After a long history of operating in Afghanistan, Médecin sans Frontiéres (MSF), a globally renowned aid agency, announced its withdrawal in 2004. Five of its workers had been assassinated in Badghis province and the authorities had made no attempt to arrest the perpetrators.
“The principle championed by Doctors Without Borders – that civilian professionals providing medical help to the suffering will be granted safe passage – is now part of our nostalgic past,” wrote academic Cheryl Bernard in The Wall Street Journal. Michiel Hofman, however, believes the reality is more complex. Head of the team who took MSF back to Afghanistan in 2009, Hofman co-authored a chapter of the book – and says that while the assassinations were “terrible enough”, they alone were not the reason for the withdrawal.
“MSF is an organisation that knows it is working in conflict situations and instils in its employees and volunteers that if you sign up, you have to accept that you are taking personal responsibility for an unusual level of risk,” he tells iMaverick.
“What happened in 2004 [is that] there was an implication of the government security forces in the killings. And then…the opposition claimed responsibility for the killings. The two parties in the conflict that you need to rely on to allow you this space to work were both implicated in the killing of five of my colleagues.
“It’s an example of when your space to work becomes zero.”
For Hofman, the key has always been negotiations above obligations. He believes it is an MSF practitioner’s role to find the overlapping objectives between humanitarians, politicians, military and warlords to gain safe access, and work from there.
“From their side there can be a multitude of things they’re looking for. The most common one is: if you’re a military the only way to control the population is to also provide some basic services to the population,” says Hofman.
“What people need is food, water, shelter and medical care. We provide the product of medical care.” In other words, those in power often have an interest in allowing MSF access. That wasn’t the case in 2004 when the opposition in Afghanistan were trying to destabilise the country. And it’s not the case now in Syria, where Hofman is trying to gain access.
But in 2009 the parties in Afghanistan were better placed to “pick up the phone”, allowing for MSF’s return, says Hofman. The opposition controlled over 40% of the country and needed to provide services, while the Obama administration emphasised more traditional rules of war, welcoming aid organisations and international human rights law.
Humanitarian Negotiations Revealed provides an insight to situations where “everything is open to negotiation”. As long as the compromises “reduce the number of deaths, the suffering and the frequency of incapacitating handicaps within groups of people who are usually poorly served by public health systems,” reads the introduction.
But as actors in conflict zones who enter into agreements with warlords, rebels, aggressors and governments, MSF’s compromises are a gamble and subject to criticism. In Sri Lanka it was suspected of supporting the Tamil Tigers, and so agreed with the government not to speak out on what it saw. In Somalia, it was required to pay taxes to Al Shabaab militants.
“We negotiate on many things… because everything is object to negotiations,” says Rony Brauman, a medical doctor and MSF veteran – noting that the only area in which there will be no negotiation is torture. (MSF’s Belgian branch abandoned the work it was doing in Libyan prisons during the civil war when it found it was treating prisoners who would then return for more torture.)
The book reveals MSF’s dedicated attempts to offer medical services to those in need and, it appears, the organisation does not stray far from this essential goal. But this has been a controversial decision at times: there have been calls for MSF to work harder at addressing the root causes of societal issues, rather than remaining mere observers. Critics have argued that it could “name and shame” more often, or form more alliances with civil society.
Hofman, however, says staying silent is a tricky issue and that there is no hard and fast rule for what is appropriate in a given situation. MSF is not a news service, but, for example, members won’t stay silent about what’s happening to their patients in their hospitals. Their ability to speak out can also be used as a negotiating tool.
Bauman says there’s room for collaborations on mutual issues, such as MSF’s work with the Treatment Action Campaign in South Africa, but “addressing the root causes of a certain situation or issue or problem doesn’t convince me. Because I’m not sure what the root cause is. It will depend on my own philosophy of existence, my own political opinions.”
He continues, “We can have common positions but we are a non-national, operational group. Our goal is not to raise awareness of the Indian ministers and what’s happening in their own country (in relation to malnutrition, for example). It would be very arrogant. It would be ridiculous for us to pretend that we’re aware of the fate of poor people and they’re not. So alliances could be quite tricky.”
Bauman explains that legitimacy is MSF’s only strength. They do what they say. “We speak on the basis of rigorous analysis and well-thought experience. If we embark on ‘nice’ campaigns – the poor should be better treated, for example…everyone would agree and we wouldn’t make any difference.”
By being aware of that specific field of legitimacy and staying within its limits, MSF is able to access patients in some of the most dangerous conflict and disaster zones around the world. But for those who negotiate the organisation’s way in, it comes at a personal cost.
“You are in charge of the negotiation. You are in charge of gaining the guarantee from all the ruling parties that they will leave your patients, hospitals and staff alone. You’re the one that has to convince the doctors and nurses that go into these conflict zones about personal safety,” says Hofman. “You’re bearing that burden all the time.”
During the recent famine in Somalia, Hofman set up the emergency response mission in Mogadishu. Two of his colleagues were shot in the following months.
He hopes that laying bare the complex reality of MSF’s work in Humanitarian Negotiations Revealed will help the aid industry become more transparent. “Wars are nasty, dirty, messy places. Anybody that enters into that arena will become part of the messiness. Everybody that engages will make compromises, take risks and continuously struggle with dilemmas that are very uncomfortable,” says Hofman.
“In the end, transparency, to be honest about it, is still the best weapon to be able to get access.” DM
Photo: Doctors from Medecin sans Frontieres perform surgery on a young boy in a hospital established near Bunia’s refugee camp in the northeast of the Democratic Republic of Congo June 18, 2003. About 100 people have been hospitalized. REUTERS/Jacky Naegelen.
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