The roots of Médecins Sans Frontières / Doctors Without Borders extend back to the passionate debates of left-wing French intellectuals after World War II, and to the moral anguish and indignation of young physicians from that milieu serving with the International Red Cross during the Nigerian civil war of the late 1960s.
Following the liberation of France in 1944 from its occupation by Nazi Germany, “for a period of about twelve years … the issue of communism—its practice, its meaning, its claims upon the future—dominated political and philosophical conversation” among the French intelligentsia, the historian Tony Judt writes:
The terms of public discussion were shaped by the position one adopted on the behavior of foreign and domestic Communists, and most of the problems of contemporary France were analyzed in terms of a political or ethical position taken with half an eye towards that of Communists and their ideology …. The Vichy interlude had served to delegitimize the intellectuals of the Right …, while the experience of war and resistance had radicalized the language, if not the practices, of the Left.1
“The prestige of the Soviet Union and the French Communist Party was enormous among the French intelligentsia, who were attracted both by the rationalist element in Marxism—the vision of progress and the explanation of history—and by its appeal to faith—the triumph of the oppressed,” the polymath social scientist Stanley Hoffmann has commented.2
In the mid-1950s, two sets of events precipitated a shift away from this engagement with European Communism and radicalism. On the one hand, there was the death of Joseph Stalin and the disillusioning impact of Nikita Khrushchev’s “Secret Speech” denouncing Stalin and the failings and crimes of Stalinism at the Twentieth Congress of the Communist Party of the Soviet Union in 1956. On the other, there was the accelerating wave of anticolonial movements and decolonization engulfing Africa,3 Asia, and Latin America, which brought in their wake a new preoccupation with the so-called Third World.
In the late 1960s, a post-Stalinist “New Left” movement led by middle-class student youth emerged on the French intellectual scene. Its conception of alienation, liberation, and revolution extended to the Third World, whose political leaders it heroized as true revolutionaries. The movement reached its climax in the May 1968 student uprisings in French universities and the accompanying nationwide general strike of French workers.
The thirteen young Frenchmen (physicians and several medical journalists)4 who founded Médecins Sans Frontières (MSF) on December 22, 1971, were “inheritors” of this history, as Xavier Emmanuelli, one of its “founding fathers,” eloquently testified:
[W]e were descendants of the ranks of the idealistic Left. Students in medicine, sons of medical families, medicine for us was already idealized; but above all, we had as reference the great antifascist struggles, the heroes of the Resistance, and we grew up in the wake and the mythology of the world war. We had masters, struggles, landmarks.
[Moreover,] the French have always considered an adventure in Africa as educational, and … still have a secret emotional esteem for the continent. We had a colonial past.5
At the beginning of the 1960s, I was young, and I wanted a destiny.
I was filled with the epic of this century. I ardently wanted to become a son of the adventure, a navigator of the tragic, and to face the blaze of revolution. But I was only a medical student.… It seemed to me essential to belong to the race of rebels, of those who had struggled to change the world, and it was completely natural that when my classmates approached me, I joined the Communist Party.6
A key element in MSF’s historically grounded myth of origin portrays its original members as a small group of young “French doctors,” working as volunteers for the French branch of the International Committee of the Red Cross during the Nigerian civil war of 1967–1970, in the seceded southern province of Biafra, whose inhabitants were primarily of Igbo tribal origins. These physicians blamed the famine-stricken plight of the Igbos that they had seen firsthand on the “genocidal” intentions of the Nigerian government in blocking the distribution of food to them.7 They wanted to denounce the government publicly, but they were constrained from doing so by the contract they had signed, which pledged them to observe a policy of “discretion.” The International Committee of the Red Cross (ICRC) explained it this way:
The efficacy of humanitarian action depends largely on the direct and long-term access to victims. In pursuing that objective, the ICRC long ago embraced discretion as a working method. This simply means that it maintains a reserved attitude when it comes to communicating with third parties the observations and findings of its delegates in the course of its activities. It is an approach that allows the authorities concerned to accept on their territory the activities of an institution which they know will not divulge information that could be exploited by their adversaries. It also helps to build up a relationship of trust with the victims in much the same way that medical secrecy does between doctor and patient.… The purpose of maintaining discretion with regard to the parties to a conflict is not only to gain access to victims but also to ensure continuing access.8
The “French doctors” were morally outraged by this mandatory silence. Out of this experience, when they returned to France, they founded MSF on twin pillars: “acting and speaking” and “treating and witnessing.”
The document they drafted in which they formally stated MSF’s core principles became its “Charter” (always written with a capital C). The Charter pledged all the members of MSF to “provide assistance to populations in distress, to victims of natural or man-made disasters, and to victims of armed conflict … irrespective of race, religion, creed, or political convictions”; to observe “neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance”; to “maintain complete independence from all political, economic or religious powers”; and, “as volunteers,” to “understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them.”
However, the principle of témoignage, or witnessing, remained implicit in MSF’s ethos until 1995, when the so-called Chantilly Document was drafted, based on agreements reached at an international meeting of MSF held in Chantilly, France. While affirming that the “actions of MSF are first and foremost medical,” this document states that “témoignage/witnessing [is] an integral complement” to them. “It is expressed through … the presence of volunteers with people in danger as they provide medical care, which implies being near and listening; a duty to raise public awareness about these people; [and] the possibility to openly criticize or denounce breaches of international conventions.” The latter, the Chantilly document comments, is “a last resort used when MSF volunteers witness mass violations of human rights, including forced displacement of populations, refoulement or forced return of refugees, genocide, crimes against humanity and war crimes.” The Chantilly document concedes that “[i]n exceptional cases,” “it may be in the best interests of the victims for MSF volunteers to provide assistance without speaking out publicly or to denounce without providing assistance.”9 This concession grew out of MSF members’ experiences in the field, which confronted them with the fact that however virtuous speaking out might be, it can have unwanted harmful consequences for the provision of medical humanitarian care, for the persons whom that care is intended to assist, and for those delivering the care.
The first of two crises in MSF’s early history arose eight years after it was launched, in 1979, when it became entangled, through Bernard Kouchner, its most conspicuous founding member and first president, in a controversy created by the appeal for “Un bateau pour le Vietnam” (A Boat for Vietnam) made by a group of renowned French intellectuals.10 This project involved chartering a vessel to rescue the so-called boat people—Vietnamese refugees fleeing their embattled country by ship, who were drowning and dying by the thousands in the South China Sea.11
Most members of MSF opposed this venture. Its second president, Claude Malhuret, Kouchner’s successor,12 had tasked Rony Brauman—an early member of the second generation of MSF physicians—to investigate its feasibility, and Brauman had deemed it technically impracticable. Brauman’s advice was important to Malhuret for several reasons. Between 1975 and 1978, as a physician in the merchant marine, Brauman had been ship’s doctor on a vessel laying underwater cables along the west coast of Africa. He had remained in touch with some of the officers with whom he had served, and he solicited their opinion about the Vietnamese boat project. In 1979, moreover, MSF had recruited Brauman as its first permanent physician member, in which capacity he had acquired firsthand knowledge of refugee populations through numerous field missions in refugee camps served by MSF.13
In a scathing article, Xavier Emmanuelli, who had become MSF’s vice president, attacked Kouchner’s “grandstanding” and the “illusory” nature of the venture.14 Nevertheless, Kouchner and his intellectual companions proceeded to charter a ship called L’Île de Lumière (Island of Light). Along with a few other physicians, accompanied by journalists and photographers, Kouchner sailed to the China Sea, where his group provided medical aid to the boat people. The journey received highly theatrical media attention.
Emmanuelli’s article helped precipitate a deeper crisis unfolding inside MSF. Concretely, his conflict with Kouchner turned around one of MSF’s foundational principles—témoignage: its commitment to bear witness to, and to speak out about, the predicament of the individuals and populations to whom MSF provides in-the-field assistance, and where it observes serious abuses, or violations of human rights occurring, to publicly condemn them.
Emmanuelli was no less committed to the principle of witnessing than Kouchner; but what he reacted against passionately was the media “spectacle” made of the plight of the Vietnamese “boat people,” of their exodus, and especially of Kouchner’s “staging” of the Île de Lumière rescue mission. In Emmanuelli’s view, the whole episode had been “mediaterized” to a degree that distorted the essence of medically and technically competent humanitarian action.
A schism developed within MSF over the boat people. Kouchner and his compagnons (companions), who included most of the founders of MSF—“the elders of Biafra”—espoused politically symbolic action like the rescue of the boat people. Opposing this and supporting Malhuret were the second generation of MSF members—many of whom had worked in refugee camps in Cambodia and Thailand. In contrast to Kouchner, Malhuret focused on practical field action: on the development of a more structured, better administered, more medically competent approach to the emergency and longer-term care that MSF was providing in refugee camps. At the 1979 meeting of MSF’s General Assembly, Kouchner’s faction was in the minority. In a “solemn speech,” Kouchner denounced the “takeover” of MSF by “bureaucrats” and “schemers,” predicted that it would destroy MSF, and “left the room,” taking with him “the quasi-totality” of MSF’s founders, Rony Brauman recalls.15 Led by Kouchner, this departing group founded another medical humanitarian organization: Médecins du Monde / Doctors of the World.16
Five years later a second schism shook MSF, pitting MSF France against MSF Belgium. MSF France demanded that the Belgian section of MSF be forbidden to use the name Médecins Sans Frontières and its logo. MSF France alleged that MSF Belgium had “progressively distanced” itself from MSF France, and from its “allegiance” to its association mère (mother association) by its “refusal to subscribe to the connection created between MSF France and a foundation named ‘Liberté Sans Frontières.’ ” On July 10, 1985, the case of Médecins Sans Frontières France versus Médecins Sans Frontières Belgium was heard by the Tribunal de Première Instance de Bruxelles (the court of the federal district of Brussels, where the initial trial of a legal action in that district is brought).
The Liberté Sans Frontières Foundation (LSF) had been created by MSF France and approved by its General Assembly in 1984. Its co-originators were two prominent members of MSF France: Rony Brauman and Claude Malhuret. Brauman was named the foundation’s director, and Malhuret was elected its president. The board of directors was composed chiefly of members of the editorial committee of the conservatively oriented magazine Commentaire.
In presenting their conception of Liberté Sans Frontières to the General Assembly, Brauman and Malhuret had described it, in a calculatedly “euphemistic way,” as a “group reflecting on questions of the rights of man and of development in the Third World, free of all ideological prejudice.”17 The documents that MSF France submitted to the court characterized Liberté Sans Frontières in an equally “euphemistic” manner, as “a center of research on the problems of Human Rights and development”:
The objective of the Liberté Sans Frontières Foundation is to … stimulate pragmatic research outside of the assumption that there is only one model possible and that it is necessary to follow it; to analyze the problems of development and Human Rights without making reference to the idea of the Tiers-monde [Third World], whose unity does not exist in fact; … to draw from this research its consequences for action; … [and to] ensure its diffusion among the principal relayers of opinion: the media, the political world, groups and associations.18
As Brauman later admitted, deliberate dissembling was involved in the relatively neutral, ideological fashion in which he and Malhuret depicted Liberté Sans Frontières. From the outset, they had conceived of it as “an organ of ideological combat that it was completely legitimate for MSF to establish, because of its action in the field. For us [this] objective was clear.”19 The combat was directed against the valorization of the Third World by much of the French Left.
Another document outlined the “themes” around which Liberté Sans Frontières had organized an inaugural colloquium on Le Trois-Mondisme en question [The Third-Worldism in Question], held on January 24–25, 1985, in the chamber of the French Senate in Paris. These themes included: “Neither Third-Worldism nor Cartesianism,” “The End of Revolutionary Myths,” “The French Colonial Heritage Beyond Legends,” “The Third-Worldism of Lenin in Our Time,” “How to Reduce Poverty: The Example of Rural Asia,” “The New Industrial Asia: History of a Takeoff,” “Aid for Development, For or Against?” and “The First Requirement: Political or Socioeconomic Rights?”20
MSF Belgium testified that it was not opting for a “rupture” with MSF France, but rather for a “momentary interruption of collaboration” until MSF France “distanced” itself from “being a part of the Liberté Sans Frontières Foundation (LSF).” The core problem, MSF Belgium argued, was that “the support and sponsorship of LSF [was] not compatible with MSF’s Charter and the ideological and political independence that is expressed in it.”21 “The difference” between MSF France and MSF Belgium “did not rest on a question of ‘allegiance,’ but much more fundamentally on the ethical foundation” of MSF, and on the “underlying philosophy as expressed in the common Charter.”22 A basic principle of MSF, the Belgian section affirmed, was its “apoliticism.” And in its anti-Third-Worldism, LSF had violated this.
The Belgian court ruled that MSF France’s demand was “unfounded” and that it could not prohibit MSF Belgium from using the name Médecins Sans Frontières and its logo. In her decree, the presiding judge stated that “the cornerstone of the litigation is the common Charter of the two parties; that the present litigation must be analyzed in the light of the text of this Charter; that this clear and precise text strongly emphasizes the principles to which the physicians have subscribed.” The court then had to determine whether MSF France and MSF Belgium were adhering to Article 2 of the Charter, requiring that Médecins Sans Frontières work “in the strictest neutrality and complete independence, refraining from any involvement in the internal affairs of states, governments, and parties in the territories [in which it is] called to serve.” Considering the goals pursued by the Liberté Sans Frontières Foundation that MSF France “has agreed to be part of … the judge can say that there is an apparent divergence between the philosophy and goals on the one hand of MSF, and on the other of LSF.”23 In linking itself with LSF, she implied, MSF France was failing to adhere to the principles of the Charter.
Before the trial, Kouchner and two other co-founders of MSF, Dr. Jacques Bérès and Dr. Max Récamier, drafted a public letter defending MSF Belgium. They accused MSF France of having engaged MSF in “ideological and political combat” with the creation of Liberté Sans Frontières:
That is why [they wrote] in the face of this breach of the ideal, the ethic that animated the founders of MSF, we support our friends of MSF Belgium in their quarrel with the Parisian “apparatchiks.” It seems normal to us to support them in the face of the moral and intellectual fraud [escroquerie] that the creation of LSF constitutes. It is MSF Belgium that is maintaining the … practice and ideal of … the Charter and its statutes. It is MSF France that is perverting them.24
In a newspaper article, Rony Brauman (who by this time had been president of MSF France for three years) was quoted as calling this “intrusion” of Kouchner in the internal MSF debate “comical.” He dismissed this “daughter organization turning against her mother” as a natural psychological phenomenon.
Seen in the sociological perspective of Max Weber, the internal convulsions rocking MSF at this historical juncture were characteristic of organizations that begin as movements under the charismatic inspiration and authority of founder-leaders. As these organizations grow and become more institutionalized, their “charismatic element does not necessarily disappear”; rather, it becomes embodied in a less personal, more rationalized structure and mode of operating. This transition is often accompanied by conflicts erupting around the succession of the movement’s leaders, and of the generations of members within it.25 MSF was undergoing just such a passage from its charismatic origins in the creation of Liberté Sans Frontières and the resulting litigation.
MSF was also making another crucial transition. From its inception in 1971 until 1980, it had consisted only of the French group, with its headquarters in Paris. But in 1980, MSF Belgium and MSF Switzerland were founded, followed in 1984 by MSF Holland. MSF Belgium played a proactive role in the creation of these other European sections. It drew up a provisional statute calling for MSF France and MSF Belgium to found an “internationalized” MSF Europe to function within a “common structure,” directed by a Comité de Direction Collégiale (Committee of Collegial Direction), made up of different member-sections. Within this framework, each section would have one vote and decisions would have to be unanimous and ratified by all the sections.26 However, with a few exceptions, the most influential members of MSF France were opposed to the concept of an MSF Europe. Thus, during the period when MSF France launched Liberté Sans Frontières (1984–1986), and of its subsequent lawsuit against MSF Belgium, it was grappling with what it perceived as a threat to its hegemony spearheaded by MSF Belgium. More fundamentally, MSF France was confronting the reality that it was no longer the sole, authoritative embodiment of MSF—of its principles, organization, and decision-making.
In addition, during these years, MSF France was affected by major ideological shifts. The trajectory of French intellectuals’ break with Marxism and Communism, their move “towards the non-European world [and] towards tiers-mondisme,”27 and the reaction of anti-tiers-mondisme had their parallels inside MSF. These shifts were dramatically played out in the “first public appearance” of Liberté Sans Frontières: the 1985 Le Trois-Mondisme en question colloquium. As organized by Brauman and Malhuret, this was designed to be “a frontal attack against tiers-mondisme,” in Brauman’s words. Filling the Senate chamber in Paris and participating vigorously in the discussion were “top tiers-mondistes,” as well as “anti-tiers-mondistes”; and newspapers representing the entire Left-to-Right political spectrum of the Paris press gave extensive coverage to the event.
Identifying the content of “tiers-mondisme,” the orientation of “tiers-mondistes,” and the outlook of “anti-tiers-mondistes” was not easy, French intellectuals having defined these concepts and categories so variously. As Claude Liauzu observed in the historical journal Vingtième Siècle:
Since the colloquium organized by Liberté Sans Frontières in January 1985, a debate as animated as it is confused has periodically recurred. The uninitiated have difficulty in situating its protagonists, in penetrating its meanings, and in defining its ends.…
… When [French] intellectuals speak of the Third World, they speak about and for themselves.…
[T]his debate is fundamental: its stakes concern both representations of the Third World in French opinion, and the ideological relationships between the Right and the Left.…
An initial definition of what is called tiersmondisme today consisted of taking into consideration that the West was no longer the measure of everything, that the Third World was both a new force and a constituent of what Europe was becoming.28
Brauman, the chief architect and spokesman of Liberté Sans Frontières, manifested the ideological vagueness of the Third World debate. He said he was simultaneously “a militant anticommunist” (who earlier had belonged to the “extreme Left”—the “Proletarian Left”), “a tiers-mondiste,” and an “anti-tiers-mondiste.”29 What could this mean? He explained: “On the one hand, I was totally centered on countries of the Third World, feeling truly ‘good’ in many African countries, etc.… and, on the other hand, I was ferociously anti-tiers-mondiste, because I found that all that was being recounted about the responsibilities of the North in the economic and social disasters of the South, proposed to us as the new economic order, as perspectives of organized emancipation, were at best derisory sentimentalism, and at worse, a complicity with the bloodiest regimes.”30 Third-Worldism, Brauman asserted, attributed the misfortunes of Third World countries entirely to their exploitation by powerful and prosperous “Northern” and “Western” societies—particularly former colonial powers; it ignored the “primordial” role that Soviet and Communist expansion was playing in the Third World. In “almost all refugee camps in the world,” MSF teams reported, “the overwhelming majority” of the displaced persons had “fled from Communist regimes.”31 Brauman strongly condemned Third-Worldism for failing to recognize that in numerous Third World locales, “liberation” movements, often “brandishing … Marxist-Leninist emblems,” had established “totalitarian regimes” that were despoiling these countries of their wealth and resources and committing acts of brutality that violated human rights.32 To Brauman, Third-Worldism was “a tropical version” of the most repressive forms of Communism.33
The overall tone of the colloquium was accusatory, even combative. Some of the presentations suggested that as used by “tiers-mondistes,” the “tiers-monde” concept was a vague, inconsistent, and indefinable “scrap bag.” What was more, it was contended that the “Third World” was not a “real-world” entity. It projected a false unity on a wide range of politically, economically, culturally, and ideologically different countries in Africa, Asia, and Latin America, simplifying their complexity and mutual interests, and imputing to them an equally false solidarity. Anti-tiers-mondiste presenters rejected the attribution of the problems of Third World countries, especially those of poverty, to their exploitation by capitalist, imperialist, colonialist, and neocolonialist powers. They claimed that the “disastrous strategies of local governments … produced the disasters of the Third World, … not the world economic system”; that the “ravages of authoritarian [economic] planning were greater than those of capitalism”; and that liberal, industrial, free enterprise–oriented, democratic societies were the “most efficacious in preventing [economic and political] catastrophe. Third-Worldism was impugned for “almost exclusively” explaining “disparities” in the development of different societies in economic terms, and for slighting political, historical, and anthropological factors.34
The colloquium also denounced the “dolorous” and “paternalistic” portrayal of the members of Third World societies as “victims”—in the vivid words of Rony Brauman, as an “infantilized, irresponsible mass, estranged from its history, bent under the weight of the oppression of rich countries.” There were elements of “simplifying leftist patterns in this binary conception of a world divided between victims and oppressors,” he declared, “expressed in a penitential rather than an insurrectionary version, but mistaken nonetheless.” “The persons I saw in hospitals, in refugee camps where I worked were victims of a precise, given situation, of an illness, an aggression, a war that had uprooted them,” he recalled. “One can be a victim of something, of a theft, an epidemic, a persecution, but one is not victim [Brauman’s emphasis] by status, as if that state had become an identity.”35
The colloquium vehemently upheld human rights as set forth in the Declaration of the Rights of Man and of the Citizen passed by the French National Assembly in 1789, which include the right to liberty, to property, and security; the right to resist oppression; and the right to freedom of thought and expression. The colloquium viewed these “precise and limited” rights, “based on the equality in the law for all individuals,” as “categorical imperatives” that pertain to “human nature,” and that are universally applicable to, and valid for, all times and places. The claim was made at the colloquium that largely through the influence of Marxism, other concrete economic and social rights had been added to the original Rights of Man and of the Citizen—such as the rights to work, health, material security, housing, development, and education. Although the anti-tiers-monde participants in the colloquium did not dismiss these additional rights, they made it clear that they regarded them as less fundamental, universal, and timelessly important than human rights; and they were critical of what they regarded as a growing tendency to consider material rights more “real.” They characterized certain devastating events (most particularly the 1984–1985 famine then ravaging Ethiopia, and the famine, deaths from treatable diseases, and genocide under the Khmer Rouge in Cambodia in 1975–1979) as horrendous outcomes, not only of the failed “social engineering” of Communist insurgencies and regimes, but also of their disregard of basic human rights. They saw a baleful affinity between the priority given to social and economic rights in these countries and the tendency of tiers-mondistes to demand that these rights come first and universal human rights second, as an additional “reward.”36
The overlap in time between the 1984–1985 famine in Ethiopia, the creation of Médecins Sans Frontières, and its inaugural colloquium had a major influence on how the members of MSF France experienced and participated in this meeting. For them this famine was a catastrophe with which MSF France had been deeply involved in the field, exemplifying the horrific abuses of human rights perpetrated by the “revolutionary” government of a Third World country. This profoundly traumatizing event brought MSF face to face with the realization that “under certain circumstances humanitarian aid can do more harm than good.”37
The famine that beset northern and southeastern Ethiopia, which resulted in the deaths of hundreds of thousands and the destitution of millions, was as much—perhaps even more—a consequence of the policies of the government of President Mengistu Haile Mariam, and the counterinsurgency campaign of the Ethiopian army and air force against his opponents, as of drought and harvest failure. Mengistu had assumed power as head of state following the overthrow of Emperor Haile Selassie I in 1974 by the Derg, a committee of military officers and enlisted soldiers of which Mengistu was a member. From 1977 to 1978, Mengistu and his Derg regime conducted a reign of terror against the Ethiopian People’s Revolutionary Party and constructed what he grandiosely labeled “the first authentically Communist country of Africa.” All rural land and foreign- and locally owned companies were nationalized. The Marxist-Leninist Workers’ Party of Ethiopia was founded as the country’s ruling party, with Mengistu as secretary-general, and members of the Derg were appointed to the Central Committee of its Politburo. The country was renamed the People’s Democratic Republic of Ethiopia.
The government’s primary response to the drought and famine was a “resettlement” and a “villagization” program, forcibly transferring populations in southern Ethiopia, destroying their villages, and grouping the uprooted into new sites under Party control:
Ostensibly designed to relocate northerners away from the “famine-prone” region for their benefit, the plan served to deprive … opposition movements of a base of local support and to advance the government policy of collectivization. Relief was thoroughly manipulated, denied to areas not held by the government, and used as a weapon to control populations in the north.… Food distribution centers became traps, attracting populations to a central location at which many were forcibly recruited into the army or signed up for transfer to the south in accordance with quotas set by Addis Ababa.…
The people were deported in deplorable conditions to the south. No effort was made to keep families, villages, or ethnic groups together. Many died en route. Almost all destination villages lacked infrastructure, and the new arrivals were required to clear land and construct their shelter. Due to the lack of health care and sanitation, tropical disease inflicted a high toll on the weakened population.38
In 1984, MSF started programs to treat malnutrition in a number of hunger-stricken regions of Ethiopia. Initially reluctant to allow Western aid organizations into the country, the Mengistu government changed its position “as it began to turn the international humanitarian action to its economic, diplomatic, and military advantage.… Aid was the bait and the presence of international NGOs gave the [resettlement] program an element of legitimacy and security.”39 In 1985, MSF France confronted the government after some six thousand children “died in a camp where they had adequate materials for assistance but were not allowed to distribute them because, according to government officials, a sufficient number of adults had not agreed to be resettled.”40 Because MSF France spoke out about this tragic incident, and more generally about the government’s misuse of aid to relocate millions of its people, the government ordered it to halt its activities, and it was expelled from Ethiopia in December 1985.41
Ethiopia was a critical event for MSF France, for Brauman and Malhuret, and for their conception of the Liberté Sans Frontières Foundation and its colloquium. It reinforced their anticommunist and anti-tiers-mondiste outlook, and their inclination to view Communism and tiers-mondisme as antitheses of MSF’s democratic, anti-totalitarian, “humanitarian spirit.”
Notwithstanding the passion surrounding Liberté Sans Frontières, it was short-lived. It became increasingly focused on Third World issues such as health insurance, food, debt, and development. The Foundation produced fifty-five booklets on such topics, which it distributed to a list of some 1,500 national and international “opinion leaders.” Brauman found these topics increasingly “boring” and feared that MSF would come to be seen as an agency specializing in Third World issues. To him this was neither appropriate nor desirable.
In 1984, at the time that he had organized the Trois-Mondisme en question colloquium, Brauman has said, “if anyone had told [me] that ‘tiers-mondisme’ was going to collapse like a house of cards, [I] would not have believed it.42 But already, by 1987–1988, Third-Worldism was foundering. It was a period of transition, Brauman observed. In his view, the core ideas of Liberté Sans Frontières were being increasingly accepted. “Humanitarianism was no longer a subject of contradictory debates but a subject of general consensus … of all praise [and] all virtue.” Brauman felt that “the work [he] had devoted to the renovation of the philosophical and ethical bases of humanitarianism no longer had a reason for being.”43 It seemed “pointless.” So, he “decided to let Liberté Sans Frontières go.”44 In his double capacity of director of Liberté Sans Frontières and president of MSF France, he told the foundation’s board of directors that he wished to terminate LSF. Brauman described it as a “very tense meeting,” because the board was unwilling to close down LSF, and according to the bylaws of the foundation, a two-thirds vote of approval of its members was required to do so. Brauman, who regarded himself as a “leftist neo-con,” had never felt entirely at ease in his discussions with more conservative interlocutors like the LSF board members. “The paradox,” he stated, “was that very often, I felt emotionally closer to those whom I criticized than to those who approved of LSF.”45 This contributed to tension in his discussions with the obstinate board. In order to break the impasse, Brauman informed them that MSF France would no longer be able to raise or contribute funds to support LSF, evoking acrimonious responses from the board members. They accused Brauman of manipulating them, of discarding them when he had no further need of them, and of seeking to ingratiate himself politically with his more leftist friends, now that François Mitterand, the leader of the French Socialist Party, had just been elected for a second term as president of France.46
Although formally speaking LSF was never voted out of being, by April 1989, its de facto existence had come to an end.47
What an MSF member once referred to as the “saga” of Liberté Sans Frontières, with “the ideological adventure”48 and the associated courtroom confrontation between MSF France and MSF Belgium, could be considered an event of faded significance in MSF’s history and collective memory if MSF were not still facing cognate issues. Although under changed and changing circumstances, MSF continues to confront challenges posed by its organizational growth and its increasing geographical and societal scope. It still struggles to realize its “sans frontières” vision more fully, partly through achieving greater “internationalization.” It still wrestles with questions about its foundational principles, their interpretation, and their implementation in humanitarian action—including its principles of neutrality, impartiality, and “bearing witness.” It still anguishes over humanitarianism’s “inherent paradoxes,” which “can lead to some negative consequences” that “contradict its fundamental purpose by prolonging the suffering it intends to alleviate.”49 And it is still confronted by the core dilemma that Liberté Sans Frontières threw into relief: how to deal ethically, wisely, and effectively with the fact that (in the words of MSF’s Nobel Prize acceptance speech), “the humanitarian act is the most apolitical of acts, but if its actions and its morality are taken seriously, it has the most profound political implications.”