“Despite grand debates on world order, the act of humanitarianism comes down to one thing: individual human beings reaching out to their counterparts who find themselves in the most difficult circumstances. One bandage at a time, one suture at a time, one vaccination at a time.”
Dr. James Orbinski, President of the International Commitee, MSF.

By Malena Sánchez Moccero
Translation: Guy Simpson
Fotos: Gentileza Verónica Nicola

A coup d’état, totalitarianism, Islamic guerrillas, Soviet intervention, and, as if that weren’t enough, a Taliban regime and air strikes by United States warplanes. A entire series of ill-fated events that have marked the lives of today’s adult and elderly Afghan population. It was hard to withstand and many chose to seek refuge in neighbouring countries. Which is how Argentinian pediatrician Verónica Nicola met Afghan women in Iran. The final tragedy they had to live through in their home country was flight. Nicola repeated to MYRIADES1 the story she heard so often from the lips of her Afghan patients: “One night the Talibans arrived and set fire to the whole village. They had to escape with their children, leaving everything behind. They went and hid in the mountains. Their husbands stayed to defend the little that remained.”
This took place during her first assignment with the human-aid organization Medecins Sans Frontières, also known as “Doctors Without Borders”. Nicola was 25 when she travelled to Mashrad, Iran, in 1999, to help with the refugees from Afghanistan. At that time, Afghans formed the largest group of refugees in the world: more than two million between Iran and Pakistan; they arrived destitute and the city hospitals refused to treat them because they had nothing to pay with. MSF gave them treatment and medication and contracted Iranian doctors to help them. “We also took mobile clinics once a week to mosques made available to us by Afghanis who had come to Iran during the seventies,” Nicola recounted. As the only female doctor, the women were drawn to her. Some were in physical pain, but the real suffering was in what they had to tell her. “What they wanted was to talk to someone and tell them what they had been through.”

Getting there
To get to places like the refugee camp in Iran is what Medecins Sans Frontières is all about. “MSF teams travel to places that many people have never heard of, to assist those who have fallen victim to natural or man-made disasters,” their website states. In accomplishing their aim, they follow four principles of humanitarian aid: humanity, independence, neutrality and impartiality.
The organization’s independence is made possible by private funding from its 2½ million members and supporters all over the world.
Neutrality can prove more of a challenge at times. At least this is the opinion of Daniel Rubens, who has worked for MSF in the Middle East and Africa: “When there are two groups grossly differentiated by the use and abuse of power, it is difficult to maintain neutrality. But it is this principle that permits you to do your job, which is to take care of the victims.” In any case, neutrality doesn’t prevent MSF from publicizing violations of human rights. “It is a vital part of what we do to bear witness to what we see. Our presence and the direct contact with the people makes us potential witnesses of transgressions of their most basic rights. When the violations are serious, we report them to the international community,” declared MSF-Spain nurse and delegate Laura Calonge to MYRIADES 1. But her medical organizational work can be compromised by these denouncements and have repercussions for the very people they are trying to help. “It means risks for the staff in the field and for the people receiving treatment, because the government can throw us out; so these things have to be given due consideration.” MSF’s strategy is to pass the information on to other organizations which focus specifically on human rights. “We always work closely with organizations like Amnesty, Human Rights Now, the United Nations and the Red Cross. In the humanitarian area there’s a lot of networking going on,” said Verónica Nicola. “I think the idea is to avoid overlapping in what we do, and to try to work together for social justice and avert human rights violations, protect children’s rights and conventions.”
When big business or government activities harm the local population, MSF attempts to stop them by coming together with other organizations to make a joint appeal. Recently MSF joined with Oxfam and other NGOs such as The Global fund, as well as political and religious leaders - some 400,000 people all in all --  to ask Swiss pharmaceutical giant Novartis to withdraw its claim against Indian patent law, which allows known drugs with minor improvements to be sold cheaply without patent. Novartis went ahead with the case, but MSF had reason to celebrate last week after the court denied the claim in order to continue to “provide easy access to citizens to life-saving drugs.”
Not all relations between the worldwide networks are so harmonious, however. MSF has constantly maintained a critical view of certain of the UN’s activities, and of other institutions which defend “military humanitarian operations”, like NATO. Dr James Orbinski, receiving the Nobel Prize on behalf of MSF, said in his acceptance speech:  “Humanitarian action exists only to preserve life, not to eliminate it (...) this is why we refused any funding from NATO member states for our work in Kosovo. And this is why we were critical then and are critical now of the humanitarian discourse of NATO.”
As for the UN’s interventions, Orbinski cited the genocide in Srebrenice, Bosnia Herzegovina, in 1995: “Srebrenica was apparently a safe haven in which we were present. The UN was also present. It said it would protect. It had Blue Helmets on the ground. And the UN stood silent and present - as the people of Srebrenica were massacred. (...) If UN military operations are to protect civilian populations in the future, going beyond the mea culpa excuses of the Secretary General over Srebrenica and Rwanda, there must be a reform of peacekeeping operations in the UN.”

Strategy and security
With a presence in more than 75 countries, 500 projects currently in operation and 18 office in the five continents, MSF has 36 years of experience behind it and has been awarded Prince of Asturias prize for its lifetime’s work and, in 1999, the Nobel Peace Prize. By maintaining – in the words of the Nobel Committee – “a high degree of independence, the organization has succeeded in living up to [its] ideals.”
In addition to medical assistance at conflict points. MSF sets up dispensaries and hospitals, carries out campaigns for vaccination and the prevention of infectious diseases, as well as water and waste treatment and the training of local personnel. It also publishes daily communiqués with reports, articles and interviews to tell the world about forgotten peoples.
Projects tend to be presented to the respective national authorities so that MSF can count on official collaboration and safe conduct. Where governmental structures are absent, the missions are set up without them in order to give urgent medical aid. “In cases where armed groups threaten our safety, we seek guarantees from these groups to permit us to work unmolested with patients,” explains Laura Calonge.
The establishment of secure conditions relies significantly on their ability to transmit the concept of humanitarian aid to the different players on the conflict scene. Colange highlights how important it is, “that they see that we are not taking any part in the conflict; that they are confident that our only interest in being there is to assist people in need. This is, in the end, the essence of humanitarian action: its capacity to negotiate safe, direct access so that one can reach those who need help and protection, create a ’humanitarian zone’. And it is this that has been undermined during the last fifteen years, particularly as a consequence of the abuse of the concept humanitarian.”
The World Health Organization (WHO) has compiled data that show that between 1985 and 1998 three hundred and seventy-five aid workers died, with a progessive increase in the number of intentional violent deaths. In a recent report, the UN confirmed that the number of attacks on humanitarian aid workers in Darfur doubled in 2006.
The medical workers we spoke to recognize that risks exist, and try to minimize them. Before going on a mission, they receive a security manual about the county in which they will be working. “It’s written by people who were there, who know how security works there and and also its weak points,” says Nicola.
Rubens has witnessed no attacks on the organization’s staff on any of the missions he has taken part in. Nicola has very different memories. In 2004 she was in central Afghanistan, returning to base after working in a health centre, when news reached them that five MSF workers had been killed in the north-east of the country. “I was the field coordinator and tried to calm my team down. It was stressful because we didn’t know if it was an attack on MSF and they intended to kill more of us,” she related. The head of the mission in Kabul decided to evacuate the staff to the capital by helicopter. After a series of internal meetings, which were unable to clarify the incident satisfactorily, the organization resolved to withdraw from the country as a protest. Before it left, MSF transferred its activities to local NGOs so that they could continue their work.
Medecins Sans Frontières has five operational offices in Spain, Holland, Belgium, Swizterland and France. And all of them had staff in Aghanistan, working on different projects. “We always try to leave some kind of infrastructure in place and working, so that we we aren’t abandoning completely the people we have been helping,” Calonge said.

Group work
One imagines doctors arriving en masse in war zones. But they tend to be few in number. “On my first mission, there were two of us: one nurse and me,” recalls Nicola. The teams are usually put together in conjunction with local groups. “The idea is to work with all the available local resources, but someone from outside will be there to maintain objectivity in the mission; someone who can have an overview of the situation without being emotionally or politically involved,” Nicola explains. Team work is an essential feature of the organization, as Rubens emphasizes: “Anyone who can’t work in a team, can’t work in MSF. You have to be able to fit in; and coordinators need to know how to lead the team through situations that can be difficult.”
The most sought-after staff after general practitioners are obstetricians, since one of the most serious problems in many countries is deaths in childbirth. Yet certain missions require other types of specialists. The Palestinian Territories provide an example. “There are a lot of organizations working there,” Nicola explained. “Since it attracts a lot of political attention, it is easier to get grants. European countries are more willing to give money for work done in Palestine than in Ethiopia, where nobody has any idea of what’s going on.” It was for this reason that MSF focussed on an area that was being neglected: mental health. “We were in Hebron with two psychologists and we worked with a group of children who had been traumatised by the chronic violence that they were living through,” the pediatrician told MYRIADES 1 .
Team members have explicit roles to optimise the organization’s efficiency, which needs all its various parts to work effectively. “The doctor takes care of medical treatment and its supervision; the nurse, of managerial and nursing needs; the logistical administrator and field coordinator are there also to direct, organize and arrange all the elements of the project on the ground, taking charge of human resources and security,” Nicola explained.

Curing the worst sickness: neglect
Medecins Sans Frontières aims to reverse the world’s abandonment of  certain regions and diseases, which have dropped out of media coverage, by going back to them and publicising their plight. As an organization it concentrates above all on helping the victims of “forgotten” conflicts, or “forgotten” diseases. “There are a lot of conflicts which are extremely serious which the general public hardly knows about, because the media aren’t covering them. Amongst them are the conflict in Chechenia, which has been going on for twelves years, conflicts in Sri Lanka, the Congo Democratic Republic, Somalia, Haiti,” Calonge enumerates. And she adds: “There are many diseases, also, which cost millions of lives every year, but which are ignored by rich countries and laboratories which could be researching and developing new and more effective drugs to combat them; everyone has forgotten about them.” Examples cited by MSF include tuberculosis, sleeping sickness (African trypanosomiasis) in Africa  and Chagas Disease in Latin America.
In spite of the fact that they affect millions of human lives, most of the armed conflicts around the globe go unreported. This is the opinion of MSF Spain’s Director General, Aitor Zabalgogeazkoa. As an example, he points out: “Haiti is only fifty miles from the United States and the media devote half a minute every year to covering the situation of a population subjected to unremitting violence in Port-au-Prince.” Zabalgogeazkoa added,  reflecting on  the importance of media coverage as a means of increasing aid and and political awareness: “Perhaps there is nothing worse than to be utterly abandoned and forgotten about.”
Rubens complained that incomplete reporting leads to distorted representations of the real situation: “Angola, for instance, was the country with the highest economic growth in 2005, thanks to the diamond and oil industries, but you have to be there to realize how far removed the local population are from that growth. They are dying of hunger.” Rubens talks with the authority of someone who saw oil trucks taking up all the road along which MSF was trying to transport its patients during a cholera epidemic.
Further south, in the heart of Africa, Nicola was witness to another tragedy. In the vast territory of the Congo Democratic Republic, the war had ended and MSF was taking care of displaced people and refugees who were returning to what was left of their old homes. The mission centred on treating people for malaria and malnutrition. “It was the first time I saw children so badly malnourished that they died in your arms,” she said. The memory is one of impotence, “because you knew that if we had got to the children earlier, if we had had more resources, we could have done something to prevent it.”
Without the information or first-hand knowledge of what is going on, it is difficult to imagine the magnitude of some conflicts. Total silence usually precedes oblivion. And the frequent use of euphemisms perverts the truth. “The 1994 genocide in Rwanda. The 1997 massacres in Zaire. The 1999 actual attacks on civilians in Chechyna. These cannot be masked by terms like ‘Complex Humanitarian Emergency’, or ‘Internal Security Crisis’,” declared MSF’s James Orbinski in his Nobel address.
MSF has taken upon itself the mission of pressurizing the world’s government and business establishment in order to awaken in it a humanitarian conscience – a planetary conscience, paradoxically resulting from the same globalization which promised to bring people together only to push them further apart – and offers itself as a network, interconnected with others, in order to come to the aid of those who have been “disappeared” from the health system, by the media, by economic interests, by society. A network which, like many others, is working day to day to connect to the darkest corners of our global society, to hold out threads of hope.

For more on Medecins Sans Frontières: http://www.msf.org.ar/
Acceptance speech by Dr. James Orbinski, President of MSF International Committee on the award of the Nobel Peace Prize, 10 December 1999