Between 2002 and 2010, I conducted more than a hundred interviews with MSFers, as well as academics and objective outsiders. I spent several weeks visiting teams in Angola, Afghanistan, Pakistan and Haiti as well as several MSF offices in Europe and North America. These interviews provided the bulk of the material in these pages.
The notes that follow are not comprehensive but include the sources I have quoted in the text, those that provided the most helpful background, and those that are readily available to readers interested in learning more about MSF and humanitarian aid.
The aid community benefits from a number of excellent news services available on the web, including Reuters AlertNet (www.alertnet.org) and ReliefWeb (www.reliefweb.int), both of which I consulted extensively.
MSF reports, press releases and internal documents were invaluable research material, though I have listed only the most important here. Many are available on MSF websites, including www.msf.org, www.doctorswithoutborders.org, and www.msf.ca.
Introduction: Fixing Up the Humans
David Rieff’s comments: A Bed for the Night: Humanitarianism in Crisis (New York: Simon & Schuster, 2002), 83.
The golden age of humanitarianism: Tony Vaux, The Selfish Altruist: Relief Work in Famine and War (London: Earthscan, 2001), 43ff.
Chapter 1: Stand and Deliver
Background on Haiti: Paul Farmer, The Uses of Haiti, third edition (Monroe, Maine: Common Courage Press, 2006).
MSF briefing paper, A Perilous Journey: The obstacles to safe delivery for vulnerable women in Port-au-Prince (May 2008).
Chapter 2: Biafra and the Bumblebee
Bernard Kouchner biographical details: Michael Ignatieff, Empire Lite (Toronto: Penguin Canada, 2003); “Charlemagne: Bernard Kouchner, Controversial Proconsul for Kosovo,” The Economist (US), July 19, 1999, 48; Carol Devine et al., Human Rights: The Essential Reference (Phoenix: Oryx Press, 1999); John Hanc, “Healing the World,” Runner’s World, December 1993, 36.
Influence of the Paris milieu on Kouchner: Renée C. Fox, “Medical Humanitarianism and Human Rights: Reflections on Doctors Without Borders and Doctors of the World,” in Jonathan Mann et al., eds., Health and Human Rights: A Reader (New York: Routledge, 1999), 419.
None of the most comprehensive sources on the early history of Médecins Sans Frontières is available in English. Olivier Weber’s French Doctors: Les 25 ans d’épopée des hommes et des femmes qui ont inventé la médicine humanitaire (Paris: Robert Laffont, 1995) covers the two-and-a-half decades that followed the Biafran war. I am indebted to Geneviève Séguin for translating portions of this book. Dorthe Ravn’s Læger Uden Grænser (Frederiksberg, Denmark: Bogfabrikken Fakta, 1998) was also invaluable, with thanks to Kurt Dahlgaard for providing an unpublished English translation by René Bühlmann. See also Anne Vallaeys, Médecins Sans Frontières: la biographe (Paris: Fayard, 2004); Rony Brauman, “The Médecins Sans Frontières Experience,” in Kevin Cahill, ed., A Framework for Survival (New York: Basic Books, 1993); and Patrick Aeberhard, “A Historical Survey of Humanitarian Action,” Health and Human Rights 2, 1 (1996): 31–44.
Kouchner’s personal reflections on Biafra: “From Doctors Without Borders to Patients Without Borders,” lecture delivered at the Harvard School of Public Health, March 6, 2003. See also Alvin Powell, “Kouchner Calls for Global Health Care,” Harvard University Gazette, March 13, 2003.
History of humanitarian intervention: David Rieff, A Bed for the Night: Humanitarianism in Crisis (New York: Simon & Schuster, 2002); Hans Köchler, “Humanitarian Intervention in the Context of Modern Power Politics” (Vienna: International Progress Organization, 2001); Francis A. Boyle, “Humanitarian Intervention: A Joke and a Fraud,” Doctor Irma M. Parhad Lecture, University of Calgary, 2001; Philippe Guillot, “France, Peacekeeping and Humanitarian Intervention,” International Peacekeeping, spring 1994, 31.
Bernard Kouchner and the development of humanitarian intervention: Tim Allen and David Styan, “The Right to Interfere? Bernard Kouchner and the New Humanitarianism,” Journal of International Development, August 2000, 825–42; Mary Kaldor, “A Decade of Humanitarian Intervention: The Role of Global Civil Society,” in Global Civil Society Yearbook 2001, Helmut Anheier et al., eds. (London: London School of Economics, 2001); Hugo Slim, “Military Intervention to Protect Human Rights: The Humanitarian Agency Perspective” (International Council on Human Rights Policy, 2001); Olivier Corten, “Humanitarian Intervention: A Controversial Right,” UNESCO Courier, July/August 1999, 57–59. I am grateful to Tim Allen of the Development Studies Institute at the London School of Economics for help in providing historical context and perspective.
Rony Brauman’s comments on MSF’s intervention in Afghanistan and Cambodia: Médecins Sans Frontières, World in Crisis: The Politics of Survival at the End of the 20th Century (New York: Routledge, 1997).
Jacques de Milliano’s journal of Sudan: Anke de Haan, Edith Lute and Roderick Bender, Médecins Sans Frontières: 10 Years Emergency Aid Worldwide (Amsterdam: MSF-Holland, 1995).
Harry and Marijke in Sudan: Peter Dalglish, The Courage of Children (Toronto: HarperCollins, 1998), 270–80.
French citizens’ desire to work for MSF: Ronald Koven, “Crisis Alert: Volunteer Medics Heal the World,” The World & I, July 1989.
Chapter 3: We Don’t Need Another Hero
One of the most articulate personal accounts of life inside MSF is Leanne Olson’s A Cruel Paradise: Journals of an International Relief Worker (Toronto: Insomniac Press, 1999).
Motivations of MSF volunteers: Elliott Leyton and Greg
Locke, Touched by Fire: Doctors Without Borders in a Third World Crisis (Toronto: McClelland & Stewart, 1998).
Recruiting and training: Michael J. VanRooyen, “Emerging Issues and Future Needs in Humanitarian Assistance,” Prehospital and Disaster Medicine, October–December 2001, 216–22; Rachel T. Moresky et al., “Preparing International Relief Workers for Health Care in the Field: An Evaluation of Organizational Practices,” Prehospital and Disaster Medicine, October–December 2001, 257–62.
Michael Maren’s comments: Might Magazine, March/April 1997, quoted at www.netnomad.com/might.html.
Chapter 4: Doc in a Hard Place
Karin Moorhouse and Wei Cheng describe their time in Angola in their book No One Can Stop the Rain (Toronto: Insomniac Press, 2005).
Dominique Larrey and the history of emergency medicine: M.K.H. Crumplin, “Surgery in the Napoleonic Wars,” Journal of the Royal College of Surgeons of Edinburgh, June 2002, 566–78; Miguel A. Faria Jr., “Dominique-Jean Larrey: Napoleon’s Surgeon from Egypt to Waterloo,” Journal of the Medical Association of Georgia, September 1990, 693–95; Robert L. Pearce, “War and Medicine in the Nineteenth Century,” ADF Health (Journal of the Australian Defence Health Service), September 2002; Moshe Feinsod, “The Surgeon and the Emperor: A Humanitarian on the Battlefield,” in Aryeh Shmuelevitz, ed., Napoleon and the French in Egypt and the Holy Land, 1798–1801 (Istanbul: Isis Press, 1999).
Chapter 5: In the Yellow Desert
Background on Kandahar and southeastern Afghanistan: Christina Lamb, The Sewing Circles of Herat (Toronto: HarperCollins, 2002); Eliza Griswold, “Where the Taliban Roam,” Harper’s, September 2003, 57–65; Daniel Bergner, “Where the Enemy Is Everywhere and Nowhere,” New York Times Magazine, July 20, 2003; Phil Zabriskie, “Undefeated: On the Afghanistan–Pakistan Border, the Taliban Are Regrouping, Bent on Spreading Terror,” Time (Asia edition), July 21, 2003; United Nations High Commissioner for Refugees, particularly the report “Return to Afghanistan” at www.unhcr.ch.
Medical needs of displaced people: Médecins Sans Frontières, Refugee Health: An Approach to Emergency Situations (London: Macmillan, 1997); Rony Brauman, “Refugee Camps, Population Transfers, and NGOs,” in Jonathan Moore, ed., Hard Choices: Moral Dilemmas in Humanitarian Intervention (Lanham, Md.: Rowman & Littlefield, 1998).
Siege of Mir Wais hospital: Ellen Knickmeyer, “U.S., Afghan Forces Kill al-Qaida Holdouts,” Associated Press, January 28, 2002; Michael Ware, “Dead Men Talking,” Time, February 2, 2002.
Attacks on humanitarian workers in Afghanistan: Mercy Corps, “A Lesson from Afghanistan: The Price of Unfinished Business,” ReliefWeb, April 29, 2003; Françoise Chipaux, “The Taliban Are Back in Southeast Afghanistan,” Le Monde, April 5, 2003; Todd Pitman, “Two Afghan Red Crescent Workers Killed; UNHCR Attacked,” Associated Press, August 14, 2003; Sayed Salahuddin, “Four Aid Workers Killed in Afghan Ambush,” Reuters AlertNet, September 10, 2003.
Slaying of five workers in Badghis: MSF press release, “MSF Shocked by Death of 5 Staff in Afghanistan,” June 3, 2004; Stephen Graham, “Agency Halts Its Afghan Operation,” Associated Press, June 4, 2004; Marianne Stigset, “Humanitarian Ideals Die with Aid Workers in Afghanistan,” Daily Star (Lebanon), June 4, 2004; interview with Samuel Hauentein of MSF-Holland, As It Happens, CBC Radio (Toronto), June 3, 2004.
Chapter 6: Ugly Realities
Nobel committee press release and presentation speech: see nobelprize.org
Joelle Tanguy’s comments: “Controversies Around Humanitarian Interventions and the Authority to Intervene,” speech delivered at the University of California, Berkeley, November 6, 1999.
David Rieff’s comment on Kosovo: A Bed for the Night: Humanitarianism in Crisis (New York: Simon & Schuster, 2002), 198; italics in original.
Attack in Ethiopia: MSF press release, “MSF Team Attacked in Ethiopia: One Person Killed, One Badly Injured,” February 8, 2000.
Fundraising and activities after the South Asian tsunami: MSF internal report, Six Months After the Asia Tsunami Disaster, June 21, 2005.
Mental-health programs: Kaz de Jong, Nathan Ford and Rolf Kleber, “Mental Health Care for Refugees from Kosovo: The Experience of Médecins Sans Frontières,” The Lancet, May 8, 1999, 1,616–17; Kaz de Jong et al., “Psychological Trauma of the Civil War in Sri Lanka,” The Lancet, April 27, 2002, 1517; Richard F. Mollica, “Mental Health and Psychological Effects of Mass Violence,” in Jennifer Leaning, Susan M. Briggs and Lincoln Chen, eds., Humanitarian Crises: The Medical and Public Health Response (Cambridge, Mass.: Harvard University Press, 1999).
Chapter 7: How the Other Half Dies
James Orbinski’s experience in Rwanda: Sarah Scott, “Dr. Orbinsky’s [sic] Long Road Home,” National Post (Toronto), January 4, 2003. See also James Orbinski, An Imperfect Offering (Toronto: Doubleday, 2008).
MSF’s Nobel acceptance speech: see nobelprize.org; see also Michael Schull, “MSF, the Nobel Peace Prize, and the Canadian Connection,” Peace Magazine, winter 2000.
Background on malaria: Fiammetta Rocca, The Miraculous Fever-Tree (New York: HarperCollins, 2003); MSF Access to Essential Medicines (www.msfaccess.org); Medicines for Malaria Venture (www.mmv.org); Wellcome Trust (www.wellcome.ac.uk); UN Roll Back Malaria (www.rollbackmalaria.org; mosquito.who.int); World Health Organization (www.who.int); UNICEF (www.childinfo.org).
MSF and artemisinin-based combination therapy: MSF report, ACT Now to Get Malaria Treatment That Works in Africa (April 2003).
Dispute in Ethiopia: Ethiopian Federal Ministry of Health press release, “The Malarial Situation in Africa,” December 23, 2003; also reports from IPS-Inter Press Service (www.ips.org) and UN Integrated Regional Information Networks (www.irinnews.com).
Background on HIV/AIDS: Tony Barnett and Alan Whiteside, AIDS in the Twenty-First Century (Hampshire, UK, and New York: Palgrave Macmillan, 2002); Elizabeth Reid, “A Future, If One Is Still Alive: The Challenge of the HIV Epidemic,” in Jonathan Moore, ed., Hard Choices: Moral Dilemmas in Humanitarian Intervention (Lanham, Md.: Rowman & Littlefield, 1998); UNAIDS (www.unaids.org).
MSF and antiretroviral treatment: MSF report, AIDS: The Urgency to Treat (December 2002); Richard Bedell, “The Introduction of Antiretroviral Therapy in Resource-Poor Settings: Some Ethical Reflections,” lecture delivered in Toronto, December 2002; UNAIDS fact sheet, “Access to HIV Treatment and Care,” December 2003.
Patent laws and generic drugs: Daryl Lindsey, “The AIDS-Drug Warrior,” Salon.com, July 18, 2001; MSF report, Fatal Imbalance: The Crisis in Research and Development for Drugs for Neglected Diseases (September 2001); MSF report, Drug Patents Under the Spotlight (May 2003); World Trade Organization (www.wto.int).
Anthrax and its effect on the generic-drugs issue: Mike Godwin, “Prescription Panic: How the Anthrax Scare Challenged Drug Patents,” Reason, February 2002; Gardiner Harris, “Bayer’s Cipro Will Be Profitable, Even on Discount Deal with U.S.,” Wall Street Journal, October 26, 2001; V. Sridhar, “Perilous Patent,” Frontline (India) 18, 24 (November 24–December 7, 2001); Kavaljit Singh, “Anthrax, Drug Transnationals, and TRIPs,” Foreign Policy in Focus, April 29, 2002.
Canada’s potential for leadership on access to generic drugs: James Orbinski, “Access to Medicines and Global Health: Will Canada Lead or Flounder?” Canadian Medical Association Journal, January 20, 2004, 224; David Morley, “We Led on AIDS. Why Hang Back Now?” Globe and Mail, October 24, 2003, MSF press release, “Bill C-9: How Canada Failed the International Community,” April 29, 2004.
Malnutrition in Niger: Frederic Mousseau with Anuradha Mittal, Sahel: A Prisoner of Starvation? A Case Study of the 2005 Food Crisis in Niger, The Oakland Institute, October 2006; MSF report, Malnutrition: How Much is Being Spent? (November 2009).
Chapter 8: Best Performance in a Supporting Role
Non-medical roles in humanitarian organizations: Carol Bergman, ed., Another Day in Paradise: International Humanitarian Workers Tell Their Stories (Maryknoll, NY: Orbis, 2003).
Chapter 9: New Fridge Syndrome
For a complete account of the Fred Cuny case, see the PBS documentary The Lost American; www.pbs.org/wgbh/pages/frontline/ shows/cuny.
Delivering medical assistance in Chechnya: Khassan Baiev, The Oath: A Surgeon Under Fire (New York: Walker and Company, 2003).
Deaths of aid workers: Dennis King, “Paying the Ultimate Price: An Analysis of Aid-worker Fatalities,” Humanitarian Exchange, August 5, 2002; Mani Sheik et al., “Deaths Among Humanitarian Workers,” British Medical Journal, July 15, 2000, 166–68; Francisco Rey Marcos, “When the Red Cross Is the Target,” Reuters AlertNet, November 18, 2003; Genevieve Butler, “Afghan Promises Held Ransom by Violence,” Reuters AlertNet, December 12, 2003.
Arjan Erkel abduction: Quote from NRC Handelsblad in
MSF-Switzerland report, “Arjan Erkel: Hostage in the Russian Federation since August 12, 2002,” August 12, 2003; Marie Jégo, “MSF accuse des officiels russes de maintenir en otage un de ses volontaires,” Le Monde, March 10, 2004; Oksana Yablokova, “Mystery Shrouds Erkel’s Release,” The Moscow Times, April 13, 2004; Simon Ostrovsky, “Light is Shed on Erkel’s Release,” The Moscow Times, April 15, 2004; Netherlands Ministry of Foreign Affairs press release, “Déclaration du ministère néerlandais des Affaires étrangères concernant la libération d’Arjan Erkel,” May 28, 2004; Natalie Nougayrède, “Les Pays-Bas ont versé une rançon pour la libération d’Arjan Erkel, otage dans le Caucase russe,” Le Monde, May 29, 2004; Natalie Nougayrède and Jean-Pierre Stroobants, “La polémique monte entre le gouvernement néerlandais et MSF,” Le Monde, May 30, 2004; interview with Rowan Gillies, As it Happens, CBC Radio (Toronto), June 15, 2004.
Psychological toll of aid work: Piet van Gelder and Reinoud van den Berkhof, “Psychosocial Care for Humanitarian Aid Workers: The Médecins Sans Frontières Holland Experience,” in Yael Danieli, ed., Sharing the Front Line and the Back Hills (New York: Baywood, 2002); Ruth Barron, “Psychological Trauma and Relief Workers,” in Jennifer Leaning, Susan M. Briggs and Lincoln Chen, eds., Humanitarian Crises: The Medical and Public Health Response (Cambridge, Mass.: Harvard University Press, 1999).
Rob Gordon, “The Stress of Humanitarian Work,” edited by Amanda Allan and Colleen McFarlane, presented at the Australian NGO Psychosocial Forum, Melbourne, November 2003.
Colin Powell’s remarks: US Department of State, “Remarks to the National Foreign Policy Conference for Leaders of Nongovernmental Organizations,” delivered in Washington, DC, October 26, 2001.
Tony Blair’s remarks quoted in Francisco Rey Marcos, “When the Red Cross Is the Target,” Reuters AlertNet, November 18, 2003.
Chapter 10: You Can’t Stop a Genocide With Doctors
MSFers arrested in Sudan: MSF-Holland report, “The Crushing Burden of Rape: Sexual Violence in Darfur,” March 8, 2005; Human Rights Watch, “Darfur: Arrest War Criminals, Not Aid Workers,” May 31, 2005.
David Rieff on MSF’s place among aid agencies: A Bed for the Night: Humanitarianism in Crisis (New York: Simon & Schuster, 2002), 83, 187.
Afghan refugees and IDPs: UN Integrated Regional Information Networks (IRIN) report, “Afghanistan: Focus on Chaman Border Crisis,” May 7, 2002; IRIN report, “Afghanistan: Special Report on Displaced People in the South,” July 21, 2003; UNHCR report, “More than 2.3 Million Returnees since 2001,” Afghanistan Humanitarian Update No. 68, August 15, 2003; IRIN press release, “Pakistan: Waiting Area Refugees Subjected to Negative Policies, Says MSF,” August 27, 2003; UNCHR press release, “Afghan, Pakistani Governments Agree to Gradually Close Border Camps,” August 28, 2003; UNCHR report, “UNHCR’s Operation in Afghanistan: Donor Update on Afghanistan,” September 8, 2003.
Stories from Democratic Republic of the Congo: Silence On Meurt: Témoignages (Paris: L’Harmattan, 2002), English excerpts published as Quiet, We Are Dying (Toronto: MSF, 2003).
Increasing technical nature of humanitarian aid: David W. Robertson, Richard Bedell et al., “What Kind of Evidence Do We Need to Justify Humanitarian Medical Aid?” The Lancet, July 27, 2002, 330–33.
MSF’s activity and communications during the Rwanda genocide and its aftermath are meticulously recorded in two internal documents, Genocide of Rwandan Tutsis, 1994, and Rwandan Refugee Camps in Zaire and Tanzania, 1994–1995, part of the series “Case Studies: Médecins Sans Frontières Speaks Out.”
Documents revealing Hutu plans to exploit international aid: Fiona Terry, Condemned to Repeat? The Paradox of Humanitarian Action (Ithaca and London: Cornell University Press, 2002), 156.
Cholera and dysentery in Goma, Operation Turquoise and other background on Rwanda: William Shawcross, Deliver Us from Evil: Peacekeepers, Warlords and a World of Endless Conflict (New York: Simon & Schuster, 2000).
How aid sustained the Hutu regime in Rwanda: Fiona Terry, Condemned to Repeat? 196; long-term effects on MSF, 2. Terry devotes an entire chapter to the situation in the Zairean camps.
David Rieff on the decision to withdraw from Rwanda: A Bed for the Night, 187.
James Orbinski’s Nobel acceptance speech: nobelprize.org.
David Rieff’s comments after Nobel Peace Prize: “Good Doctors: Humanitarianism at Century’s End,” New Republic, November 8, 1999, 23.
Criticism of Afghan food drops: MSF press release, “MSF Refuses Notion of Coalition Between Humanitarian Aid and Military,” October 6, 2001.
Colin Powell’s remarks: US Department of State, “Remarks to the National Foreign Policy Conference for Leaders of Nongovernmental Organizations,” delivered in Washington, DC, October 26, 2001.
David Morley’s comments: “Humanitarianism in the 21st Century,” lecture delivered at the University of Toronto, February 11, 2003.
Aid organizations in Iraq: Rony Brauman and Pierre Salignon, “Iraq: In Search of a Humanitarian Crisis,” in Fabrice Weissman, ed., In the Shadow of “Just Wars”: Violence, Politics and Humanitarian Action (Ithaca and London: Cornell University Press, 2004) 271; see also Jack Epstein, “Charities at Odds with Pentagon: Many Turn Down Work in Iraq Because of U.S. Restrictions,” San Francisco Chronicle, June 14, 2003.
Potential paralysis in aid organizations: Mary B. Anderson, “You Save My Life Today, But for What Tomorrow? Some Moral Dilemmas of Humanitarian Aid,” in Jonathan Moore, ed., Hard Choices: Moral Dilemmas in Humanitarian Intervention (Lanham, Md.: Rowman & Littlefield, 1998).