THE NEW IMPERIALISTS
Medecins sans Frontieres is at the heart of the modern global establishment, says Kirsten Sellars WITH perfect symmetry, the Nobel Peace Prize ends the century as it began it, by honouring an international medical organi- sation. In 1901, the winner was Henri Dunant, founder of the International Com- mittee of the Red Cross. This year it is the turn of the Brussels-based agency Medecins sans Frontieres (Doctors without Borders). Plus ca change, one might think. Yet today's humanitarians work to a very different agenda from that of their forebears. The Red Cross stood above the political fray, respected the authority of states, and relied on quiet diplomacy to achieve its ends. In contrast, MSF prides itself on its aggressive interventionism and willingness to ruffle the feathers of governments.
MSF's origins lie in the Red Cross — the very organisation against which it rebelled. In 1968, a small group of French Red Cross doctors travelled to Biafra, the enclave bat- tling for secession from the British-backed Nigerian government. While working at the beleaguered Awo-Omama hospital, Dr Bernard Kouchner and his comrades became frustrated by the Red Cross's scrupulous neutrality and deference to offi- cialdom. 'By keeping silent,' Kouchner argued, 'we doctors were accomplices in the systematic massacre of a population.' Between 40-hour shifts, they hatched a plan for a new medical organisation committed to dispensing aid without having to rely on the approval of governments. Sans fron- tierisme was born. When Kouchner returned to Paris, he founded the Interna- tional Committee against Genocide in Biafra: precursor of today's MSF.
Biafra was the crucible of the modern humanitarian movement. The apparent righteousness of the secessionist cause emboldened the aid agencies to abandon their traditional apolitical stance and open- ly back the Ibos. Their sensationalised accounts of the suffering of Biafra provided the blueprint for future aid missions. They invoked the Holocaust with predictions of 'Final Solutions' and 'genocides' — a vocabulary that has since become familiar in campaigns from Cambodia to Bosnia. And they speculated wildly about death- tolls. Oxfam got the ball rolling by claiming that 'two million may die'; an overestima- tion to the power of three. During later emergencies, such as Ethiopia and Zaire, the phrase 'one million dead by Christmas' became a seasonal fund-raising slogan.
It was against this crusading background that Medecins sans Frontieres was set up in 1971, under the leadership of the former Marxist, Bernard Kouchner, and the Catholic conservative, Max Recamier. In the following years, MSF doctors assisted victims of the 1972 Nicaraguan earthquake and the 1974 hurricane in Honduras. As another leading light, Bony Brauman, admits, these early shoestring operations were 'highly ineffective' and the doctors 'Look, the agency sometimes thinks that mixed marriages can cause slight problems with adopted children, Mr & Mrs Prxrszk-Prxxszk.' were derided as 'medical hippies'. MSF also acquired a reputation for outspokenness: Kouchner subscribed to 'the law of hype' and argued that one must 'popularise mis- fortunes and make use of feelings of remorse'. These tactics upset rivals, but they had the desired effect. The money rolled in, especially after the Ethiopian famine, and MSF joined the aid agency big boys.
The Eighties were a boom time for the non-governmental organisations (NGOs). Conservative governments and internation- al donors wanted to promote private-sector solutions to poverty abroad. As a result, funds channelled through the NGOs rose sharply. Also, in political terms, aid agen- cies could get to the parts that governments could not reach. They acted as intermedi- aries between donor and recipient, bypass- ing Third World governments, and they were a handy foot in the door in places where official donors were unwelcome. On top of this, they were 'sexy', especially after BandAid dragged charity out of the duffle- coated Dark Ages. The NGOs' confidence grew with their enhanced status. MSF, like others, began to throw its weight around, occasionally in places with no shortage of doctorss. This rebounded on them in 1989 when they were forced to abort a mission to China to care for the victims of the Tiananmen Square massacre.
MSF has been a barometer for changing times and its evolution also mirrors the political trajectory of the French Left. Many early MSF members were former radicals, veterans of the Fifties' and Sixties' anti-colo- nial movement. Kouchner, for example, cut his teeth on the Algerian crisis, and trav- elled to Cuba to meet Castro in 1964. How- ever, their enthusiasm for African socialism and the Chinese Cultural Revolution waned during the Seventies, and disillusion with Third World governments eventually turned into contempt. This ideological shift is illus- trated by a clash between MSF and another agency in 1983. Freres des Hommes had secured a television slot in which it attacked corporations for exploiting the Third World and exhorted viewers to eat less in order to assuage world hunger. MSF publicly denounced its approach as simplistic, argu- ing that local elites were as culpable as the industrialised countries for the plight of the Third World. As one pundit observed, the Left's 'complacently ignorant Third World- ism has given way to a convinced Western- ism'.
By the Nineties, the MSF's intervention- ist perspective had penetrated the core of mainstream foreign policy. Bernard Kouch- ner had left the agency in 1979, but his doc- trine of devoir d'ingerence (duty to intervene) became the template for the 1988 UN resolution giving NGOs uninhib- ited access to 'natural disasters and similar emergency situations'. The floodgates were opened. Heeding the impulse to take up the latter-day 'White Man's Burden', bat- talions of NGOs marched into Mogadishu, Sarajevo and Goma armed with Landcruis- ers, satellite phones and the latest liberal- imperialist orthodoxies. Local govern- ments retreated in their path, and soon many areas in these countries became de facto zones of occupation under the con- trol of the humanitarian armies.
The medical agencies spearheaded this new colonialism. Third World govern- ments find it difficult to resist the promise of medical aid but, in time, their ministers of health find themselves answering to NGOS accountable only to Western donors. In East Africa, for example, healthcare has been overrun by aid agen- cies. As Alex de Waal of African Rights notes: 'The entire basic drug supply for clinics in the capital of Sudan, primary healthcare in Uganda and almost all TB and leprosy programmes in Tanzania are largely directed by international NGOs using funds from Euro-American institu- tional donors.' With other agencies taking responsibility for transport, water supply, immigration and even aspects of foreign policy, it is small wonder that African states are collapsing.
Although MSF encourages its popular image as the scourge of governments and bureaucracies, it is at the heart of the new global establishment. Even its seemingly bold criticisms — that the UN doesn't intervene enough; that Western govern- ments don't intervene correctly — actually serve to strengthen the interventionist sta- tus quo. The career of Bernard Kouchner demonstrates the logic of the `duty to intervene'. The former anti-colonialist is now the UN's chief administrator in Koso- vo, where he presides over the internation- al community's latest trusteeship like a traditional governor-general. (Old hakits die hard, and he has already got himself in hot water for exaggerating up the number of corpses lying in Kosovo's mass graves.) Where once MSF sought the spotlight, today the spotlight follows them. The actors Isabelle Adjani and Jeremy Irons may star in a film about the agency. A poll claims that 80 per cent of French girls want to marry an MSF doctor. Thirty years ago, their parents would have thrown up their hands in horror. Today, they wel- come the 'medical hippies' with open arms.
Kirsten Sellars is a journalist. She is writing a critical history of human rights.
`Who wants to be at the heart of Europe and who wants to be at its throat?'
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