Humanitarianism under Fire

November 30, 2004


PAIGE ARTHUR: This evening, we celebrate the release of the fall issue of Ethics & International Affairs, which features a special section on humanitarian aid and intervention. Please welcome Nicolas de Torrenté, Gerald Martone, and Roy Gutman.

Nicolas de Torrenté is the Executive Director of Médecins Sans Frontières in the United States. He has run MSF programs in many countries, including Rwanda, Liberia, and Afghanistan, and has published numerous articles. De Torrenté holds degrees from the Graduate Institute of International Studies in Geneva, the Fletcher School of Law and Diplomacy at Tufts University, and a Ph.D. in International Relations from the London School of Economics.

Gerald Martone is the Director of Emergency Response at the International Rescue Committee's Headquarters in New York, and is responsible for implementing emergency start-up operations, maintaining the agency's preparedness to respond rapidly, and conducting assessments of complex humanitarian emergencies. He has overseen emergency operations and assessments in Burundi, Liberia, Kosovo, Chechnya/Ingushetia, the DR Congo, Sierra Leone, Congo-Brazzaville, Rwanda, East Timor, Aceh, Mulukas Islands, Northern Uganda, Albania, Macedonia, Angola, Ethiopia, Ivory Coast, Sudan, Afghanistan, and Iraq. He served two elected terms as the Co-Chair of the Disaster Response Committee of InterAction and on the Sphere Project Management Committee. In 1999 he participated in the UN Inter-Agency Emergency Mission to East Timor, and, in 2000, in the UNHCR Mission to Angola. He is also Associate Professor at Columbia University's School of Public Health and an Adjunct Lecturer at Columbia University's School for International and Public Affairs.

Roy Gutman is the Foreign Editor of Newsday. He is also the Director of the Crimes of War Project, an effort dedicated to furthering public awareness of war crimes, which stems from his 1999 book, co-edited with David Rieff, entitled Crimes of War. Among his many awards, Gutman received a Pulitzer Prize in recognition of his reporting on the 1993 war in Bosnia and Herzegovina, where he provided the first documented reports of concentration camps there. Gutman has also worked at Reuters and, most recently, at Newsweek.

We have brought together these three speakers today to discuss an increasingly urgent dilemma. As humanitarian operations become ever more massive and complex, as they require greater dependence on large donors, as they follow on the heels of interventions whose primary concerns are not humanitarian, how can organizations and their workers maintain their traditional neutrality, impartiality, and independence—and should they?

The stakes of this debate are high. At issue is not just the potential to help populations in currently high-profile crises, such as in Iraq and the Sudan, but also people in places that the world has largely forgotten—for example, Angola or the Democratic Republic of the Congo.

The reality is that humanitarian operations are expensive. They can be overwhelming from the standpoint of logistics. Dependency on funding sources tied to governments, such as the United States, is a simple fact of existence for many organizations. Integrating the efforts of the many groups at work under the guidance of the United Nations, for example, seems to make a lot of sense and to carry a lot of benefits for the people being helped.

For some, however, integration has a strong downside. It means effectively the integration of impartial groups into agendas that have nothing to do with humanitarianism, whose purpose is the immediate and unconditional act of saving lives.

The aims of those agendas—which may include economic development or conflict prevention—may be good, and they may be undertaken in good faith. But they are not humanitarian, and some argue that integrating them into purely humanitarian action can have detrimental effects, not least of which is damaging the perception of neutrality with respect to all victims that humanitarian organizations have historically prized.

In his book, A Bed for the Night: Humanitarianism in Crisis, David Rieff has called the people who work for humanitarian organizations "the rich world's designated consciences in all these landscapes of disaster," among whom he cites, of course, workers from Médecins Sans Frontières and the International Rescue Committee. I am very pleased to have representatives from these two groups here tonight. To help us sort out these dilemmas I turn to our distinguished panel.


NICOLAS DE TORRENTÉ: I want to say a few words about the origin of the special section in this issue of Ethics & International Affairs. It stems from a conference that was held a year ago, in October 2003, at the Carnegie Council. The Council convened it, in part, after we had approached them following the big crisis of 2002, which went unnoticed here in the United States—the crisis in Angola. The civil war ended in Angola in 2002 with the death in battle of Jonas Savimbi, the leader of UNITA, the rebel movement that had been waging war against the government in Luanda for many years and had divided the country, with huge, immense human suffering. With Savimbi's death, UNITA all of a sudden collapsed. For many years, aid agencies were not able to get into UNITA-held areas and did not know what was going on in those areas. But, following UNITA's collapse, hundreds of thousands of people who had been trapped in UNITA territory streamed out, finally able to get access to humanitarian agencies. The plight of these people all of a sudden became visible; they were in very bad shape, and were experiencing high rates of mortality and severe malnutrition, including among adults, which is really the sign of a very acute crisis.

It seemed like a straightforward situation; on the one hand, there were hundreds of thousands of people who needed immediate assistance, on the other, there were the UN and NGO aid agencies deployed in the country, whose security was not really a concern since the fighting had stopped. Aid delivery was still logistically difficult because Angola is a large country, but otherwise the conditions were there that made a straightforward aid response feasible. The response, however, turned out to be very subpar, very slow, and very weak. As a result, thousands of people died unnecessarily due to the sluggishness of the aid response. Why was that? Was it just lack of capacity, poor preparation, or emergency preparedness?

When we looked into the experience of MSF trying to respond to this crisis—we managed to organize a sizable intervention in terms of nutritional assistance, though we were unable to meet the people's needs entirely—it became apparent that something else was at play. The UN agencies and the donor governments were not pushing the humanitarian imperative and trying to get aid and access to the areas in need. The government in Luanda was resistant to securing access to those areas at the time, and the UN and the donor governments were waiting to make an overall deal with the government about how the population in these areas and the UNITA fighters who were coming out would be treated.

It was important for the UN to have a strategic and comprehensive approach to the issues of demobilization, disarmament, and reintegration. Until that happened, humanitarian assistance would be held back. In the case of Angola, it wasn't clear whether it was a tit-for-tat—"if you allow us access, we will give assistance"—but it is a fact that the international agencies did not push hard enough on the humanitarian side.

We even found that the UN had called donor governments and told them not to fund individual aid agencies to respond to the crisis or to the nutritional problems, because they thought it better for everyone to go in together. This delayed the response by several weeks and cost thousands of lives. Something is fundamentally flawed when humanitarian aid is held hostage by political calculations and concerns. When there is an attempt to balance political priorities and humanitarian concerns, political considerations always overrule the humanitarian ones.

We approached the Carnegie Council, and a conference was convened to talk not only about Angola, but also about the broader context of the issue.

It is important to note that efforts to integrate humanitarian assistance into the framework needed for the promotion of peace, security and development is not a new trend. It is rather a broad agenda that is being promoted, and humanitarian assistance is seen increasingly as part of that agenda. Humanitarian aid in the service of political goals during the Cold War was something that most people knew about, but in the 1990s the trend accelerated significantly. It is now formal policy in the UN, both within the headquarters' institutional arrangements and the integrated missions in the field. The mandates of the missions in Afghanistan and Liberia specify that the humanitarian branch reports to the political branch of the organization, and ultimately to the Security Council. There is an increasing emphasis on preventing these interventions from trying to serve strictly humanitarian purposes.

There are a lot of strong drivers behind this trend. Clearly, a "donor fatigue" exists about always responding to emergencies but never dealing with the causes—and this inspires the effort to "do something more than merely save lives," that is, to try to promote a broader, more durable response that could bring about the conditions for peace and development. It sounds very good: "we need to have more political utility from aid, not just expend efforts on saving people from one day to the next." And, of course, humanitarian assistance is associated with many positive values, and being able to present military or political interventions as humanitarian in the context of an integrated mission carries a lot of public relations value.

In my article in Ethics & International Affairs, I argue—which is also the concern of MSF—that for a number of reasons, the integration of humanitarian assistance into a common framework with political and military actors is a very harmful trend. Most importantly, such kind of integration is unnecessary and unjustified. While it looks fine in principle to save lives while simultaneously trying to promote peace, build security, and enhance development, in fact, when you look at what happens on the ground, you actually see that integration injects a different kind of logic to humanitarian assistance, doing away with the traditional humanitarian principles of impartiality (the delivery of aid according to needs alone) and neutrality (aid organizations don't take political sides in conflicts). Integration injects into humanitarian action the logic of development assistance—that it is permissible to give aid conditionally, and use it as a carrot or stick to reward and punish; that it is permissible to be selective and give aid to those who could be useful to the political purpose of development and deny them when they are not; that aid could sometimes be withheld in the present if it is believed that doing so would be helpful in achieving future goals. Allowing such trade-offs, however, when the immediate and severe needs of a lot of people are at stake, is extremely harmful, and I give specific examples of how in my article.

The political and military responses of governments to crises around the world today are driven by strategic considerations, not humanitarian concerns. This is why many crises remain unnoticed by the public in the West. Of course, it would be great if the theoretical ideal of integration could be implemented, and governments looked around the world and said, "This is the crisis that is having the biggest human impact, and we will respond to it with all the tools at our disposal. We will provide assistance, and then we will have a political response, and a security response, and it will all be commensurate to the need that is there." Unfortunately, we don't think this ideal will be followed through in reality. For this reason, keeping humanitarian action independent from the institutional influence of political actors is crucial to ensuring that humanitarian organizations are able to make decisions to respond to crises based on evaluating the humanitarian need alone.

In the article, I draw from the analysis in a book that MSF published earlier this year, entitled In the Shadow of 'Just Wars', that tries to categorize the response to crises around the world. There are three main categories:

1. The first category brings us to the current cases of Iraq and Afghanistan. It is the type of response that occurs when governments intervene militarily and say, "This is a strategic concern of ours; let's intervene militarily and let's associate humanitarian aims with the purpose of our intervention". In these cases, there are dangers for humanitarian assistance; aid is viewed by forces on the ground as partisan, or as an extension of the political or military agenda. This is what we have seen happening in Iraq and Afghanistan, and this is the major reason why humanitarian workers have become the intentional targets of murderous attacks.

2. The second category, which entails a large number of examples, is where the international community is involved in an attempt to contain the crisis. Very little of this involvement is done through political and military means, but instead humanitarian assistance is put at the center of the response. This is what is happening in Darfur today. Although the rhetoric is very strong, in fact the main means of action by the international community is the provision of humanitarian assistance. North Korea is such a situation.

When aid becomes the main political response of the international community, it puts pressure on humanitarian assistance and actors on the ground, who again come to be seen as extensions of the international agenda, and hence are left vulnerable in the field. We are starting to see this happen in Darfur.

3. The third, and biggest, category is abstention. When the international community does very little or fails to intervene, and aid agencies are left alone to fend for themselves, facing belligerents who are let loose to do whatever they want, massive suffering occurs. That is what we have seen in the Caucasus as well as in the Congo for instance.

So, if you compare the professed theory of integration with the response to crises in practice, you see two quite different pictures. This itself is a strong reason why humanitarian organizations should not link themselves to this integration agenda, because in that way they would link themselves to varying political responses driven by varying goals. Integration offers very few benefits for the cause of humanitarian aid and the assistance to people in need.

There are many ways to show that it is actually unjustified and unnecessary to attach humanitarian aid to the promotion of peace, development or the resolution of conflict. There is no real proof that this actually works, and there are plenty of reasons for why we should be skeptical that it would. Therefore there's no real compelling reason, either from an ethical or from an effectiveness point of view, for humanitarian assistance to be attached to the political response in this way.

So what should be done about this? If you look at the articles in this volume of Ethics & International Affairs, you will see that there's a growing recognition of the problem posed by integration. The very visible tip of the iceberg is the attacks on humanitarian aid workers in Afghanistan and Iraq, which illustrate this problem very vividly, and are a big contributing factor in the growing recognition that maybe aid organizations need to pull back from such close association with a political response. The integrated approach itself is not what is attacking us, nor is it the United States' policy that is attacking aid workers in Iraq—but they are a contributing factor in provoking attack. These attacks are happening in the context of an integrated approach of U.S. policies in Afghanistan and Iraq, where the integration of aid into military policy has increased the likelihood of aid workers being attacked.

Because of that, MSF withdrew from both countries. As other major organizations have pulled out, most likely for the same reasons, it has become impossible to deliver any meaningful assistance to the people who need it, especially in Iraq as the violence escalates in different parts of the country.

I think the growing recognition of the problem posed by integration is also illustrated by the fact that there is no UN contributor to the special section in Ethics & International Affairs. The UN Office for the Coordination of Humanitarian Assistance is increasingly ambivalent about the integrated approach, which is being pushed by the UN's political wing. Off the record and when they speak personally, most UN officials working for OCHA increasingly want to move away from integration. There are of course institutional interests in having a humanitarian voice among the political debates in the Security Council, but it's evident that OCHA is not cheerleading for the integrated approach at the moment.

Governments and donors, of course, see integration as very important and strategic, as they are aware that labeling all political intervention as humanitarian is of great public relations value.

Within the NGO system there is also an incentive to continue, maybe inadvertently, to push an integrated approach when calling for protection and international security forces in different environments.

But there is a way out. Governments need to be part of it. They have clear political obligations vis-à-vis humanitarian assistance, and this obligation is quite different from integrating humanitarian aid. Governments have a political responsibility to defend and promote humanitarian assistance that they are not fulfilling. In fact, the right way for governments to fulfill their humanitarian obligations is to promote the independence of humanitarian aid.

On the other hand, NGOs and humanitarian actors also have to play their part in reasserting independence. Larry Minear in this issue of Ethics & International Affairs talks about the difference between insulation and independence of humanitarian actors. He insists that the move has to be toward independence, but that independence is not ensured through the disengagement of political actors, and in fact there need to be institutional guarantees for it to become a reality. Within the UN system, for instance, humanitarian agencies must be institutionally separate from the organization's political arms. Can we structure the UN so that there is an independent humanitarian branch, with independent and assessed funding for instance, so they don't have to depend on the vagaries of political interests?

NGOs also need to assert strongly their independence, challenge governments, and not portray themselves as partners and associates in the way that they have done in the past. If they don't use such actions to assert publicly their independence, they must openly acknowledge that they are working in a different way, but they are not being transparent. Many organizations are playing both sides—claiming to be independent humanitarian organizations while actually working in close association with intervening governments—and this is a dangerous trend.

GERALD MARTONE: Nicolas did a good job of outlining the dilemma we face, and of conveying the annoyance, the consternation, and the irritation, that this particular watershed moment represents for NGOs. We have a set of humanitarian principles that we feel are somewhat corrupted by the coherence agenda, or the integrated political approach. Nicolas mentioned the principles of neutrality, impartiality, independence, and another motive called humanity, one that is rarely mentioned but vitally important, as the fourth humanitarian principle. Humanity means that all efforts should be expended to address and relieve suffering.

I think this is where the departure is most stark between the humanitarian and the politicized agenda, because the military or political objective often involves directly inflicting suffering, whereas the objective of humanitarians is one of relieving suffering. A defining moment in the integration debate happened in October 2001. Shortly after September 11, Secretary of State Colin Powell declared that NGOs are "a force multiplier for us," and "an important part of our combat team." If you could just imagine the revulsion felt by aid organizations when this statement was made! We felt like "embedded" humanitarians. This statement raised the issue of the danger of instrumentalization of aid, including the strategic effects and the cooptation of aid. I'd like to think, Well, you know, that was Iraq and Afghanistan, and that's limited, and hopefully this is not going to happen again, and hopefully we've been sufficiently chastened by our failed experiment in Iraq not to do this again. But, unfortunately, lurking on the horizon are Iran, North Korea, Syria, and others.

Yesterday, AlertNet, which is part of the Reuters Foundation, a Web service that serves the informational needs of a lot of humanitarian agencies, put out a viewpoint from a couple of workers from Save the Children about Ivory Coast. They said that in Ivory Coast they felt the integration was causing them harm. Like Nicolas said, the fact that under the integration agenda the senior UN humanitarian person in Ivory Coast reports to the same individual overseeing the peacekeeping forces, is a source of corruption for them. It led to security effects for them, and created a real question of credibility and legitimacy among the people that they are trying to serve.

Then, just this morning, InterAction sent around an email to the NGOs saying that some U.S. government officials have noticed that U.S. military officials providing humanitarian relief in Ethiopia right now are wearing civilian garb. This is something that is a real point of annoyance for NGOs. We call it "cross-dressing," when the military dresses up as aid workers, which causes a real blurring of the lines, and it's something that we're just really quite annoyed by.

As Nicolas mentions, the context of our work is armed conflict and political oppression. We work in areas where there is fighting and there are belligerent forces, so it is inevitable that we'll conduct our work and have to coordinate and contact and interact with fighting forces—opposition forces and occupying forces. Belligerence is the reality of the work we do.

The enormous crisis in Darfur right now is a harsh example of that. Our daily activities involve contact with the Sudanese Liberation Army rebels and with the government of Sudan's military. In reality contact is inevitable. The question is: how can we provide some distinction, some firewall or insulation, that protects our independence, or, at least, the perception of our independence? NGOs are struggling with this at present. Integration has posed a new challenge for us, and we are struggling to codify how we should distinguish ourselves and retain our distinct humanitarian identity in appearance and in function.

Hugo Slim of the Henry Dunant Centre for Humanitarian Dialogue, who has written a lot on this topic, is perhaps at the other end of the spectrum from some of the points that Nicolas mentioned, specifically with regard to the point that humanitarian agencies don't own the monopoly on humanitarian assistance, but that military forces should and could be involved in it. Certainly history bears that out. Since the earliest days of organized armies, military forces have provided assistance to civilian populations. Marcus Aurelius reminded his generals that benevolence is a great weapon of war. Even Alexander the Great told his commanders that it was a humane gesture to the vanquished to provide them with emergency assistance—and also a great way to win their loyalty as their new conquerors. During the American Revolutionary War, military physicians helped civilians from the frontier posts throughout the west. In Vietnam, obviously, there was an elaborate campaign to aid civilians in a hearts-and-minds campaign. So there is some tradition within military culture of providing humanitarian assistance.

I come from a military family. My father and my brothers are all officers. I am often struck by their perception of themselves: they really see themselves as white knights. My brother, who designs laser-guided missiles for the Air Force, explained to me that he is in the business of saving lives—he believes this in his mind and his heart. I have often found in the field that military forces are often befuddled by any reluctance or avoidance in cooperating with them.

In our attempt to provide some guidance, and our professional obligation to describe how we should conduct and distinguish ourselves, there has been the notion that NGOs have been developing what is called "operational independence." This is what we hope will be a very discrete way of identifying ourselves. We recognize there may be some times when coordination with armed forces and belligerents in a conflict zone is inevitable, but we really have to be very conscious of our separation and distinction from the military objectives. The proper relationship that we are aiming for is coordination, not subordination.

We have criteria about sufficient access to the populations that allow us to select, identify, and assess the populations that we want to target. The first criterion is that we directly control, implement, and monitor our interventions in order to assure the outcomes. Second, that we have unhindered entry, egress, and freedom of movement. Third, that our assistance not be diverted, manipulated, seen to condone an occupying force, or used to influence public opinion. And, finally, that the activities we do be impartially selected by our own organizations as the result of an objective assessment. There are all kinds of criteria surrounding information-sharing, co-location of facilities, press conferences, interaction with the media, surface/air transport, use of military assets in any of our logistics, visibility, and logo requirements. These are some distinctions that we're attempting to describe, to give us some sort of charter about how we should conduct our interactions.

There are, however, exceptional circumstances, such as when the presence and access of humanitarian agencies is lacking, or their capacity is inadequate, or the security environment is prohibitive. In order to prevent unacceptable suffering, these are situations where military assets or logistics may in fact be necessary for an appropriate intervention. For reasons of pragmatism and to save lives, NGOs have not resisted that.

There have been several precedents that people are probably aware of: Ethiopia and Sudan in the mid-1980s; northern Iraq in 1991; Goma, Zaire in 1994; and Kosovo and Macedonia in 1999. There are exceptional circumstances where professional contact between humanitarian aid and military forces providing technical advice or expert consultation to ensure evidence-based humanitarian intervention would be appropriate. It must be emphasized that we perceive this engagement to be time-bound and not open-ended, and as soon as possible the responsibility should be transferred to civilian humanitarian agencies; and at all times, the control and coordination of these activities should be under a civilian structure.

I do remember years ago when we, in the humanitarian agencies, would talk about the humanitarian "alibi," or "fig leaf." That is, instead of the needed determined political or forceful engagement, the only actual intervention was by humanitarian organizations, in the form of providing blankets, food, and shelter. It's ironic that now we find ourselves in just the opposite situation.

Lastly, I want to bring up the issue of neutrality. Neutrality is a term that we use quite frequently but that is not well understood. It implies a distance from the political objectives of what's happening. To some extent, it has made its way into our vernacular and into our covenants of what humanitarian assistance is, but there really has been a question of the ethics of silence. Is neutrality sufficient and appropriate?

Certainly in the founding of MSF in 1971, it was the implacable neutrality and silence of doctors working for the ICRC [International Committee of the Red Cross] that rose up to create MSF. Oxfam was created the same way, when Oxford academics who were providing relief to Greece in 1942 during the Nazi blockade recognized that this wasn't a question of not enough food, but rather of a lack of political engagement.

It's a cruel irony that now, at the tenth anniversary of the Rwandan genocide, we find ourselves once again in ethnocide in Darfur, western Sudan. We operate in an environment where we must interact with the government of Sudan and the rebel forces at work. We are forced to be careful about our public statements, to choose our words carefully, and to watch what we say. For example, some of you might be aware that the other day the country representatives of Oxfam and Save the Children UK were both expelled from Sudan because of public statements they made that were critical of the government of Sudan.

Although there is a purist ideal in humanitarian aid that wants to provide freedom from want, we recognize that we must provide freedom from fear—that it's not just about stopping the dying, but also about stopping the killing. As such, the question of neutrality, of silence, has really come into question as perhaps obsolete, romantic and utopian, and perhaps it is even morally repugnant to be neutral in times of a moral crisis.

We feel that we have a responsibility and a capacity to exert influence on the political, military, and economic contexts in which we operate. Therefore, in a situation where humanitarian agencies are outraged, it's rather uncreative and cruel to react through silence, when we feel that we have to in fact be vocal advocates for populations in extremis.

ROY GUTMAN: Thank you for having me on this very distinguished panel with representatives of two very effective organizations, with some of the best people out there in conflict zones.

I will give some observations as a journalist. Since the end of the Cold War, the attitude of the leading powers toward "small wars" has been that these conflicts are beneath our level of concern. One thinks of Afghanistan, for example. During the Cold War, this was, at one point, the heart of the East-West conflict. Then the Russians pulled out and so did the Americans. American aid had been flowing in the last years of the Afghan insurgency in significant quantities, yet within a couple of years of the Russian pullout, American aid sank to next to zero. Yet the conflict continued. It moved from a resistance against Russian occupiers to resistance against the Russian puppet left behind. Then, because nothing was settled in a political way, and because the United States essentially abandoned the field with little interest in the outcome, the parties started fighting each other. Then followed the four-year period of civil war, followed by the Taliban, and the Taliban, of course, weren't strong enough to defeat Ahmed Shah Massoud on their own, and had to bring in the support of Osama bin Laden, al-Qaeda, and the Arab volunteers—and so an entire force developed that we never expected. It was beyond anybody's fantasies that anything like that could ever emerge in this "small war" area which we had abandoned.

Similarly, the Western powers, starting with the United States, essentially tried to leave the scene of Bosnia and Herzegovina and the western Balkans. With respect to Rwanda, until the massive killing was over, the characteristic of Western policy was to deny that anything was happening.

The 1990s were a period of abdication by governments from crises that were occurring right in front of them. The only answer was to send in humanitarian aid and UN peacekeepers with no real mandate to use force. For example, in Bosnia the "peacekeepers" in war zones were not there to actually keep peace—because there was no peace to keep-but supposedly to protect humanitarian aid deliveries, and then on the whole they didn't succeed in doing even that.

On the whole, what we tend to do is deal with the symptoms and send in the aid workers to the refugee camps and provide aid. The excuse is that, well, at least we're doing something. In such situations of massive impunity, we have done as much as possible to apply band-aids and provide food for those who manage to survive.

One of the big issues of the 1990s for aid organizations concerned the question of what their role should be in such a situation: Are they going to sit by and just participate in the alleviation of suffering when nobody is addressing the causes? Is there something they can do, or should do, as a practice to alert the world to what is really going on, what really is the cause behind the disaster that they are treating?

Different aid organizations have come up with different answers. MSF has been one of the leaders in the debate. In the Balkans, MSF, as well as the ICRC, were going out where soldiers feared to tread. The international community pretended to be protecting them, but as a matter of fact it was really abandoning the aid workers to this eye-to-eye confrontation, and on the whole they did really magnificent work in those circumstances. It was a very frustrating period for every one of these organizations, but it was also a period of real heroism. In Rwanda, MSF led the way in deciding to withdraw, and in such a way speak out when the genocidaires fled to the refugee camps in the neighboring Congo, and the international community responded by sponsoring an airlift in these camps, in effect on behalf of the genocidaires. MSF decided to leave. They decided that staying on the ground in those conditions of genocide and international neglect was producing more harm than good. Their act of conscience was still the right thing to do, and it sparked the debate about responsibility to act.

One of the conclusions of that period was that we can't just sit around and watch genocide happen. But on the other hand, it is not right to expect that aid organizations should be the ones to take sides and condemn the parties to the conflict, when these organizations are there on sufferance and by their permission.

The first decade of the twenty-first century is turning out to be very different. In the last decade, the problem was governments refusing to act, to use force, to acknowledge crises and small wars. In the current decade, the problem seems to be that governments, starting with the United States, but also the Europeans, are willing to use force but not enough force. They are pretending, as my colleague just said, that they can use so much force and then the humanitarian organizations are going to be the "force multiplier."

In Afghanistan, the Americans have no interest even in prosecuting the crimes of the Taliban. The mass grave of Dasht-e Leili near Mazar-i-Sharif in the north is really "a cross-section" of the modern history of Afghanistan—because there are layers of mass graves from the civil war period, the Taliban period, and, unfortunately, also from the period of the American invasion and takeover. Then we have the U.S. attitude toward crime as exemplified in the cases of Guantánamo, Bagram in Afghanistan, and Abu Ghraib. Our action has been to pretend nothing was happening until the information came out from the leaked ICRC reports and other sources.

A serious problem that humanitarian aid organizations face today is funding. Who pays the bills for the humanitarian operations? MSF of course raises money from nongovernmental sources, but so many of the great international organizations, including the ICRC, are funded by the United States which is their major contributor.

It is reasonable to say that the U.S. government, especially in Iraq, in the name of humanitarian ideals, with the claim of humanitarian ideals, intervened there and in the process has basically destroyed the possibilities for humanitarianism by failing to provide enough security, and by using humanitarian aid organizations as a front to dress up its failure. The aid organizations, on the whole, have had no choice but to pull out. I think that withdrawing, quitting, and protesting is probably a very understandable response. I just feel that your departure is going to hurt the very people that you really want to help in the end, and I'm not quite sure how you can live with that. Of course, the real test will be to see whether governments will move to provide more security in response to your withdrawal.

NICOLAS DE TORRENTÉ: I want to make an important clarification. MSF's withdrawal from Afghanistan was not a protest withdrawal, and it was in full recognition that our departure would hurt people that we were trying to help—and that's what made it so painful. We do recognize that we are leaving people behind—and even while we were still in, we were not able to reach a lot of people who were in real need in Afghanistan, particularly those in the south and southeast, where fighting has been intense, and because of that there is hardly any access for aid organizations.

However, our departure is due to the fact that there have been over forty aid workers who have been deliberately targeted and killed in the past almost two years, including five MSF staff, and there is recognition that we just cannot operate in an environment where we are taken as targets and specifically murdered just because we are trying to help. This ongoing threat and the lack of response from the Afghan government in MSF's case, its failure to follow up on the people who carried out the killing of our five staff, in effect raises the question about what the relationship is between the government and these people—and this has made it just impossible for us to continue with our work in Afghanistan.

Questions and Answers

QUESTION: Could you elaborate a bit on the situation in the Congo? I'm just returning from three years there with the UN Peacekeeping Mission in the Congo. I agree that the integrated system was completely flawed: it's not normal to be delivering vaccines through our UN helicopters and military observers. But we never really understood how we could disassociate the two. The UN's logistical structure was massive, and as a result we had access to places that NGOs didn't have access to. So the idea of having it not be integrated is great, but how would that work on the field?

NICOLAS DE TORRENTÉ: My point on the Congo was not to talk about the problem of UN forces carrying out some humanitarian activities as part of their presence there. The real issue in the Congo is the lack of political response commensurate to the gravity of the situation there. The IRC is present there and according to a retrospective mortality survey they conducted—which uses the kind of standards by which we can judge the severity of a crisis—in the Congo, there have been more than 3 million deaths, and this number is from a few years ago already, so the death toll has been mounting since.

Ideally, an integrated approach would involve looking at how bad the situation is and putting forward the correspondingly necessary political and assistance resources that the situation merits. This is not what happens though. On the one hand, there are situations, as in Iraq or in Afghanistan, where there is no shortage of political attention to drive intervention. The motive is strategic, however, and aid is attached to the political and military intervention as part of the strategy. On the other hand, in cases such as the Congo, there is very little political interest, and therefore aid organizations and the UN cannot even get access to the populations in need.

I was in the Congo over the summer and it's startling to see how we've come to accept as almost a given the level of violence against people and the displacement of people. I was in a place where there were 10,000 people who had just been displaced by thugs, soldiers of the newly integrated Congolese Army, who had come into their homes, raping women, and so on. And further down the road, in Goma, people didn't even know about it—"it's only 10,000." So that the UN military personnel is doing some vaccinations on the side does not present a major issue in the Congo. The main issue in the Congo is the lack of political response from governments which has left aid organizations on their own.

QUESTION: I want to address the current U.S. offensive of Fallujah, the intense fighting and the terrible crimes happening in the streets that there are some reports of. Nicolas, what do you think about the question of impartiality and neutrality in the face of serious war crimes, especially when in question is hospitals being bombed, doctors who are either unable to perform their duties or perform operations by candlelight because there is no electricity, aid workers who are not able to come into Fallujah and help the civilians in need, where dead bodies are on the ground for days and days. Is there a responsibility to respond when things like this are happening?

NICOLAS DE TORRENTÉ: The present situation in Fallujah is an example of the reason why humanitarians should be very reluctant to be integrated along with Western intervention forces. Western publics implicitly hold this idea that Western militaries are benign forces, that they go in and fight "humanitarian," "life-saving" wars, with high standards for conduct in war and advanced equipment, and that there will be no casualties. I think Fallujah is sufficient to dispel that notion. Why would we, humanitarian organizations, want to be working together and associated with a military force that will commit atrocities—because this simply is the reality of war—even if they're Western, hold themselves to high standards and strong values, and take international humanitarian law more seriously than many other armies?

For MSF, Fallujah is a huge frustration. We were able to get one international aid worker into Fallujah in April 2004, at great risk, and he reported that the road was blocked and the hospital was occupied by U.S. forces. We tried to bring up this issue publicly. With respect to the other allegations regarding the situation at present, we were not able to go into Fallujah this time around, because we had to withdraw fully from Iraq, and therefore we were not able to be witness to the events. It is MSF's principle that we only talk about things that we have seen firsthand; we don't base our actions on journalistic reports or hearsay. We only speak about our direct experience of trying to deliver aid and see the problems we face.

Of course, we should and want to be in Fallujah, because this is where the fighting is taking place and where the victims are. But we simply cannot be there, most importantly because we are being threatened, kidnapped, and murdered, etc., and then also because of the integration and cooptation of our efforts.

GERALD MARTONE: The situation in Fallujah is reprehensible. Unfortunately, it's so starkly similar to twenty-nine other situations around the world right now. WHO recently published a report that said now is the most violent moment in human history. There has never been more ethnocide, forced expulsion of populations, deliberate rape, torture, and famine seen in the history of this planet. So, sadly, this is the nature of our work, and the demand continues to grow.

If you can believe it, we work for a profession whose bottom line, the humanitarian bottom line, our metric, is something called crude mortality rates, the number of people per 10,000 refugees that die per day. This is how we measure our work. So it is a gruesome reality, the environments in which we work.

QUESTION: I am bewildered because, Nicolas, you spoke very strongly about the practical importance of independence, and yet you also explained that aid organizations are not able to function independently without security. Given this, how is it possible to have real independence in practice? And then you spoke about impartiality and neutrality, on the one hand, and the importance of speaking out against injustice and brutality, on the other. Are they compatible?

NICOLAS DE TORRENTÉ: I don't have an easy answer as to how we get out of our current predicament in Iraq or Afghanistan. The solution that I have heard so far—"this is a new world, forget your principles, get on with the program, take armed protection, go with the U.S. forces"—is not the right thing for us to do, not just from a principled, but also from a practical point of view. Independence actually does help us, and in most cases continues to be a very valuable tool in gaining access and in negotiating with belligerents. In all sorts of conflicts, with all kinds of shady groups involved, we have been able to gain access.

Some things are clear: trying to be independent doesn't work in Iraq and Afghanistan, where we are being associated with the Western military intervention forces and are therefore being seen as partisan and, as a result, as legitimate targets of attack. It doesn't work there.

Joining with the United States and taking armed protection would change completely the nature of our work and I don't think, pragmatically, would provide protection either. After all, the U.S. forces are being attacked in Iraq on a daily basis. How would we be exempt from that if we took U.S. armed protection?

In exceptional circumstances (I agree with Gerry) we should consider it. And we have done it: MSF has worked with armed protection in Somalia, during the famine of 1992, where we felt there was no other way. Actually in Somalia today, we continue to work with armed guards, and all agencies do. So it's not that we will never do it—but I think it's not the right solution in Iraq, where we would simply be seen as completely associated and therefore be attacked very much as a consequence.

GERALD MARTONE: I echo a lot of what Nicolas said. Humanitarian principles are a bit nuanced and there are distinctions that wouldn't be very interesting to go over. I think if I were to drive home a point, it's that we do want to work very hard to distinguish and separate ourselves from any association with combat forces, that we want the perception of independence, and that we hope that our visibility—our white flags, our white vehicles, our white T-shirts—confer some protection, that all sides recognize that we don't have a stake in this fight. That's why when the lines become blurred, and people become confused about just who we are, we are put in great danger. In many countries there is no legacy of charity; people don't really understand it and even mistrust these caregivers that come from far away to do good.

Part of our security is in fact something called an acceptance strategy, that our contact and rapport with the people we work with, we hope confers some protection on us. That's why this contamination that is brought by integration worries us tremendously.

QUESTION: Given the difficulty and the importance of separating yourself from the U.S. military and the other militaries that are trying to derive strategic benefit from humanitarian assistance, I wonder what you think of the proposition that there simply may be certain circumstances in which civilian humanitarian workers ought not to operate. For example, in war zones where the U.S. military or any military is actively trying to do humanitarian work at the same time being a belligerent, it may be simply impossible for any other aid organization to separate itself from that activity. So might there be certain sorts of war zones, or certain sorts of conflicts, or even certain sorts of humanitarian disasters, where it may be more appropriate, given this emerging reality, for aid workers to work, and others where it simply may not be possible to maintain your neutrality and thus you can't work at all?

GERALD MARTONE: I think we're all a bit infatuated with the extraordinary logistics of the military. Their resources are vast, incomprehensible. But they are not aid practitioners. They are soldiers. They don't spend the excruciating amount of time that we do to perfect our craftsmanship, our guild, the work that we do.

Some of my colleagues in Iraq have referred to the "painting of Iraq," criticizing the military's efforts at doing highly visible humanitarian aid gestures in a "hearts and minds" campaign, but not really making meaningful projects.

A lot of aid work is not the delivery of goods and the provision of services, but in fact is the imparting of ideas. There is a notion in public health that there's no such thing as a tropical disease, there are only diseases of ignorance and poverty. A big part of what aid work does is teach people about contaminated water, about how to re-hydrate a sick child, how to recognize signs of malnutrition, what are useful coping tools that people are resorting to. There is a tremendous amount of effort that goes into teaching health awareness.

Most of our staff are refugees themselves who go from tent to tent to instruct people about the health trends and disease patterns in camps. This is really what humanitarian aid is about. Assets and logistics are necessary, but a lot of what we do is help people to learn the behaviors they need to survive.

QUESTION: What should be the humanitarian mandate in the era of the globalization of responsibility?

NICOLAS DE TORRENTÉ: The questions gives me the opportunity to highlight an added difficulty that we have in disassociating ourselves from belligerents, which is that most aid organizations historically have been from the most powerful countries in the world, from Europe and the United States, and so are, by and large, Western organizations. There is a tradition of humanitarian aid and assistance in other cultures in other parts of the world, but the highly visible organizations, and even the UN in a way, are seen as Western institutions. MSF is no different in that respect. That is an added difficulty in trying to explain the distinction between us and the intervening forces for sure.

The funding aspect is clearly another aspect where there are a lot of structural problems. At MSF we have really tried to insist on having a civil society base of funding. Over 80 percent of our funding comes from private individuals around the world, and only 20 percent from governments, which is quite different from most organizations. The argument for independent funding is a topic of many discussions among NGOs and its importance has been made clear. Yet, in a way, we have had it come back at us, saying, Well, does it make that much of a difference? In Afghanistan and Iraq, you had only private money, you had no money from the U.S. government, contrary to most organizations, yet you were still seen as part of the Western intervention there and so on. I'm not denying that there are very important practical difficulties and a much bigger effort, new ways, have to be developed. There is a lot of thinking in the aid world about trying to find new ways to establish the legitimacy of the humanitarian enterprise, if you will, or the humanitarian ideals in other parts of the world.

In the Middle East and Central Asia there is a specific challenge to do that because there is a lot of suspicion of us. They say, "Who are these people? Why are they coming here? They say they're independent. What does that mean? They're rooted in their own societies, supported by private individuals. Does it make a difference?" There are a lot of problems there, and I think we have to find new ways. I don't think that just changing and having more international teams is enough—in MSF, IRC, the UN, and other organizations we actually have a lot of people from other backgrounds. Does it really make that much of a difference? Are there other strategies, new ways of dialogue, new ways of trying to gain acceptance—because our ideal is universal?

That's also why I continue to advocate for a narrow view of what constitutes humanitarian assistance, because the narrow core mission of humanitarian aid—providing immediate life-saving assistance—is universal. I think there arise many more problems, and the problem of Western values comes much more into play, when you talk about, "We're here to save lives but we're also here to educate, and we're here to teach you about democracy, and we're also here to promote peace." Expanding the humanitarian mandate in such a way brings in much more controversial and contentious issues.

Humanitarian aid has to remain very much focused on the core of what we are trying to do if we are to have any hope of gaining acceptance and regaining the lost ground.

PAIGE ARTHUR: I think we should end it there, on that very strong note. I want to thank everyone for coming. I want to thank the panelists, Gerry Martone, Roy Gutman, and Nicolas de Torrenté.

--Prepared by Lydia Tomitova, Ryan Dempsey, and Catrin Egerton.

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