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Dying to help: A drift towards humanitarian martyrdom

‘MSFers were supposed to take risks, but to come back alive.’

Injured men receive treatment in hospital after sustaining wounds from a blast at a wedding hall in Kabul, Afghanistan 18 August, 2019
Injured men receive treatment in hospital after sustaining wounds from a blast at a wedding hall in Kabul, Afghanistan 18 August, 2019. (Mohammad Ismail/REUTERS)

Despite terrible losses, Médecins Sans Frontières has decided to keep working in Afghanistan in the name of a “humanitarian imperative” – and in contradiction of its own security policy.

On 12 May, 25 people were executed by Islamist insurgents in an MSF-supported maternity hospital in Kabul, including two children, 16 mothers in their beds, and one MSF midwife. Five years before, 45 people were burned to death or cut to pieces in an MSF hospital in Kunduz by the US Air Force, including 24 patients and 14 MSF staff. These two massacres represent the worst killings in MSF facilities since the genocide in Rwanda. No other NGO has experienced such a level of violence against its staff and patients in Afghanistan.

Since its inception in 1971, MSF has placed exposure to danger as an integral part of its identity; one of the four short paragraphs of its charter recognises the inherently risky aspect of its mission. This “chivalrous” spirit, however, was tempered by another principle: the rejection of sacrifice. MSFers were supposed to take risks, but to come back alive.

Golden rules

In 1990, the French section of MSF adopted a short “memo” to help operational teams draw a line between a “risky” mission and one that is too risky. This memo was endorsed in 2015 by MSF boards of directors as the “Policy of Risk Taking and Security Management for MSF OCP staff”.

The memo was drafted after the first killings of international MSF volunteers: In Sudan, in December 1989, a plane taking off from Aweil was shot down, killing four people on board, including two MSF staff. Four months later in Afghanistan, a logistician was executed by insurgents in the context of a feud between rival commanders.

The 1990 memo opens with the statement: “There is no humanitarian immunity”, warning that the greatest danger for aid workers is believing they are protected by their principles, their logo, and the quality of their work. The killings in Afghanistan and Sudan had cruelly demonstrated that providing valuable help to the population and being appreciated by civilian authorities and patients did not stop someone from shooting down an MSF plane, or assassinating a logistician.

The second rule of the memo states that the protection of aid workers depends upon their understanding of the context and their ability to build a network of contacts and relationships. They need to understand who threatens them, and who protects them. Aid workers’ security relies on their ability to find a protector (or protectors) with an interest in ensuring their safety, so as to benefit from their actions. That includes the medical services and material assistance they provide (heathcare for wounded combatants and their families, social services delivered to the social base of the armed groups), the money they spend (for salaries, rental contracts, local expenses, etc.), their access to mass media, and their ability to portray the political authorities in a more or less positive light.

This raises a concern: At what point do aid organisations become more useful to the military forces that surround them than to the civilian population? They have to avoid being victims, but they also have to avoid being complicit in mechanisms that produce violence.

In highly insecure situations, the third rule recommends limiting operations to curative healthcare by smaller teams (to expose fewer staff to risk).

The fourth rule reiterates that there is no place for martyrdom. In contrast to some UN agencies or the International Committee of the Red Cross (ICRC), which are mandated by states to work in conflict situations, NGOs like MSF have no mandate. They choose where to work and the level of risk they want to take. And as far as MSF is concerned, its members are not supposed to die for humanitarian ideals.

The fifth rule, established after the strafing of a clearly-marked MSF vehicle in Sri Lanka in 1991, asserted that “MSF refuses to intervene in high security risk areas where there is an absence of authorities with which to negotiate our safety and/or when it is impossible to protect ourselves from groups demonstrating radical hostility against us.”

In other words, MSFers are prepared to face the danger of being hit accidentally in war zones, but not of being deliberately targeted, whatever the reason: as a “bad doctor” – blamed for the death of wounded combatants; as “spies” or “apostates” accused of supporting the “crusaders”; as an employer accused of unfair dismissal; as a “supporter of terrorist groups”; as a “high-value target” that earns media attention; as “bounty” for kidnappers; as “regrettable but necessary collateral damage”.

Rule six reaffirms that the top MSF managers have the duty and power to call a halt – to stop teams that appear to be in a reckless mood – but not to manage their exposure to danger on a day-to-day basis.

These rules provide a framework for discussion, not an algorithm for decision-making. Yet, this very framework is currently challenged within MSF, by the decision to keep a large presence in Afghanistan after the recent massacre.

Proponents of staying in Afghanistan argue that – despite the deliberate killing of MSF patients and staff, and despite the so-called Islamic State’s earlier suicide attack on the Save the Children compound in 2018, and despite their recent statement declaring aid workers a legitimate target – no group has demonstrated a radical hostility toward us. Some colleagues even suggest that the massacre of patients and MSF personnel might be an opportunity to negotiate a kind of Memorandum of Understanding (a “fatwa of protection”) with IS that could exempt MSF from its policy of mass murder.

Some members argue that even if MSF fails to negotiate such an MoU or to find a reliable protector, it has to “stay and deliver”. The risk of targeted killings by radical groups should be considered a “new normal” we have to adapt to. The security debate within MSF has gradually shifted from, “have we reached the red line” (are we targeted), to “should we cross the red line”, to “should we move the red line”?

MSF is drifting toward an embrace of humanitarian martyrdom, consistent with what’s happening within the broader aid sector. As we have shown elsewhere, one of the primary consequences (not to say functions) of the portrayal of aid workers as heroes, and of the adoption of a risk management culture, is to make the growing number of dead, wounded, and kidnapped acceptable.

By treating aid worker killings as an occupational hazard, and memorialising casualties, the aid industry, including MSF, is justifying the exposure of its workers to a greater risk of death*.





(*The phrase was amended on Monday, 7 December 2020 to clarify that the author is not suggesting MSF and other aid groups are deliberately sending staff to their deaths.) 

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