Doctors without Borders/Medˇcins Sans Fronti¸res (MSF) is the world's largest independent international medical relief agency aiding victims of armed conflict, epidemics, and natural and man-made disasters, and others who lack health care due to social marginalization.

Photo/G. Turine/MSF

With offices in 18 countries, MSF sends more than 2,000 volunteers of more than 45 nationalities to some 80 countries annually. When medical assistance is not enough to save lives, it will speak out against human rights abuses and violations of international law which its teams witness in the course of providing medical relief. In October 1999, the organization was awarded the Nobel Peace Prize, honouring its extraordinary work. Ann Marie Erb-Leoncavallo of the UN Chronicle spoke with Dr. James Orbinski, the International Council President of MSF, about the right to humanitarian assistance, the protection of humanitarian workers and how the United Nations and MSF can better cooperate to save lives.

The right of human dignity is how I would prefer to state it. I think MSF's unique contribution has been its adherence to a civilian-based, independent humanitarian action-a humanitarian action that is free from political, economic or religious influence and that acts, if necessary, outside of normal institutional structures and normal systems of law. The fact that we were willing in 1971 to do that, and that we have continued our commitment to the dignity of people and their right to humanitarian assistance, I think that is our unique contribution to the world of humanitarianism in the last 20 to 30 years. Now, as to whether or not people in crisis have more access or less access to humanitarian assistance, or more protection or less protection, in reality, I think, the debate is not settled. There is no question that in terms of the general understanding of international humanitarian law and the general presence of discourse, at least at the level of international relations, the discourse is very much alive and well, and far more so than it was 30 years ago. At the field level, I think there is a danger that we could be moving in a direction where we have what I would call "virtual humanitarianism", whereby there are well-known laws, well-known charters, well-known systems of coordination and so on, but that these are possibly increasingly divorced from the reality of what is happening in the field. I'm not saying that this is what is happening; I'm saying that this is really something for me to reflect on at this point. We are trying to understand what is happening now in the field; it is not clear.

Are you referring to the attacks on humanitarian workers, that this is one of the symptoms of "virtual humanitarianism"?

Yes, but also, more importantly, the questionable ability of humanitarian actors to freely and independently access all populations in danger. I'm just thinking, for example, of Congo-Brazzaville. There are vast tracts of the country where there is virtually no humanitarian access. I'm thinking too of Chechnya, also of certain regions in Africa, primarily some areas of Sudan. International humanitarian laws and principles are well known, but is it actually possible to act on those principles in all circumstances? That is the question.

What are the reasons for this lack of access?

It is clear that all forms of humanitarian need emerge because of a political failure of one kind or another. The willingness of political powers to recognize the right to humanitarian assistance and the obligation to respect human dignity is very much tied up with that political failure.

The United Nations and its Secretary-General have political as well as humanitarian roles to fill. What do you think the Secretary-General's role should be in humanitarian crises?

Well, there is no question that the Secretary-General's role is primarily political. In that sense, I would argue that part of the role of the United Nations in general, and particularly of the Secretary-General, is to ensure that humanitarian action is viable, is possible, is put before politics and that it is unconditional. That is always, particularly for a UN agency or a UN actor, including the Secretary-General, a difficult set of goals. And they are often seen as mutually exclusive, but I would argue that "humanitarian space", as we call it, must become a priori before any form of politic; it must be a given.

MSF has worked in various locations with UN peacekeeping operations. What has been learned from these experiences?

Probably one of the most important lessons is that when you mix military with humanitarian actions, there is a very real danger that independent humanitarian action can be misconstrued or perceived to be tied with the political process that underlies a military action-and that is a major risk. It is a risk that we are unwilling to take. Because of that, we make every effort to ensure we remain independent of military actors and our humanitarian action is not necessarily coloured with the same lens that military action is coloured with or perceived through.

Humanitarian coordination is extremely important for the success of operations. In your opinion, is there anything the United Nations can do to facilitate cooperation with organizations such as yours?

First of all, I think it's important to be realistic about what is possible. It's always easy to seek a perfect rational answer or solution to a problem or situation. But some problems are so complex that they belie easy answers or solutions. And sometimes the only thing that can be achieved in such circumstances is an illumination of the complexity of the problem. I think, at this point in time, and obviously there are exceptions, that the question of achieving some kind of universally accepted and effective coordination system is very much up in the air. I would say that from an MSF perspective, there is no question that we as an NGO (non-governmental organization) collaborate with UN agencies. We attend UN meetings, both to be informed and to inform, in New York, Geneva and in the field. There is also no question that on a technical level, we have very, very intricate relationships with UN agencies in terms of health procedures, health strategies in emergency situations, etc. So there is a great degree of collaboration between MSF and UN agencies, and also with other NGOs. But the major problem is the very wide diversity of actors that exist at this time-the wide diversity of UN actors and other NGOs; and the question of coordination is usually oriented towards avoiding duplication and ensuring appropriate security and a consistent overall approach to a particular crisis. We certainly have no difficulty in collaborating to reduce the probability of duplication and increase the consistency of overall action, but not in a way that hampers the independence and impartiality of our organization. This is very much a condition for our action in any kind of crisis. We are happy to coordinate with UN agencies; there is no question about that. But I think we really have to look carefully at the question, "are we prepared to be coordinated by UN agencies?" The answer to that, at this point in time, is no.

Please use this version of the article for printing.

Next Page of this article