Mercy Knows No Frontier

Doctors Without Borders Brings Aid to Developing, Warring
Regions

Since 1998, the medical aid group Doctors Without Borders has
released an annual list of the top 10 most underreported
humanitarian stories of the year. Based on field reports from more
than 70 countries, the list is calibrated according to the relative
severity of various crises balanced against the coverage they were
given by Western news organizations. In 2005, television networks
in the U.S. broadcasted a total of roughly 14,000 minutes of
evening news; together, the top 10 stories on the Doctors Without
Borders list received a combined eight minutes of news coverage. I
recently spoke with Nicolas de Torrenté, executive director of
Doctors Without Borders (also known as Médecins Sans Frontières, or
MSF) about the list and about MSF from his office in New York.

The Congo has appeared on your list for seven years
straight. What is the situation there, and why has it been on the
list for so long? The Congo does stand out. In terms of
the duration and the magnitude of the war, and in terms of its
effect on the civilian population, it is extremely serious by any
measure. It’s the direct violence against people, including sexual
violence, and then it’s the indirect violence — forced
displacement, people having to leave their homes, the destruction
of livelihoods, and so on. And then it’s the collapse of
infrastructure. Basically, the entire public infrastructure has,
after decades of war and misrule, completely collapsed. Right now
we have a situation in one part of the Congo called Katanga where
there’s been renewed fighting between government soldiers and
militia groups that were formerly allied with the government, in
opposition to the Rwandese forces that were invading the country.
Now they are fighting each other, and it’s led to huge
displacement — about 100,000 people in the last few months in
Katanga.

Considering the enormity of the issue, why don’t we hear
more about it? There are objective reasons. It’s been
going on for a long time, it’s complicated — you know, you can’t
generalize. [The Congo] is vast, logistically difficult, and quite
insecure. … So, there are objective reasons why it’s a hard story
to cover. But beyond that, I think there is a basic lack of effort
by the media to develop some understanding of the issue and to
transmit that to its audience, to unpack what’s happening there. I
think one of the main reasons for that is the assumption that
people just don’t care, that the American public doesn’t care about
what’s happening. It’s a vicious cycle: You assume there’s no
audience for this, you don’t invest the resources, there’s no
coverage, and what coverage it does get is very superficial and
doesn’t help people understand what is occurring, and, as a
consequence, people aren’t interested.

Chechnya is another perennial crisis — it’s been on the
list every year since 2000. This despite a ceasefire, and at least
the appearance of stabilization. Normalization is the
catchphrase that’s being used to describe what’s happening, but it
just doesn’t do justice to what’s actually happening. There has
been some movement of people back into Chechnya in the last couple
years, but the main reason for that is that they have been forcibly
removed from neighboring republics. Assistance was cut off for many
of the refugee camps by Russian authorities. Insecurity has spread
in the region, which means that it wasn’t any safer to be in
Ingushetia [a neighboring republic] than to be in Chechnya. So
there has been a movement of return, but it hasn’t meant that
things have drastically improved inside Chechnya. Clearly, the
level of services available for people who have returned is far
below what is needed, and people continue to be exposed to a great
deal of violence and continue to be deeply traumatized by the
situation.

What about southern Sudan? A peace treaty was recently
signed there, ending the 50 years of war between the Islamic
Sudanese government in central Sudan and the Christian and animist
rebels in the south. The common assumption is that when
there is a [peace agreement], at least on paper, conditions on the
ground have also improved. What we often see is that this political
progress does not lead directly to improvement from a humanitarian
perspective, which is certainly the case in southern Sudan. There
has been less fighting, but that doesn’t mean the fighting has
stopped entirely — fighting has continued in various regions in the
last year. And there has been a big return of people. But the
efforts of aid agencies and the efforts of the UN have not matched
at all the expectations of people. In fact, we had as many
emergency situations in southern Sudan in the last year as we have
had in previous years. Things have not improved — we have high
levels of malnutrition, high levels of people affected by
violence.

Most of these crises we’re talking about occur in war
zones. How do you reconcile MSF’s doctrine of neutrality with these
very highly charged political situations, in which one group of
people may be very clearly repressing another? For us,
being neutral means not taking sides in a conflict, not aligning
ourselves with one side or the other. That doesn’t mean we would
not call attention to atrocities as they affect one side or
another. That we will do. For us, that is compatible with
neutrality. Without taking sides in a conflict, you can still
denounce atrocities. For us, that is not breaching our mandate to
remain neutral, even though it may be perceived that way by the
parties involved.

The Hippocratic Oath requires doctors not to withhold
medical care from someone in need. By operating in war zones, does
that mean that MSF might end up aiding and abetting despotic
regimes, or soldiers committing war crimes? The key
distinction in humanitarian law — and as a consequence, in
humanitarian aid — is between people who are combatants
participating in fighting, and noncombatants. By far, the majority
of the people we treat are civilians. The most vulnerable groups in
war zones almost always are women and children and the elderly. But
of course we will treat wounded combatants. Now, does that aid and
abet despotic regimes, does that fuel wars? We have to be very
aware of the consequences of what we do, we have to monitor
ourselves very carefully. We try to limit all of the negative
effects of what we do. And they do exist. Anytime you are working
in a war zone, you are prone to being used or manipulated in some
way. … And in some extreme cases we decided that our aid was doing
more harm than good, and it was being used against the people we
were trying to help, and we pulled out.

For example? We pulled out of North Korea in
1998. In North Korea, we were not convinced that our nutritional
assistance was actually improving the lives of the children there,
because we were not allowed to work freely. So the question was
whether we were just aiding the North Korean regime. But overall,
when you provide aid in Darfur today, or in Congo today, aid is not
the reason people are being starved, displaced, and killed. The
motivation of the belligerents is not to capture aid. Aid is not
fueling war. I’m convinced of that.

One story on the Without Borders list not related to war
was AIDS in the developing world. In particular, we are
trying to attract attention to the issue of AIDS infections in
children, which thankfully is not a big problem in America and in
the industrialized countries. There were fewer than 60 children
born with HIV/AIDS in the U.S. last year. But in the developing
world it is a huge issue. We had 2.2 million children worldwide
born with AIDS last year, and hundreds of thousands who need to be
put on antiretroviral therapy. … Right now, we lack the means for
diagnosing children who are less than 18 months of age, in the
field. There are complicated lab tests that would be available in
the U.S., but in the field we don’t have such sophisticated
equipment. Half the kids born with HIV [in developing regions] die
before the age of two. So, if you can’t detect whether they are HIV
positive before 18 months — you are missing so many. That’s just
unacceptable. When you see the devastation caused by AIDS in
kids — AIDS is unacceptable, in general, but with kids it is so
much more so.