The French medical relief agency, Médecins Sans Frontières (MSF), has always been viewed by other mainstream humanitarian organisations as the nonconformist of the relief world. This is not meant as a compliment. The great mantra of contemporary humanitarian action is co-ordination. The assumption is that private organisations like Oxfam, World Vision, and MSF must not set their policies by themselves, or even in consultation with the people on the ground they have come to assist, but must adhere to common frameworks for their actions that they thrash out together and in consultation with the relevant UN agencies such as the World Food Programme, the Office of the UN High Commissioner for refugees and Unicef. Only in this way, or so the conventional wisdom goes, can aid be effective.
From the Cambodian genocide through the Ethiopian terror famine of the mid-1980s to the tsunami today, MSF has argued otherwise. It has pointed out that, in practice, co-ordination often means subsuming the goal of humanitarian relief to other goals such as forging a durable peace or helping to secure a desired political outcome. These goals may be laudable, but the essential intuition of MSF is that all good things do not go together. The view at the UN or among most relief groups may be that humanitarian action is part of a "toolkit" of remedies available to the "international community" to deal with war-ravaged or failed states in the poor world, but MSF's position has always been to insist that its priorities might not be peace, or development, or some decent political outcome in a Sierra Leone or a Kosovo.
Of course, as citizens, its workers might well subscribe to exactly those outcomes—the restoration of democratic rule in Sierra Leone, say, or a Nato military intervention in Kosovo. But as a member of an emergency medical relief group, this is not their role, not their responsibility and, in an argument that implictly turns the accusation of hubris back against those who routinely level it against MSF (this often means Oxfam), not their right because it passes beyond their level of competence. The MSF view is that emergency aid, above all the medical relief the group provides, is not an archimedean lever for peace-building or social justice, but rather something far more operationally and, by implication at least, morally limited—not charity in the 19th-century European imperial sense so much as the provision of what, in an earlier era, we knew as succour. In this, MSF is actually closer to the International Committee of the Red Cross than to relief organisations like Oxfam, the International Rescue Committee or Concern.
The debate between MSF and other humanitarian agencies has been raging for several decades. Although it has mostly been an internal matter for the agencies, at several periods it has broken out into the open. One such moment was the mid-1980s, when MSF withdrew from Ethiopia on the grounds that aid was being used by the government in Addis Ababa as part of its campaign of terror against its own population. Another was 1995 in eastern Zaire, when the aid effort was sustaining the very groups that had orchestrated the Rwandan genocide before fleeing east. But rarely has MSF taken as controversial a move as it did when, in early January, it announced that it was suspending its appeal for funds for victims of the Asian tsunamis.
On the face of things, the gesture seemed incomprehensible. Here was one of the great natural calamities in recent history—an epochal, society-breaking, consciousness-transforming disaster on a par with the Lisbon earthquake of 1755. And unlike the so-called forgotten wars and orphan diseases to which the public of the global north was largely indifferent, the tsunamis had engendered an unprecedented outpouring of money, sympathy and pressure on governments, from Berlin to Washington, to act. And rightly so, or so the argument went, for how could there be too much money made available for relief when much of Sumatra and Sri Lanka had been devastated? There was something impious, almost satanic about the thought—as if the Marquis de Sade had been put in charge of the home for battered wives. There was also something deeply disturbing about it. For MSF to say that it couldn't use any more money in its programmes in earthquake and tsunami-ravaged areas suggested that such generosity might be useless. And this was the most troubling idea of all.
In fact, all the French doctors were articulating was a commonplace of humanitarian work. In a natural disaster of this scale and devastating effect, the emergency component of the response is far less important than the long-term reconstruction and rehabilitation effort. Even in what in relief worker jargon is called the "emergency phase," the efforts of the best private voluntary agencies are likely to be less important than the rapid deployment of military assets—above all, transport aircraft to fly in large amounts of supplies and helicopters to reach people cut off by floods and mudslides. And MSF officials, despite the group's longstanding scepticism over so-called humanitarian military interventions in places like Somalia or Darfur, were the first to insist on the point.
On the face of things, then, the firestorm of criticism that the MSF decision provoked among other relief agencies seemed hard to explain. An emergency relief group was saying it had received enough money from its public appeals to fund those operations in the tsunami-hit areas that it thought viable, and that such programmes were not infinitely expandable the more money was made available. But what MSF revealed was that this last assumption is the one on which so many relief and development agencies have based their appeals. The more money you give us, they imply, the more we will be able to do.
That, of course, is no more true in relief and development than it is in any other sphere of human endeavour. At best, such a claim is sometimes true; certainly, it is often false. We cannot make our good wishes come true, or realise all our hopes. A hospital ward teaches you that. So does a natural disaster. MSF's misdemeanour was to say so publicly—to bring a check to the humanitarian fundraising machine that has become increasingly divorced from realities with its Christmas appeals and its oversimplifications. And it is not as if MSF were stopping all its appeals for funds. As a note on the group's website said plaintively: "We need more contributions for our work in Darfur."
Worst natural disasters since 1800
1931 Flood, Yangtsze river, China, up to 3m dead
1887 Flood, Yellow river, China, 900,000 dead
1970 Cyclone/flood, Bangladesh, 700,000 dead
1881 Hurricane, Haiphong, Vietnam, 300,000 dead
1976 Earthquake, Tangshan, China, 242,000 dead (official figure—unofficial estimates as high as 655,000)
1927 Earthquake, Xining, China, 200,000 dead
1920 Earthquake, Gansu, China, 200,000 dead
2004 Tsunami, Indian Ocean, 150,000 (?) dead
1923 Earthquake, Tokyo, Japan, 140,000 dead
1991, Flood, Bangladesh, 139,000 dead
1908 Earthquake, southern Italy and Sicily, 123,000 dead
1948 Earthquake, Turkmenistan, 110,000 dead
1815 Volcano, Sumbaya, Dutch East Indies (now Indonesia), 92,000 dead
1896 Tsunami, Japan, 27,000 dead (worst tsunami before 2004)
