort is being made to liquidate the refugees, how can we then oppose it by ‘silent advocacy’?” The members of the Board of MSF-France collectively opposed this strategy: “The ultimate priority for MSF is the defence of populations in danger; that is what should guide our action” (Board meeting April 1997). This statement, the product of inter-sectional strife over témoignage, summarises well the MSF-France view of responsibility in a context as extreme as the hunting down of refugees, and even beyond that: it was not a matter of care v. témoignage or assistance v. protection. The “defence of populations in danger” did not create oppositions, but was the basis of both care provision and the practice of bearing witness:

“As you know, we denounced this situation in an attempt to stop the slaughter and draw attention to the number of missing persons. Yet again, the tension between the offices of the MSF sections generated an absurd battle … The absence from the field of the French section and our support for outright denunciation, plus the risks evoked by the on-site teams, led to a violent argument of the ‘speak out and leave v. stay and keep quiet’ kind. To remain silent in such circumstances is unacceptable, for that means we deny the massacres and turn ourselves into accomplices. To leave in such circumstances is to condemn those who can be saved, and that, too, is certainly intolerable. How can such simple things, repeated over and over again, be called into question at the very moment when MSF can show some judgement?” (AR 1996-97).

Despite the bitter force and clarity of these words, the prevailing mood was one of deep pessimism. The crisis represented a new extreme and it was felt that meaning was on the verge of being lostInterrogation and denunciation may have been seen as ways to express this feeling, particularly when aimed at UNHRC in the final stage of the crisis. MSF repeatedly attacked the UN body for the mediocrity of its decisions, including when it had become obvious that all the solutions were equally disastrous. At one point, neither remaining nor repatriation offered any significant chance of survival; and the UNHCR had decided to comply with the desire of some refugees to die at home if death was inevitable.. Every possible issue concerning responsibility in a context of violence had surfaced. States had used the humanitarian argument and humanitarian action to disguise the political motives behind such crises and to ignore the responsibilities they entailed, a factor MSF felt compelled to make public. The presence of MSF had not reduced the level of violence, indeed it had even been used as a lure. The organisation had exceeded the limits it had set for itself (the call for a military intervention), and subsequently had to reappraise the effectiveness of its appeals. It had been forced to acknowledge the precariousness of the fundamental distinction between combatant and non-combatant, as well as the difficulties involved in defending it against political actors. MSF furthermore experienced the helplessness of the humanitarian actor faced with extremist policies whereby the very people who were entitled to protection (civilians and refugees) became targets – not ‘collateral damage’ resulting from conflict and bids for power. The existence of “total wars that make no distinction between combatants and non-combatant populations” referred to by the president some time earlier (AR 1994-95) was thus confirmed, and explains the emergence of the figure of the “civilian” at MSF during this period.Use of the term ‘civilian’ (once almost non-existent), increased as the years went by. See the appendix for occurrences of “civilian” and “civilian populations”.

For MSF, these three years had represented “a systematic, repetitive and sustained confrontation between humanitarian action and a unique form of logic: the logic of extermination”. The tone was one of doubt, but the need for action was also confirmed: “Is it possible to humanise the inhuman, or should we renounce that course at the outset? … In this context, we have tried to do our best, to do the least possible harm. We have abstained, we have withdrawn, we have denounced, we have been threatened for doing so, we have had rows with everybody – UNHCR, the other sections – we have been thrown out and threatened with death, we have stood fast, we have returned, we have been driven out yet again …” (AR, 1996- 97). MSF could only deploy bad solutions, the “least worst solutions”The expression is from P. Mesnard; quoted by R. Brauman in ‘L’école des dilemmes’ article cited, p. 12.. Certainly, these experiences had resulted in a sense of disillusionment, a certain loss of confidence. Does this therefore indicate that we had once held illusions? Had we believed that we could provide the refugees in Srebrenica or Zaire with physical protection? Had we really put our faith in the dawning of a new era, the era of the international community? The answer to all these questions is no. But we did believe that it was right to try to influence these situations, to make some kind of impact. What the period between 1990 and 1997 undeniably tells us is that the view that we might be able to alter the course of events and achieve the desired impact underwent a gradual reappraisal, which contributed to the adoption of a more reserved position.

However, it should be noted that the value attributed to presence had not declined during this period; numerous documents attest to its benefits in terms of solidarity, the status of the witness and medical activities:

Iraq: “Thirty-three people at the moment … the presence is both medical and political” (Board meeting, August 1991). The former Yugoslavia: “These actions are of great importance in terms of presence and solidarity … our presence at Karlovac enables us to monitor the situation” (Board meeting, June 1993). Rwanda: “We cannot leave the country without a foreign presence” (Board meeting, May 1994). Burundi: “In 1994, the teams increased to 24-25 people … Utility should not be defined in technical terms, there is no medical emergency but there is a population in danger… Nevertheless, we should assess the false sense of security that people might derive from our presence” (Board meeting, June 1995). Afghan refugees in Iran: “The impression is that things are better when there is a presence. We shall see, for example, if it’s worth passing information to UNHCR” (Board meeting, November 1995). The Great Lakes: “Only a prolonged, down-to-earth, supple and politically informed presence will enable us to continue emphasising the plight of populations” (Board meeting, December 1996). Burundi: “We are not contemplating closing everything down because our presence as both doctors and witnesses is indispensable” (Board meeting, February 1997).


Before we leave the ‘era of appeals’ it is worth noting that besides extreme violence, MSF was also faced with the oppressive policies pursued by authoritarian regimes during this period. In Mozambique in 1991, the army regrouped populations in camps as it gradually recovered territory. These camps, in which the mortality rate was very high, were used to lure international aid agencies: “Given the present famine aid is essential, but it is being used to fuel the infernal machine which is driving thousands to starvation and death”. After some 35. 30 debate, it was decided to continue the provision of essential aid, but also to “denounce the situation, and in particular demand that people be allowed to move freely and choose their place of residence; and that agencies be able to conduct assessments …” (Board meeting, March 1991). In post-genocide Rwanda, MSF decided to denounce the disastrous situation in the prisons: “So as not to become a humanitarian organisation in the service of repression and discrimination, so as not to become tame doctors in a detention centre where the living conditions alone were responsible for one in eight prisoner deaths in the space of nine months, MSF simply did its work” (AR 1995-96). The move contributed to the organization’s expulsion. In the case of Korea, there were arguments between those who believed that MSF was “going to deal with hostage-takers” and those who took the view that “behind the regime there [were] populations” (Board meeting, May 1996). It was decided to go ahead with the intervention. However, it soon became apparent that while it was impossible to ascertain whether aid was actually helping the population, it was certainly strengthening the regime. MSF decided to “stay put and speak out” (Board meeting, April 1998). In all cases, the problem was exacerbated by a twofold dilemma: support for the regime and active complicity in criminal policies. On each occasion, the second issue (the diversion of aid and its use against populations – the ‘Ethiopian paradigm’) enabled us to clarify the dilemma and decide. In other words, the reluctance to support a regime or policy was not in itself enough to invalidate the idea that our responsibility lay in being present alongside populations (which again confirms the value accorded to presence mentioned above). It thus lay at the same time in analysing the situation and examining the role played by aid:

“At Médecins Sans Frontières, we are proactive in situations which demand in-depth understanding – meaning we have to keep our eyes and ears open – and then that we announce what we have seen and learned. If we fail to do this we may, according to the circumstances, be guilty of anything from simple voyeurism to complicity in murder” (AR 1997-98).

The voyeurism of the passive witness and the complicity of the exploited humanitarian worker – the two taboos of the responsible humanitarian actor.