HUMANITARIAN NEGOTIATIONS REVEALED CLAIRE MAGONE, MICHAEL NEUMAN, FABRICE WEISSMAN (Editors) Humanitarian Negotiations Revealed The MSF Experience Médecins Sans Frontières HURST & COMPANY, LONDON First published in the United Kingdom in 2011 by C. Hurst & Co. (Publishers) Ltd., 41 Great Russell Street, London, WC1B 3PL © Médecins Sans Frontières, 2011 All rights reserved. Printed in the United Kingdom The right of Médecins Sans Frontières to be identified as the authors of this publication is asserted by it in accordance with the Copyright, Designs and Patents Act, 1988. A Cataloguing-in-Publication data record for this book is available from the British Library. ISBN: 978–1–84904–163–8 paperback 978–1–84904–162–1 hardback This book is printed using paper from registered sustainable and managed sources. www.hurstpub.co.uk ALSO FROM MEDECINS SANS FRONTIERES François Jean (ed.), Populations in Danger (London: John Libbey, 1992). François Jean (ed.), Life, Death and Aid: The Médecins Sans Frontières Report on World Crisis Intervention (London: Routledge, 1993). François Jean (ed.), Populations in Danger 1995: A Médecins Sans Frontières Report (Paris & London: 1995). Julia Groenwald (ed.), World in Crisis. The Politics of Survival at the End of the Twentieth Century (London: Routledge, 1996). Fabrice Weissman (ed.), In the Shadow of Just Wars. Violence, Politics and Humanitarian Action (London: Hurst &Co., 2004). Xavier Crombé and Jean-Hervé Jézéquel (eds), A Not So Natural Dis- aster: Niger 2005 (London: Hurst & Co., 2009). CONTENTS About the Contributors ix List of Maps xi Abbreviations xii Acknowledgments xiii l Introduction: Acting at Any Price? Marie-Pierre Allié 1 PART I: STORIES l Sri Lanka: Amid All-Out War Fabrice Weissman 15 – Ethiopia: A Fool’s Game in Ogaden Laurence Binet 35 – Yemen: A Low Profile Michel-Olivier Lacharité 41 l Afghanistan: Regaining Leverage Xavier Crombé (with Michiel Hofman) 49 – Pakistan: The Other Side of the COIN Jonathan Whittall 69 l Somalia: Everything is Open to Negotiation Michaël Neuman and Benoît Leduc 77 l Gaza Strip: A Perilous Transition Caroline Abu-Sada 95 l Myanmar: “Golfing with the Generals” Fiona Terry 109 l Nigeria: Public (Health) Relations Claire Magone 129 l India: The Expert and the Militant Stéphane Doyon 147 – South Africa: MSF, an African NGO? Michaël Neuman 163 – France: Managing the “Undesirables” Michaël Neuman 171 vii CONTENTS PART II: HISTORY l Silence Heals… From the Cold War to the War on Terror, MSF Speaks Out: A Brief History Fabrice Weissman 177 l Caring for Health Jean-Hervé Bradol 199 l Natural Disasters: “Do Something!” Rony Brauman and Claudine Vidal 219 l Epilogue: In the Name of Emergency. How MSF Adapts and Justifies its Choices Marc Le Pape 237 l Afterword David Rieff 251 Notes 259 Index 279 viii ABOUT THE CONTRIBUTORS Marie-Pierre Allié, a medical doctor, is the president of the French sec- tion of Médecins Sans Frontières. Caroline Abu-Sada is the coordinator of the Research Unit of the Swiss section of Médecins Sans Frontières. Laurence Binet is a director of studies at the Centre de réflexion sur l’ac- tion et les savoirs humanitaires, Fondation Médecins Sans Frontières. Jean-Hervé Bradol, a medical doctor, is a director of studies at the Centre de réflexion sur l’action et les savoirs humanitaires, Fondation Médecins Sans Frontières. He is a former president of the French sec- tion of Médecins Sans Frontières (2000–2008). Rony Brauman, a medical doctor, is a director of studies at the Centre de réflexion sur l’action et les savoirs humanitaires, Fondation Médecins Sans Frontières. He is a former president of the French sec- tion of Médecins Sans Frontières (1982–1994). Xavier Crombé is a lecturer at Sciences Po in Paris. He is a former head of mission for Médecins Sans Frontières in Afghanistan (2002– 2003) and a former director of studies at the Centre de réflexion sur l’action et les savoirs humanitaires, Fondation Médecins Sans Fron- tières (2005–2008). Stéphane Doyon is the nutrition team leader at the Campaign for Access to Essential Medicines of Médecins Sans Frontières. Michiel Hofman is a former head of mission for Médecins Sans Fron- tières in Afghanistan (2009–2011). ix ABOUT THE CONTRIBUTORS Michel-Olivier Lacharité is a programme manager for Médecins Sans Frontières. Benoît Leduc is a former programme manager for Médecins Sans Frontières (2007–2010). Marc Le Pape is a sociologist and a former member of the Board of the French section of Médecins Sans Frontières (1998–2008). Claire Magone is a director of studies at the Centre de réflexion sur l’action et les savoirs humanitaires, Fondation Médecins Sans Frontières. Michaël Neuman is a director of studies at the Centre de réflexion sur l’ac tion et les savoirs humanitaires, Fondation Médecins Sans Frontières. David Rieff is an independent journalist, author of A Bed for the Night. Humanitarianism in Crisis (New York: Simon & Schuster, 2003). Fiona Terry is an independent researcher and a former director of stud- ies at the Centre de réflexion sur l’action et les savoirs humanitaires, Fondation Médecins Sans Frontières. Claudine Vidal is a sociologist, Groupe de sociologie politique et morale, École des hautes études en sciences sociales. Fabrice Weissman is a director of studies at the Centre de réflexion sur l’ac tion et les savoirs humanitaires, Fondation Médecins Sans Frontières. Jonathan Whittall is a humanitarian adviser at Médecins Sans Fron- tières—South Africa. x LIST OF MAPS Sri Lanka 14 Ethiopia 34 Yemen 40 Afghanistan 48 Pakistan 68 Somalia 76 Palestinian Territories 94 Myanmar 108 Nigeria 128 India 146 South Africa 162 France 170 xi ABBREVIATIONS EU European Union ICRC International Committee of the Red Cross IMF International Monetary Fund MSF Médecins Sans Frontières NGO Non-Governmental Organisation OCHA Office for the Coordination of Humanitarian Affairs UN United Nations UNICEF United Nations Children’s Fund UNHCR United Nations High Commissioner for Refugees (or HCR: High Commissioner for Refugees) WFP World Food Programme WHO World Health Organization xii ACKNOWLEDGMENTS This book is a collective effort. Marc Le Pape and Claudine Vidal, as well as all our colleagues and interns at the Centre de réflexion sur l’action et les savoirs humanitaires (CRASH/Fondation MSF), have all made invaluable contributions to this project. Caroline Serraf organ- ised the translations, which were proofread and edited with painstak- ing care by Ros Smith-Thomas. This book would not have been possible without the enthusiastic collaboration of the Médecins Sans Frontières coordinators in the field and at headquarters. All are warmly thanked. Paris, July 2011 C. M., M. N., F. W. xiii INTRODUCTION ACTING AT ANY PRICE? Marie-Pierre Allié President of the French section of Médecins Sans Frontières Between 2004 and 2008, nine members of Médecins Sans Frontières were killed in the course of their missions in Afghanistan, Central Afri- can Republic and Somalia. In 2008 and 2009, several MSF sections1 had to leave Niger and the north of Sudan because the authorities had either suspended their activities or issued them with a deportation order. In 2009, under threat of expulsion from Sri Lanka, MSF signed a Memorandum of Understanding obliging it to remain silent—but still did not gain access to the combat zones. In Yemen, in January 2010, the organisation was forced to withdraw public statements deemed inaccurate and insulting by the government in order to keep its activi- ties running. Should we conclude from these events that the “humanitarian space” is shrinking, as many observers of the humanitarian scene have been claiming in recent years? NGOs, United Nations agencies and donors are unanimous in deploring a “growing tendency to close the door to humanitarians, preventing them from helping victims”.2 This would be in stark contrast with a so-called “golden age” when human- itarian actors supposedly occupied “a special position on the interna- 1 HUMANITARIAN negotiations REVEALED tional political chessboard, within a privileged space, untroubled by the geostrategic and political considerations of governments”.3 Since then, according to United Nations (UN) agencies, their space has been eroded by the “blurred distinctions between the roles of military and humanitarian organisations; political manipulation of humanitarian assistance [and the] perceived lack of independence of humanitarian actors from donors or from host governments”.4 Since the end of the 1990s, MSF has also been vehemently denounc- ing the harm caused by the “blurring of lines”, heightened with the revival of western military interventionism in the wake of 9/11, the development of international criminal justice and the integration of the aid system in the United Nations’ political strategies. With their actions now equated with military, judicial and political forms of intervention- ism, NGOs such as MSF would be encountering increasing hostility in developing countries. They would be seemingly faced with a reaffirma- tion of sovereignty on the part of post-colonial states benefiting from the diplomatic and economic support of emerging powers. This book does not set out to deny the consequences of belligerents using humanitarian rhetoric, or the fact that western aid organisations come up against specific difficulties in countries where international forces are deployed. But it does argue the impact of this environment on aid operations, if only on the grounds that the global volume of humanitarian assistance continues to grow. Between 1988 and 2008, the humanitarian aid budget increased ten-fold to reach 11.2 billion US dollars.5 MSF’s own operational spending rose from 260 million euros in 2001 to 634 million in 2010, most notably in Niger and Darfur (Sudan) where the organisation carried out two of the largest missions in its history. Furthermore, evoking a “golden age” in which aid actors were able to realise their ambitions unfettered is to underplay the very real difficulties encountered during the forced displacements in Ethio- pia in the 1980s, for example, or, in the 1990s, the massacres in ex- Yugoslavia and the genocide in Rwanda.