Many books have been written in recent years about the humanitarian aid system and its failings, but there are not many good personal memoirs of front-line international emergency work. One of the most striking, for its title at least, is Emergency Sex (and Other Desperate Measures): A True Story from Hell on Earth, written by three United Nations workers whose paths crossed over a dozen years in Cambodia, Somalia, Haiti and Bosnia. In the end, however, Emergency Sex and others like it tend to be rather self-absorbed: a lot of running for cover, desperate refugee camps, occasional bouts of heavy drinking and struggles against unreasonable orders from bureaucrats in far-off headquarters — like M.A.S.H. for the new millennium.
Richard Heinzl’s Cambodia Calling: A Memoir from the Frontlines of Humanitarian Aid is a bit like this, although it lacks both drama and emergency sex. Heinzl, a founder of the Canadian branch of Médecins Sans Frontières, got the international bug when he took an elective in Uganda as a 22-year-old Canadian medical student. Essentially, what we get is a young Canadian wandering around meeting exotic people for a couple of months and developing a yen, as soon as he has returned to Hamilton, “to get back over there again. Anywhere poor and tropical.” Anywhere poor and tropical?
A few years later, he gets his wish with a six-month MSF posting to Cambodia. Essentially, this is a down-market travelogue, a series of sepia-toned vignettes without a very clear narrative, without struggle and without much direction. The exotics return, however, as do late nights, vodka and Maugham-like tree frogs chirping in the dark, steamy jungle. Heinzl’s Cambodia is certainly poor and tropical, and the horrible bureaucrats back home make regular appearances. But the author’s own illness gets more ink than his patients, and in the end we do not learn much about Cambodia, MSF, emergency assistance or the author.
James Orbinski’s book is very different. Here we get right into the suppurating wounds of desperate people and of the conflicts that have torn their lives and their bodies to pieces. In An Imperfect Offering: Humanitarian Action in the Twenty-First Century, Orbinski takes us from his first overseas assignment in Rwanda in 1987, before the genocide, to war-torn Somalia, Afghanistan and back to a Rwanda in the thick of its ultimate bloodlust. He takes the reader on a search in Zaire for hundreds of thousands of “missing” Hutu refugees, then to North Korea, Kosovo, Chechnya and the Sudan. During the 1990s, Orbinski witnessed and ministered to the victims of some of the greatest atrocities in a century. An Imperfect Offering describes with passion, eloquence and sometimes despair, the worst imaginable human behaviour, and the best.
Unexpectedly elected MSF’s international president in 1998, Orbinski was at the helm the following year when MSF was awarded the Nobel Peace Prize, and he tells that story too. The Nobel committee cited MSF’s commitment to “independent medical humanitarian action” and to “speaking out, which helps to form bodies of public opinion opposed to violations and abuses of power.”
In humanitarian circles, MSF is respected but not always loved. It has a tendency to arrogance, is often self-righteous and sometimes ignores or fails to understand the broad context in which it works. Its fractious nature can lead to the establishment of two or three independent MSF operations in a single country — one from France, one from Holland and perhaps another from Germany. It usually arrives after an emergency starts and it pulls out as soon as it has decided its work is done. Others — UN agencies, CARE, Oxfam and the like — may have been in a country such as Sierra Leone or the Congo for years before a conflict began, and will remain for years afterward as relief efforts turn to reconstruction and longer-term development. But before and after are not the business of MSF, and so it is sometimes easier for doctors without borders, fresh off the plane, to speak out on what appears to be humanitarian compromise, co-optation and hypocrisy.
MSF’s very creation was based on precisely this kind of anger, in what Orbinski calls a case of “mistaken judgment.” Bernard Kouchner, who is today the foreign minister of France (and who comes off very badly through several appearances in this book), served with the French Red Cross during the Biafran war in Nigeria. Appalled by what he saw as genocide, and by the strict Red Cross notion of neutrality (and silence), he and other doctors broke away to form an organization that would not be bound by political borders, or by a neutrality that was indifferent to victims of war crimes.
This kind of “witness” and the outspoken defence of victims of conflict have been the hallmarks of MSF ever since. But in its first instance, it was predicated on a mistake. Orbinski explains early in An Imperfect Offering that the Biafran authorities had refused to allow a humanitarian road into the enclave, using starvation as a media prop to assist in the cause for Biafran independence. It was actually worse than that: humanitarian agencies purchased locally grown cassava and other crops with hard currency at vastly inflated rates of exchange, providing Biafra with its only means of buying weapons during some of the worst months of the war. “MSF would later recognize its error in judgment,” Orbinski says, “but the organization would not reject its commitment to speaking out.”
Here is one leitmotif in An Imperfect Offering, and for the entire humanitarian enterprise: the tradeoffs that exist between a quick and perhaps brutal end to a conflict and the demand by humanitarians for ceasefire and access, which can lead to a prolongation of war and a higher death toll. Knowing when to speak out and when to remain silent is a core issue for humanitarians, and it is a core issue in this book. Speaking out against the misuse of humanitarian assistance to North Korea got MSF expelled from the country. Speaking out against Serb abuses in Kosovo served to curtail its ability to work with war victims in Serbia.
Orbinski tries to be clear on this issue, but he is only moderately successful, in part because there is no simple answer. A few weeks after he accepted the Nobel Peace Prize on behalf of MSF, he addressed the UN Security Council on the protection of civilians in conflict. He emphasized the need for a political response to political problems, a humanitarian response to humanitarian problems, and robust and credible peacekeeping forces for protection and security. He referred to cases such as Somalia, highlighting “the danger of mixing protection with humanitarian assistance.” The issue in Somalia was not so much that soldiers were actually engaged in the provision of relief, a problem in its own right. The larger issue was that the overall U.S. and UN military interventions were initiated in the name of humanitarianism, and they went badly wrong. In retrospect, it would have been better if they had stayed away, ignoring the urgent pleas of some non-governmental organizations for an invasion.
And yet MSF was one of the first and most vocal organizations to call for military intervention to halt the genocide in Rwanda. Why one and not the other? One was genocide and the other clearly was not, but to dying Somalis, that might not have seemed an adequate explanation. One might quibble over words — that an appropriately equipped UN force in Rwanda would have been about protection and security, rather than humanitarianism, had it appeared. But a military mission to Rwanda might have been as badly handled as the one to Somalia, and then what would humanitarians have said? This is not an argument to excuse inaction in Rwanda; rather, it points to the hugely complex moral challenges that face humanitarians, caught between principles of neutrality, the horrors of war and the inaction of bodies created to prevent it.
The second great dilemma for humanitarian organizations, intimately linked to the complexities of neutrality, is the humanitarian principle of independence, which, Orbinski explains, “demands that humanitarian actors remain independent of political, economic, religious or other objectives.” His narrative demonstrates time and again, from Somalia to the Balkans, the Sudan and Afghanistan, that humanitarian assistance provided by western governments has become increasingly politicized over the past two decades. Orbinski takes his title from Leonard Cohen’s Anthem: “The wars, they will be fought again / the holy dove, she will be caught again / bought and sold and bought again / the dove is never free … Forget your perfect offering / There is a crack, a crack in everything / That’s how the light gets in.”
Today, governments like Canada’s target their funding much more explicitly than in the past. This greater earmarking and direct donor intervention in humanitarian operations is the result of three converging factors. The first was the end of the Cold War and the mainstreaming of aid onto the international security agenda. The second was greater western engagement in internal wars such as Kosovo and Afghanistan, where donors wanted more visibility and recognition for their humanitarian assistance as part of their “hearts and minds” operations. Tighter earmarking of contributions to the UN and NGOs was one way of achieving this. And the third influence is said to result from changes in public sector management, with a greater emphasis on results. In the latter scenario, UN agencies fall victim to their own unwillingness to reform, and so governments become more directive with their humanitarian offerings.
The clustering of bilateral donor funding around geo-political hotspots and the consequent growth in “forgotten emergencies,” represents a growing political incursion into a humanitarianism that could once be proud of its neutrality, its impartiality and its independence. The power grab by governmental donors — in the name of improved policy coherence, greater efficiencies and (the last refuge of the bureaucrat) accountability to the tax payer — has crippled the UN and it has robbed humanitarian delivery agencies of their principles, their independence and much of their efficiency.
The problem has become more evident in Afghanistan and Iraq than anywhere else, but Orbinski traces the loss of humanitarian independence through a multitude of emergencies, including Somalia, Rwanda and its related catastrophes, the Congo, Sudan and others. MSF tries to guard its independence by limiting government financial contributions and, where it smells a rat, has been quicker than others to denounce villains and pull plugs, but the choices are often difficult.
The worst examples of humanitarian co-optation can be seen in countries where western powers are both donors and belligerents — the Balkans, Afghanistan and Iraq. Colin Powell spoke famously of NGOs being “force multipliers” for the United States in Afghanistan, and Canadian military leaders frequently rebukeCana-dian NGOs for resisting closer synergies with Canadian political and military priorities. The 2007 Manley mission to Afghanistan called for greater visibility in Canadian assistance and suggested at least one large “signature” Canadian project that could be seen and appreciated by all.
If this kind of thinking was not so sad itwould be almost laughable. Who in Afghanistan would be impressed by a signature Canadian hospital or a major irrigation project with maple leaves all over it? Big projects might do some good, but good is already being done through the invisible assistance that the Manley Commission dismissed. The issue for the commission was not the intrinsic value of a hospital over some other form of assistance; it was about visibility. And the visibility was not about impressing Afghans; it was all about impressing Canadians, and perhaps Canadian journalists, in order that they might stop criticizing the overall Canadian effort.
This kind of politics is evident in the soldier’s complaint that the schools and microfinance purveyed by NGOs are all very well in the long run, but they do not win hearts and minds in the here and now. The military wants more of the Canadian aid budget so it can hand out footballs and backpacks to kids living in dangerous areas where the hot war proliferates and where NGOs are sparse. This debate is a sterile one. There is undoubtedly a need in insurgencies for hearts-and-minds initiatives, and even for provision by the military of emergency assistance where the military alone can operate. But if the military is effective in its core competency, and if schools and microfinance help to bring stability, hearts-and-minds operations will not be long required.
If there is a failing in Orbinski’s book, it is his inability to explain clearly how humanitarians can work with unfettered independence in an enterprise where all money — even $10 donations — has strings. Individual donors gave generously to victims of the tsunami, for example, but it is harder to raise money for Darfur, and almost impossible for the Congo, where the death toll has exceeded that of the tsunami by a factor of six, if not eight. And Orbinski fails to explain how humanitarians can carve out uncontested space in the midst of war and genocide and the vested interests of donor nations. This is not, of course, a real failing. If anyone knew how to make the UN Charter — or the Ten Commandments for that matter — work, it would have happened before now. The book’s great value is its testimony on what takes place when humanitarians are not well funded, when they are not independent and when great powers seek to cloak military action — and worse, inaction — in humanitarian clothing.
What makes An Imperfect Offering so immediate is that the questions Orbinski asks are rooted in his own direct experience of war and suffering and in his great compassion for the victims. When he was president of MSF, Orbinski shuttled between Europe and Sudan, meeting government officials, rebel leaders and aid agencies in an effort to gain access to the victims of a decades-old conflict. On one occasion he took a six-hour flight from Kenya into a remote camp where MSF had a health post. “Several hundred people were there that day,” he writes, “and I examined one starving child with a hugely swollen abdomen. It was swollen, not because of starvation but because of leishmaniasis, a fatal parasitic infection carried by sand flies. I explained to her mother that because of the fighting, we couldn’t set up to give her daughter the four weeks of necessary intravenous drug treatment. ‘I will feed her and I will wait,’ she said.”
It is like that with humanitarians everywhere who struggle to work with the victims of war, with the fallout from politics that have gone septic, with selective donors and inadequate funding, and with armed factions seeking advantage at every turn: they must feed them, and they must wait.