European Affairs

Humanitarian action has the singleminded goal of seeking to create a ‘space for humanity’ amid crisis and conflict, preserving life and alleviating the suffering of those most in need, whoever they might be. As limited as this objective may be, humanitarian action plays a vital role: direct assistance can have a significant impact on people’s lives. For the past two years for instance, MSF has been delivering essential medical services to approximately one million extremely vulnerable people forcibly displaced from their homes in Darfur and neighboring Chad.

Humanitarian action is peaceful by nature, but it is not pacifist: we recognize that wars exist and we do not pass judgment on the decision to resort to force. But we operate with a single basic aim: to ensure that non-combatants are spared from undue violence and receive life-saving assistance. The principles of impartiality, i.e. needs-based assistance and non-discrimination, and of neutrality, i.e. not taking sides, fit with this fundamental goal, which nation-states have recognized in adopting international humanitarian law.

For us, these principles have an operational value. They help us gain access and reduce security risks enabling us to deliver much-needed assistance in volatile and sensitive environments. They support us as we try to overcome natural suspicion and potential belligerence towards foreigners and outside groups coming in and proposing to help. By definition, this is a suspect activity in many contexts. In our experience, the most effective way to gain acceptance and a measure of trust in conflict settings is to have a very clear and transparent humanitarian identity. When we can achieve that, it enables us, most of the time, to cross lines of division and reach those who are left out or discriminated against, those at the bottom of everyone else’s lists for assistance, and those against whom violence is being committed.

The practical importance of these principles explains why we must live up to them both in the field and in our organizational identity. To preserve our independence from military, political, religious and other agendas, we must be operationally and politically independent – and that means we must be financially independent. In the case of MSF, more than 80 percent of our annual budget – roughly $500 million – now comes from private donors as unrestricted funds (i.e. not tied to any specific crisis, country or operation). These unrestricted resources give us liberty of action in responding to need and to emergencies as they happen.

It is simply not possible for a government or military to have the unconditional ambition of only providing humanitarian action. Our objectives are thus fundamentally different from those of the military, and this remains true in light of some current views of war. In recent wars waged by Western powers, defeat of the enemy is not the only objective or rationale put forward for taking military action.Military forces also aim to restore peace, democratic political order and economic development. These goals put a premium on non-combat tools such as relief assistance, which has come to be seen as essential for success in reaching a military campaign’s overall objective and helping to garner or maintain support for the war itself. Relief operations in combat have propaganda and public relations aspects, both in the theater of operations and at home, in helping to depict the overall mission as having an altruistic or humanitarian motive.

We recognize that aid supplied by military forces can provide relief to people in need as can acts of assistance undertaken by individual soldiers or units moved by a sense of humanity. But this aid is different. It is not humanitarian assistance. It is given to reward, and it can be withheld to punish. It is often also linked with other activities, particularly intelligence gathering. By being subordinated to the military’s broader objectives, such aid is fundamentally different from humanitarian aid in its nature and intent.

There is a trend of trying to integrate NGOs into the overall Military effort

In addition to militaries providing direct assistance, there is also a broader trend of trying to integrate civilian government groups (such as USAID and its Disaster Assistance Response Team/ DART) along with NGOs into the overall effort. In this approach, NGOs, which have been described by former Secretary of State Colin Powell as “force multipliers” in the war on terror, are seen as “an essential part of the combat team” of the United States and western powers. There are increasing efforts to incorporate them into military operations.

Typically, the argument runs: “Yes, force is being used, but it is in service of broader shared goals that you, as NGOs and as humanitarians, should also embrace. There is a need to complement military operations while, of course, being careful about not blurring lines and about preserving the independence of NGOs.” This view typically continues along the lines of: “It’s a different world out there, particularly since 9/11, and it is important to join in.” Those who do not “join the program” are seen as anachronistic, adhering to an outdated version of humanitarianism. They are perhaps even viewed as suspect, as if their attitude suggests they do not want the overall mission to succeed.

At MSF, we believe, very fundamentally, that working in close cooperation with the military would mean abandoning core principles. It would turn our assistance into a partisan effort. It would entail taking sides. Given the practical benefits of needs-based humanitarian assistance, we cannot justify abandoning the principles that underpin it, despite the global trends in warfare we are seeing at this juncture. Let me describe four reasons for this.

The first is that military interventions containing humanitarian components are not carried out on the basis of human need: they are in fact highly selective and adopted as a function of political and strategic concerns. As we have seen, depending on the relevant political, economic or security considerations, crises on a massive scale of death and suffering can generate responses ranging from fullfledged military interventions (as in Kosovo) to no action at all (as during the genocide in Rwanda). In reality, we at MSF often work in crises of little strategic interest, where the population and aid workers are basically left to fend for themselves. And when there is political attention from the international community, it is the provision of aid that is often the main policy instrument put forward by Western powers. In this context, we see no justification for linking the fate of humanitarian assistance to the international community’s variable, selective and unpredictable responses to crises.

Another consideration is that, although military operations can increase the security and protection for populations, as occurred when British forces intervened late in the Sierra Leone conflict, there are also instances of false promises and false hopes given to populations who were assured protection and later abandoned, as Srebrenica tragically illustrates. On the basis of this mixed record, humanitarian organizations seem to have no place calling for military action, asking for it or being associated with it.

The third reason is that Western militaries are usually acting as belligerents. Even when they intervene with a view to restoring peace or establishing democracy, they wage war and, in the process, they can violate international humanitarian law and sometimes commit war crimes.What became evident in Somalia, the first ‘war in the name of humanitarianism’ of the post-cold war era, has been confirmed by events in Afghanistan and Iraq: interventions involve instances of disproportionate use of force, torture of prisoners of war and the use of weapons such as cluster munitions that do not discriminate between military and civilians. Humanitarian organizations can play an important role in calling attention to violations of international humanitarian law, but it would be impossible for us to do so with any credibility if we were closely associated with the armies committing these abuses.

For example, an MSF trauma center in Port-au-Prince, the capital of Haiti, treated some 1,800 gunshot victims in 2005, many wounded in confrontations between troops in the UN Stabilization Force (MINUSTAH) and the Haitian national police and armed groups affiliated in some way with former President Jean- Bertrand Aristide. About half of these victims were women, children or the elderly and ten percent of them reported having been shot and wounded by MINUSTAH soldiers during military operations in the slum areas of Port-au-Prince. In this type of situation, we need to work independently, not only to be able to treat these patients, but also to draw attention to the circumstances in which they were injured.

Voluntary organizations can play an important role in calling attention to violations of international humanitarian law

The last issue for consideration is directly operational in nature. Working closely with military forces negates the neutrality of humanitarian organizations and can pose the very real risk that, in the field, our access will be restricted or our safety jeopardized. That is why we insist on independence in the decision-making and actions of humanitarian organizations and on a clear distinction between military action on the one hand and humanitarian assistance on the other.

That said, we understand the inherent challenges and limits of our approach. So humanitarian organizations do not claim a monopoly on assistance – this is not about turf protection. Armies can play a role in providing relief, especially in peacetime and in natural disasters. In Pakistan after the earthquake, the logistical capabilities of the Pakistani army and of military forces from NATO and from other countries were very important in reaching isolated communities affected by the disaster.We have availed ourselves of these assets as have other groups.

When conflict subsides and the postconflict reconstruction gets underway, military, government and other assistance often intensify in support of a political agenda. In practice however, ‘post-conflict’ and conflict often occur simultaneously and sideby- side. Reconstruction processes can also discriminate against some people and leave others out. Even in these reconciliation situations, there is therefore a real rationale for keeping humanitarian assistance separate from reconstruction aid backed by politico-military action. This is illustrated by Afghanistan and the Democratic Republic of Congo, where parts of these countries have stabilized while other parts remain in active conflict.

Furthermore, by and large, NGOs have not resisted well when solicited by military and political leaders in the big push to integrate our work with theirs. Of course, NGOs are not a uniform group. While MSF focuses on humanitarian assistance, most NGOs are multimandate. Some describe their missions as going from relief to reconstruction and including both. Many accept substantial amounts of funding from Western governments. And many of them include in their mission broader political goals such as democracy, conflict resolution, peace and justice.

During discussions in Washington in early 2003 for instance, many NGOs were heavily consulting with the Pentagon on post-conflict reconstruction in Iraq, despite the fact that American forces were preparing to invade that country. At the time, this contradiction did not seem to be an issue for these organizations. Many have since come to recognize this close relationship with a belligerent military force as a problem. But the general trend of integration continues to gain ground.

Finally, independence and separation – maintaining the distinctions – will certainly not solve everything. The security risks are real. There are armed groups who attack humanitarian aid workers and civilian groups, especially in situations involving Western military intervention. Large international humanitarian assistance organizations such as MSF remain today primarily Western organizations, with a corresponding history, staffing and funding base. So even though we try to explain that we are not part of any Western political agenda, some groups may continue to attack and kill aid workers.

After working in Afghanistan for 20 years, MSF recently had five of our staff members there murdered, and we had to pull out. Those who killed our colleagues were, of course, fully to blame: it wasn’t any blurring of the lines that was responsible for these killings. But they did occur against this backdrop. The association of aid with broader politico-military goals has heightened the likelihood that we will become targets and will be attacked. In Afghanistan, dozens of aid workers have been killed. The murder of aid workers has become a political strategy for some factions as a way of scoring points against the international forces deployed there and against the government in Kabul.

From the perspective of a humanitarian organization like MSF, dialogue with all military actors remains essential. But it must be based on the fundamental recognition that humanitarian action and military action have different purposes and different objectives. Separation and independence are crucial.

Nicolas de Torrente is Executive Director of Médecins Sans Frontières in the United States, a position he has held since 2001. He previously worked for the organization in numerous posts in Africa and Asia. This article is based on remarks made at a conference organized by The European Institute.



The changed nature of war requires reassessments of strategies for peace. Humanitarian interventions, with or without peacekeeping or other forces, are figuring ever more prominently in such strategies today. In this connection, voluntary organizations (NGOs) are finding ever more important parts to play. But the politicization of aid work, with some voluntary organizations integrating ever more closely with governments, is creating new problems. Situations may easily arise in which motives are unclear and the allocation of functions can be questioned.

— From the citation speech awarding the Nobel Peace Prize in 1999 to Médecins Sans Frontières

Médecins Sans Frontières (MSF) – also known as “Doctors Without Borders’’ – is an international humanitarian aid organization providing emergency medical aid in more than 80 countries. It was founded by a group of French doctors during the Biafra conflict in the late 1960s. In their service they had found it difficult to remain silent and neutral in the civil war as required by Red Cross statutes. As part of their creed – sometimes described as “turbulent humanitarianism’’ – these volunteers vowed not only to help all victims but also to tell the world about violations of human rights in order to raise consciousness about the full circumstances of the plight of populations they are helping.


This article was published in European Affairs: Volume number 7, Issue number 1-2 in the Spring/Summer of 2006.