> N°131 / August-September 2004 / Médecins Sans Frontières’ newsletter MISSIONS SUDAN DARFUR Cries for Help P1 ETHIOPIA Towards a post-mortem intervention? P7 FRANCE Reform of the AME P9

DOSSIER AGM 2004 - Excerpts from the Annual Report P10 - The 2003 accounts P15

DEBATES - April 2004 © [email protected] DARFUR/SUDAN - Afghanistan : humanitaria- nism under attack P20 - Arjan Erkel :

Political kidnapping and > Darfur-Mornay Cries for Help official lies P22 - War crimes « in the shadow of just wars »P24 MSF/June 2004/ Excerpt from « Emergency in Darfur, Sudan: No relief in sight » Number 131 - The integration of After a killing spree from September 2003 until national staff P26 February 2004, there is continued violence and The ‘victims of catastrophes’ to whom severe aid shortages in Darfur, Sudan. Current relief we provide assistance, as stated in our Charter, often suffer violence orches- operations fall dramatically short of the massive trated by their governments. Humani- needs and will not prevent an entirely man-made RESOURCES tarianism, although far removed from famine. Focus on Mornay Camp, West Darfur State: any political programme, can find - Exhibition itself in conflict with authorities, “Acteurs d’urgence” P29 whether official or rebel, in its attempt - Portrait : The 80,000 displaced Sudanese > VIOLENCE AND FEAR to provide impartial assistance to Ismaël Fouad P30 civilians living in Mornay camp had populations who are in danger as a fled from 111 villages throughout The killers primarily targeted men, result of their leaders. In such - Vacancies P40 West Darfur State that had been who accounted for three out of contexts we must do our utmost to looted and burnt to the ground by every four deaths. Women and provide these populations access to pro-government militias, with the children were also killed, with more assistance. FROM THE FIELD vast majority of people arriving than 75% of the deaths among A path of destruction P32 between September 2003 and women and 50% of the deaths In the same spirit, but in a broader February 2004. According to a recent among children due to violence. context, we have decided to embark on survey carried out by Médecins Sans Survival for many of the weakest the battle for access to essential Frontières (MSF) and Epicentre, one children and elderly today depends medicines for all. It is indeed a battle, out of every 20 people, or 5% of the on traumatized and exhausted as here too we are often in conflict INFOS original population of these villages, mothers and girls while essential with numerous powers. Nobody has was killed in such attacks. While this survival items like food, drinking given us a mandate for this. It is up to Watch and read P34 Press review P35 average is appalling, particularly water and shelters are distributed us to know how to act and follow our ferocious large-scale killings irregularly and in insufficient Charter wisely, putting aside all Hommage occurred in 11 villages between quantities. Up to 200 people already naivety or saintliness, in the interest to Nicolas Nathan P39 November 2003 and February 2004. die every month in Mornay from and respect of our patients. ■ violent acts, starvation, and disease. while only half that amount seems to water needs have far outstripped the People continue to live in perpetual arrive in West Darfur. village’s capacity. MSF distributes fear of new killings and rapes because 500,000 liters of drinking water per MISSION the same militiamen who conducted The ongoing attacks around the day, or five to seven liters/person/day, the scorched-earth attacks on their camps make people entirely which is well short of the minimum SUDAN/DARFUR villages control the periphery of dependent on external aid that is standard of 20 liters/day to meet all Mornay camp. The men who survived inadequate and irregular. Because of needs. Water shortages have led to the initial killing spree cannot leave acute shortages of food, one child of interminable lines at distribution > TIMELINE without risking death, while women every five in Mornay suffers from ramps, adding considerably to the who dare venture out to gather items acute malnutrition. MSF has treated workload of girls and women. MSF/July 2004/ like wood and grass have been nearly 5,000 children in feeding Aurélie Grémaud exposed to beatings and rapes. Nearly centers – 1,000 for severe acute Latrines are rare in the camp because 14% of the 132 victims of violence malnutrition and 4,000 for moderate geologic conditions make them 25 February 2003. treated by medical teams from MSF acute malnutrition. Since early 2004, difficult to build. In a few days, or An insurrection begins over the last nine weeks were victims the camp’s residents have received, on weeks at most, heavy rains will begin in Darfur of sexual violence. Because of cultural average, less than 1,000 kcal/day, not and excrement will flow across the . 25 April 2003. Rebels occupy El Fasher airport (State capital of North Darfur), capture a general and destroy several military planes.

June 2003. MSF - First application for a travel permit.

3 September 2003. A ceasefire is signed in Abeche, with the President of Chad as an intermediary.

October 2003. MSF - First exploratory mission.

16 December 2003. War resumes throughout Darfur.

Mid-December 2003. MSF - Opening of emergency > Darfur, a destroyed village © [email protected] - April 2004 programmes in Nyala, Mornay, and Zalingei. mores, many cases of rape have most even half of the 2,500 kcal daily ration entire site. Mortality from diarrhea, likely gone unreported. needed to survive. The World Food which today represents one-third of January 2004. Program (WFP) distributed a half- the deaths, will only increase. The government army launches > DIFFICULT ASSISTANCE ration in February, a complete ration land and air attacks on in late April and another in mid-June The shelters are pitiful as well. The numerous villages in Darfur, People also wait in vain for assistance 2004, but the distributions lacked recent distribution of one sheet of forcing over 100,000 people to while there is little to suggest it will critical micronutrients like iron, plastic per family of five will not flee to neighbouring Chad. arrive in time and in quantities sufficient vitamins B1 and B2, and niacin. In prevent respiratory infections, always to prevent large-scale calamity. To feed order to better protect children under one of the leading causes of death for 15 January 2004. people in Mornay alone would require five, three times MSF has distributed children living in such conditions, from MSF- Press Release (PR): 1,200 tons of food every month. 15,000 rations that increase every increasing. “After the forced closure of the Transport alone would require 80 family member’s food rations by 25%. Nyala camps by the Sudanese roundtrips every month on sandy roads And given that rainwater tends to authorities, MSF expressed with trucks designed to carry 10 tons > LACK OF stagnate in such terrain, mosquito concern about the fate of these carrying 15. As the rainy season begins, INFRASTRUCTURES breeding sites will likely swell. The populations.” the roads will be even more difficult to seasonal malaria peak, well known to navigate. Meeting the food needs of all Until December 2003, Mornay was a the region’s residents and doctors, will of West Darfur’s 600,000 displaced village of 5,000 people. With the arrival inevitably bring severe anemia and persons would require 300 tons a day of 75,000 displaced people, drinking death to children as well as adults.

P2 messages MSF N°131 Aug-Sept 2004 Since February 2004, 15,000 children Darfur where aid is being deployed, under the age of five, or 95%, have been but the assistance is still inadequate. MSF’S ACTIVITIES vaccinated against measles. MSF Many officials, both Sudanese and teams conducted 15,000 medical foreign, have visited and often cite the MSF has been working in Darfur since December 2003. consultations with 400 hospitalizations. camp as an example of an effective aid Today, 100 international volunteers and nearly 2,000 Sudanese staff provide But this only represents a small response. Each visit brings promises medical and nutritional care in areas with more than 400,000 displaced fraction of the medical needs. Because of protection and assistance, but people. Medical teams conduct medical consultations and hospitalisation, there is not enough medical and people are still waiting desperately for treat victims of violence, care for severely and moderately malnourished paramedical staff, only one-third of the promises to translate into action. children, and provide water, blanket feedings and other essential items in pediatric consultations and an even In several instances, official visits have Mornay, Zalingei, Nyertiti, Kerenik, El Genina, Garsila, Deleig, Mukjar, smaller fraction of adult consultations yielded grotesquely staged aid Bindisi, and Um Kher in West Darfur State; Kalma Camp near Nyala and have been carried out. operations, with the objective of Kass in South Darfur State; and Kebkabiya in North Darfur State. MSF also satisfying the visitors’ political and continues to assess areas throughout Darfur. > PRESSURES public relations needs. After the Additional teams provide assistance to Sudanese who have sought refuge in AND PROMISES intense violence to which people have Chad in Adre, Birak and Tine, Iriba and Guereda. been subjected, many in Mornay perceive the ongoing attacks, food represent less than 10% of people national and international levels. As In a few days, or weeks at most, shortages, and threats of renewed displaced by a war waged against presently designed, the relief heavy rains will begin and displacement as the continuation of a civilians in Darfur. The events directly operation falls dramatically short of excrement will flow across the policy aimed at destroying them as a affect an estimated 1 million people the needs and will not succeed in entire site. Mortality from group and severely exploiting the and indirectly affect several hundreds preventing an entirely man-made diarrhea, which today represents one-third of the deaths, will only survivors after resettlement. Such of thousands more, especially in famine from wiping out tens of increase. beliefs, even if only perceptions, have terms of food security, while more thousands of lives across Sudan’s damaged people’s psychological well than 190,000 people have sought Darfur region. ■ being and further erodes their ability refuge in neighboring Chad. to survive. Promoting various political interests The MSF report « Emergency in Darfur: must give way to a massive no relief in sight » is available on Those who have fled to Mornay mobilization of assistance on the www.msf.fr Authorities recently announced that they want people in Mornay to return to their home villages as quickly as MSF MISSIONS IN DARFUR (UPDATED 1 JULY 2004/not exhaustive) possible. In Zalinge, 70 kilometers from Mornay, camp officials have been pressured by local authorities to return to their villages in the hope that many residents would follow them. Salaries of reluctant officials are being cut off while others have been threatened with arrest. Without genuine guarantees of safety or the means to survive, people now live in fear of being displaced yet again back to villages that have been completely destroyed.

Aid organizations are being asked to conduct their activities in observance of this policy and to encourage the people to return. Relief workers, already overwhelmed by the catastrophic situation in the existing camps, would have to spread out across multiple villages. It is impossible for community life and farming activities to resume on such short notice in such devastated places, TFC: Therapeutic Feeding especially as the rainy season begins. Centre Many people witnessed family SFC: Supplementary members and friends being killed Feeding Centre before their eyes, and some have not WEST DARFUR STATE: MSF is working in areas where nearly 250,000 displaced people have gathered - SOUTH yet been able to bury the corpses. DARFUR STATE: MSF is working in areas where nearly 60,000 displaced people have gathered - NORTH DARFUR Mornay is one of the first sites in the STATE: MSF is working in areas where nearly 130,000 displaced people have gathered.

P3 messages MSF N°131 Aug-Sept 2004 SUDAN/DARFUR A second disaster looms

MSF/June 2004/Interviewed by Kevin P.Q. Phelan

MISSION President of the French division of Médecins Sans Frontières, Jean-Hervé Bradol has just SUDAN/DARFUR returned from West Darfur, where he visited MSF programs in El Genina, Mornay and Zalingei.

> TIMELINE (CONT.)

9 February 2004. President El-Bashir announces the end of military operations in Darfur.

16 February 2004. The government announces the reopening of access for humanitarian agencies.

17 February 2004. MSF - PR: “Appeal for reinforcement of international emergency aid”

26 February 2004. MSF - PR: “17,000 highly vulnerable displaced persons > Darfur, early morning in Mornay © Sibylle Gerstl / MSF - May 2004 without assistance.” > Coming back from West Darfur, affected young men. The current venture outside of the camps to collect March 2004. what are your first impressions? situation is alarming, mortality is at wood or grass for their donkeys. Rape UN reports systematic Intense violence and the forced emergency levels, and one out of five is frequent. An overview of the massacres. NGOs publish displacement of the population children is suffering from acute situation: reports on the extreme violence brought about a first disaster. In the malnutrition. Violence is omnipresent -demographic catastrophe, with up to exerted on civilian populations. Mornay camp, 15% of family members around the camp. Pro-government 5% of the population assassinated in have disappeared (5% killed, 10% have militia attack the displaced, mostly some areas, one million displaced 10 March 2004. fled). Repression has particularly women and young girls, when they people and 190,000 refugees in Chad; MSF- PR: “New nutritional -overdue, irregular and insufficient assessments among displaced international aid; persons reveal an alarming A COUNTRY AT WAR -persistent violence, admittedly less situation.” MSF/July 2004/Caroline Livio intense, but making the population more dependent on insufficient Two rebel groups, the SLA/SLM (Sudan Liberation Army/Movement), 8 April 2004. assistance; and the JEM (Justice and Equality Movement) demand that conditions for As a result of this pressure, -a government project to return President Bechir agrees to sign the population in Darfur, a region in western Sudan, be improved. The government in Khartoum has long ignored this region and the population people to their villages of origin a ceasefire. now wants to benefit from the oil revenues and administrative powers to without serious guarantees of be shared. security and assistance; 28 April 2004 . Since February 2003 these demands, and the subsequent civil war in -significant logistic difficulties, soon to MSF-PR: “Measles and Darfur, have been underway in the backdrop of the peace negotiations be amplified by the rainy season. malnutrition on the increase… that started in 2002 between the government in Khartoum and the John These conditions all combine to lay the health of hundreds of Garang’s SPLA (Sudan People’s Liberation Army), the main rebel the ground for a second catastrophe thousands of displaced persons movement in the south. At war since 1983, an agreement on the sharing resulting from violence leading to of oil revenues brought about a ceasefire between the two main in Darfur is declining confinement in camps receiving opponents. This war, however, hides a tangle of conflicts and interests dramatically”. insufficient international aid and the involving neighbouring countries (Ethiopia, Eritrea to the east, Uganda to forced return of people back to their 24 May 2004. the south and most recently Chad to the west). Furthermore this north- south conflict that started during the cold war has made foreign powers, places of origin without providing MSF - Report on the the USA in particular, consider Sudan as an international political appropriate conditions of security and humanitarian situation to the interest. assistance. There exists a very real UN Security Council. risk that malnutrition and disease will

P4 messages MSF N°131 Aug-Sept 2004 kill tens of thousands of people in the > (CONT.) upcoming months, even though the TIMELINE situation is not the same all over 26 May 2004. Darfur. Peace agreement. The situation remains highly critical. > Is this a genocide? Pro-government militia have 21 June 2004. assassinated a lot of men, and have MSF - Report: “Emergency in not always spared the lives of women Darfur: no relief in sight.” and children. The two epidemiological with Epicentre figures. studies that we carried out among two groups of displaced people—100,000 people in total—in West Darfur show a high number of assassinated civilians (5% of the inhabitants of the 111 villages that the displaced people in POINT INFO Mornay come from). But mortality and > 16 July, 2004 its distribution inside different > Darfur, Mornay © [email protected] - April 2004 Democratic Republic of population groups do not suggest an attempt to exterminate an entire Congo (DRC) : faltering group of people. Our statistics clearly extermination. Concretely, in the transition process are not exhaustive, considering the The idea of genocide refers to context of Sudan, if we don’t distance Early June, fighting erupted in size of Darfur and the million specific historical situations, such ourselves from the accusation of displaced people, but they are the only as the genocide of the Rwandan genocide, we risk being sucked into Bukavu, fallen into dissident ones based on epidemiological tutsis in 1994. We haven’t seen this the camp of those who, without really hands for many days. In the studies. Furthermore, the public kind of phenomenon in Darfur. believing in it but harbouring ulterior night of June 10th-11th, a statements by the regime have not political motives, threaten military coup d’Etat in Kinshasa was called for the extermination of a intervention against the Khartoum attempted, which also caused particular group, and in the field, we regime. If we’re not clear on this issue, havoc for days. haven’t seen the kind of logistical government and the United Nations, we’ll help create in Sudan the kinds of machinery necessary for such a lacking the words that would shock difficulties we’ve already seen through The events in Bukavu have a project. It’s useful to point out that the people enough to pressure the our interventions in Iraq and direct effect on the programs inhabitants of the West make up more Sudanese regime, have validated the Afghanistan where Islamic groups are in Beni and in Kayna. In spite than a fourth of the country’s term by asking a question—Is accusing humanitarians of working in of the tensions and of the population and a majority of the army. genocide taking place in Darfur?—and the interests of the American-led evacuation of part of the The idea of genocide refers to specific affirm that at the very least it’s a military coalition. In Afghanistan and volunteers’ from other historical situations, such as the matter of ethnic cleansing. A group of Iraq, these accusations are leading to associations, our teams genocide of the Rwandan tutsis in human rights organizations, murderous attacks against humani- remain on the field, in camps 1994. We haven’t seen this kind of permanently campaigning to classify tarian organizations. for displaced people in Beni, phenomenon in Darfur. certain serious crimes as acts of and in a TFC in Kayna. Within genocide, use the example of Darfur > Isn’t forcing hundreds of two months, the number of > Why is so much attention being to promote their cause. These thousands of people from their children admitted in the TFC given to this idea of genocide in the organizations pressure the Security villages a kind of ethnic cleansing? has tripled, and now is around case of Darfur? Counsel and the states that are party The main fear right now of the 1000 children. Teams are also It’s mostly a question of a picture to the Convention on the Prevention displaced is to be sent back to their taking care of women that that’s been painted by political and Repression of Genocide to places of origin. The government, have undergone sexual players, and the idea has had a lot of construct a “new international anxious to announce that the situation assault. All this is taking place success among the media that are political order” where major violations in Darfur is back to normal, wants this in a context of daily extortions used to reducing African conflict to of human rights would justify, when to happen quickly. It’s hard to speak of endured by the local popula- simple caricatures. The conflict necessary, systematic and armed ethnic cleansing when those in power tion. between the central power and the international intervention. are making this prompt return one of Southern rebellion was presented as a In our book “In the Shadow of ‘Just their main political pillars. This These events show how many “war between Muslims and Wars’” we explain that it would be a process is disturbing enough in itself would prefer to maintain the Christians,” and the war in Darfur is mistake for humanitarian action to join without creating false perceptions military option, at the cost of now being qualified as a “war between a plan to forcefully impose a new through inappropriate labels. From a the political option for transi- blacks and Arabs.” The Khartoum international order in the name of humanitarian point of view, this tion. regime took the initiative by human rights. government project worries us as presenting the Darfur conflict as a much as the actual displaced people. [email protected] “tribal war” that the army would > Why take a position Families are weak, and their sudden pacify. In the same fashion, some on this issue? displacement during the rainy season leaders of the rebellion have The diagnosis is important. If it were a to villages that are often in ruins developed the idea of “African tribes” matter of genocide, the main issue would likely bring about high levels of being exterminated by “Arab tribes.” would not be to increase emergency mortality. Even more so in that the Some members of the American aid but rather to use force to end the displaced are entirely dependent on

P5 messages MSF N°131 Aug-Sept 2004 outside assistance for food, and will the World Food Programme (WFP) need to really make sure that this aid remain so for at least another year. currently only barely provides for half doesn’t end up being used against the The current food aid program doesn’t of the requirements. It lacks 200 interests of displaced populations. even provide for half of the people’s trailer trucks, 50 all-terrain vehicles, There are already some concrete needs, at a time when populations are and authorization to use helicopters. signs of this trend: the United Nations MISSION concentrated in a limited number of In about half of cases, food provides food aid to pro-government camps. If the people were dispersed distribution networks are not militia, the FAO provides seeds for the SUDAN/DARFUR in different villages, aid would come operational. Aid needs to be taken to a government plan to send the to a standstill, especially during the new level. displaced people to their places of rainy season. Faced with persistent origin, and the authorities are publicly violence, the displaced feel safer in > How can we reach this “new stating that, thanks to the help of the cities or in large rural camps than in level”? World Health Organization and Unicef, For further information on their villages of origin. During a visit to A more reliable transportation system the health situation in Darfur is under Darfur contact the Sisi camp, on the road between El is essential, as is the development of control. [email protected] or Genina and Mornay, men flocked peripheral aid distribution networks. From an operational point of view, we [email protected] around our car to greet us. We asked The WFP is doing what it can given the need to be ready to welcome new them if they wanted to go back home. constraints. But we have no reason to arrivals at our existing sites, to See also page 32: They pointed to a place just a few believe that it will be able to distribute as much food as possible Darfur: Path of Destruction hundred of meters away and said, “We completely cover the planned alongside the WFP and to develop the can’t even go past that hill, because operations before several months. capacities of our hospitals to deal with we know we’d be attacked. So we can’t Feeding a camp like the one in Mornay epidemics. Malnutrition and diarrhoea imagine being able to go back home requires 1,200 tons of food every are already significantly affecting in these conditions.” month. Three hundred tons of food mortality rates, which are varying would have to be distributed to satisfy between emergency level and > How could the situation the people’s needs in western Darfur, catastrophe level. Other epidemics improve? which would require a supply chain may develop during the rainy season In the short term, in order to save the that doesn’t exist, just when the rainy and will be all the more fatal to a lives of tens of thousands of displaced season is beginning. malnourished population. people, the violence must stop, and international aid must be stepped up. > What does MSF need to do? Respect for the government of rights Where violence is concerned, the The government has changed its of the displaced and the quality of government project of sending attitude. It is no longer blocking the international aid supply chains will be displaced people back to their villages arrival of aid. But it is intending to use the two determining elements for the of origin provokes legitimate concern. international aid resources for its plan survival of tens of thousands of From the point of view of assistance, to bring Darfur back to normal. We individuals in the upcoming months. ■

> Sudan - Darfur © Ton Koene - May 2004

P6 messages MSF N°131 Aug-Sept 2004 ETHIOPIA Towards a post-mortem intervention? MSF / June 2004 / Interview by Olivier Falhun

POINT INFO > 16 July 2004, Ethiopia: the answer is no…

Ethiopian authorities have finally decided to turn down the joint evaluation mission proposal that they let us hope for until now. They reckon they do not need assistance. The World Bank has led evaluation missions on its own side. Whilst recognising that on many sites, the resettlement process was unsatisfactory, it has nevertheless awarded some credits. The World Bank has also planned to send out a team of ‘consultants’ to Ethiopia. As for us, we have tried persistently to contact > During the malaria epidemic in Gutten, East Wollega, Ethiopia. © Florence Gaty /December 2003 the Bank, but in vain: the office in New York keeps A plan to resettle people from the highlands was begun last year in Ethiopia. The referring us back to the office Ethiopian government plans to move 2.2 million people over a three-year period in in Addis Abeba… response to chronic food shortages that afflict these people. But recent evaluations carried So we are back to square one, out in the Oromo region, where many Ethiopians have already been resettled, reveal an contacting various journalists alarming situation -- and the rainy season is about to begin. Graziella Godain, programme to alert them of the situation, manager for Ethiopia, describes her concerns. but with the handicap of not having a more recent evalua- tion than the last one in May. > Can you tell us how far the began a series of evaluations in April the Illubabor region – were enough to We will also attempt to contact resettlement process has got today? in the Illubabor and East Wollega convince us of the urgency of an authorities again, however Since the start of this year, 190,000 regions in order to evaluate the scope intervention, which was unfortunately without much conviction. people have already packed up and of the needs and to learn a little more rejected by the authorities. At all the Meanwhile, the rainy season moved to more fertile areas in the about the risks faced by the sites visited, we observed mortality has well settled in. framework of intra-regional move- population. rates above the alert threshold, ments mainly in Oromo, but also in the particularly for children under the age [email protected] Tigre, Amhara and SNNPR1 (see map > What did the MSF evaluation of five2. Among the causes of this overleaf) regions. In March, a joint teams observe on-site? mortality level is the nutritional team of representatives from the It is important to note that situation, which is very disturbing: the government, the United Nations and unfortunately we did not have access food rations distributed are international donors (e.g. USAID, to all the sites. We could not visit the insufficient and the many cases of European Union, World Bank) carried Haro Tadessa site, even though the diarrhoea compound the problems. out evaluations at 37 sites. The results local authorities report that is has one We observed a high prevalence of – which were disturbing – were sent of the highest prevalences of malaria malnutrition – severe or moderate – to the government and to NGOs. and malnutrition. at all sites we visited. Malaria is also a Convinced by institutional donors and Nevertheless, the evaluations that we factor of mortality: some sites have the United Nations to go on site, we were able to carry out – particularly in already been affected by the disease.

P7 messages MSF N°131 Aug-Sept 2004 MISSION ETHIOPIA

> In MSF’s archives…

Although we should be wary of drawing parallels

between the current > Internally displaced people, Ethiopia. © Stephan Vanfleteren - March 2003 situation and the resettlement policy that existed under Furthermore, the water supply is > What are MSF’s main concerns? access difficulties and the epidemic the Derg regime, a rummage insufficient at most sites visited, which We have already observed worrying risk will represent serious obstacles through the MSF archives also leads to diarrhoea among the mortality rates, particularly among to any hypothetical intervention. To all may nonetheless prove most vulnerable individuals, children below the age of five. And those who today assert the urgency of useful. In 1987, particularly children. several factors make it difficult to be waiting, we respond that it is more ■ for example, François Jean optimistic. The imminent rainy season urgent to intervene… > How do you account for the could in fact lead to a catastrophe. For wrote of the resettlement attitude of the Ethiopian example, people displaced from the policy set in motion by government? highlands are directly exposed to the 1- SNNPR = Southern Nations, Mengistu in the wake of While our relationship with Health danger of malaria since they have not Nationalities, and Peoples Region the 1985 famine: Ministry representatives was often developed any immunity. A 2- The alert threshold is 2/10,000/day. strained in the past3, it seems that this widespread epidemic cannot thus be 3- In December 2003, while a widespread time the resettlement plan is directly ruled out. There is no expected epidemic raged in the East Wollega At Médecins Sans driven by the Ethiopian Prime Minister, improvement in food aid either: region, the authorities treated MSF’s “Frontières we have always who wants to obtain funding from although the authorities have begun to Ethiopian representatives as been clear about this: international donors. However, the increase food distributions (through “charlatans” in response to our request we have only ever contested donors require “guarantees” on the Unicef and the World Food to treat malaria patients with artemisinin the way in which these coherency and smooth implementation Programme), they remain insufficient, derivatives, while the only first-line relocations were carried out. of the process before they agree to and the rainy season will not facilitate drugs authorised at the time had turned donate. There is on one side, therefore, the delivery of hypothetical assistance out to be ineffective. Since then, the However, we do also feel a government with every interest in to areas that have become authorities have changed their mind and that they are the product of minimising the consequences of inaccessible. More broadly, the have authorised us to import these drugs a development plan which resettlements in order to obtain funds, shortage of aid along with these now. has been imposed from and on the other donors sceptical of the above and which is, scope and implementation of the plan as a result, detrimental. and who are waiting to see… It is not for MSF to judge the coherency and/or relevance of this resettlement François Jean, De l’Ethiopie à “ programme, our proposed intervention la Tchétchénie - Les cahiers responds solely to the emergency du Crash (see page 36). situation that we have observed. The authorities however met this proposal with a lengthy silence before contesting the conclusions of our inquiries and “inviting” us to carry out new evaluations with them. Lacking authorisation, we are now forced to accept this offer, at the risk of seeing an already critical situation deteriorate. It remains to be seen when this umpteenth series of evaluations will be carried out…

P8 messages MSF N°131 Aug-Sept 2004 FRANCE POINT INFO Reform of the AME: > 16 July 2004, No more camps a health crisis foretold in Ingushetia

MSF / June 2004 / Caroline Livio ([email protected]) As a the result of increasing pressure put on the displaced Six months ago, Médecins du Monde (MDM) and Médecins sans Frontières (MSF) people to go back to published in le Monde an open letter to warn health and social services ministers of the Chechnya, the Satsita camp, dangers of the Aide Médicale d'Etat (AME, state medical aid) reform. Six months later, the last remaining camp in the our teams report on and denounce the perverse effects of this system. region, was closed down on 10th June 2004. The Chechen In December 2003 the government are admitted as emergencies with The commitment of these four families who did not submit to reformed the AME, a system reserved serious illnesses which have not been organisations, which has received the pressure went to swell the for people living in France with treated in time. They are also faced widespread media coverage, has ranks of the Kompakniki, extremely low incomes and no with a toughening-up of the apparently provoked a reaction from disused factories and farms. residency permit. The changes made administrative procedures involved in the new Minister of Health, Philippe Some were able to rent a to this system, which provides 150,000 compiling their files. For some, the Douste-Blazy. In a debate organised room from a local. According of the most vulnerable people in result of these problems is that they by the daily paper Le Monde, on the to the official records of the France access to health care, hinges quite simply give up any attempt to 14th June, he promised he would draft High Commission for on two main elements: the abolition of seek treatment. On the 8th of June a new circular allowing those without Refugees, at the beginning of immediate access and the end to free 2004, the four organisations again papers and requiring urgent medical June 2004, there were treatment for patients. The latter must denounced the damaging effects of attention to benefit from the AME once 54 622 displaced Chechens therefore wait for an unspecified the AME reform and requested a again. This would re-establish, to an in Ingushetia, of which 24 366 period until they receive a possible return to the system which existed extent, immediate access. For the were in the kompaktniks. positive decision from the Caisse before December 2003 which provided moment this commitment seems Primaire D’Assurance Maladie (state those most in need with genuine and more like just another empty During the night of June 21st health insurance). They must also immediate access to healthcare. statement. ■ to 22nd, commandos carried provide proof that they have been out attacks in Ingouchie which continuously in the country for a left 88 people dead and 200 period of at least three months. THE PROVISIONS OF THE AME injured. Since then, there has been a significant increase in From December 2002 onwards, many - The AME is aimed at people living in France who have no Social Security violence and pressure put on medical and welfare organisations had benefit and who earn less than the CMU threshold i.e. 566.5 euros a the displaced people, causing month. already become very active in some to return to Chechnya - Since the law reform of 1992, the AME can be obtained as a precautionary protesting against the first changes to and leaving others homeless. measure, for periods of one year, before the appearance of symptoms the Couverture Maladie Universelle On the 8th July, a special necessitating medical care. operation of identity checks (CMU =) and the AME. A petition - If eligible, the AME provides access to healthcare refundable by the CMU launched by Médecins Sans Frontières meant that in 3 MSF clinics in (visits to doctors, extra examinations, nursing care, dental care and care Ingouchie, consultations had collected more than 100,000 in hospital) with the exception of spectacles, artificial limbs and medical to be suspended as the signatures. A year later in December appliances. 2003, MDM and MSF condemned the - Immediate access to the AME is designed to allow, in cases of medical or patients, awaiting the control, damaging effects of the AME reform social emergency, rapid entitlement to those benefits which would allow hid in their homes. The in a joint appeal signed by 160 the medical care necessary to prevent any deterioration in the state of following day, the consulta- organisations, amongst which were health of the person concerned. tions were able to the Samu social de Paris and the recommence. Comité médical pour les exilés (Comede). WHAT HAS CHANGED IN THE LAW Today, several pregnant women have returned to December 2002 : The first signs of the 'health crisis' Chechnya, followed by MSF - Expansion of access to healthcare outside hospitals for those entitled foretold at that time are quickly and are no longer being to the AME who have lived for less than 3 years in France, following the looked after since access to becoming apparent. Every day, example of Paris and the Seine-Saint-Denis. medical teams from these four care is almost non existent. - Introduction of a patient's contribution for those entitled to the AME. In this region, the possibility of organisations witness the harmful The amount of the contribution, which means an end to free access to intervention for aid workers is results of the new system : in reality healthcare, is to be defined in an implementation order which is as yet patients have no access to general unpublished. reduced to almost nothing, medical care unless they are able to since the violence which is pay the cost of consultations December 2003 : being suffered by the civil - Abolition of the right to instant access to the AME, even in cases where themselves; they are sent to already populations is also affecting 'the situation demands it '. overcrowded hospitals even for humanitarian workers. - Requirement of continuous residence for the last three months in treatment which does not require the France in order to benefit from the AME. medical technology of a hospital, or [email protected]

P9 messages MSF N°131 Aug-Sept 2004 December 2003 December © Stefan Pleger – Pleger © Stefan © Ton Koene – May 2004 © Ton Darfur Uganda

DOSSIER ANNUAL GENERAL MEETING 2004 ANNUAL GENERAL MEETING 2004 Excerpts from the Annual Report

Presented at MSF’s 33rd Annual General Meeting MSF/May 2004/ Dr. Jean-Hervé Bradol, President of Médecins Sans Frontières

Although Jean-Hervé Bradol mentions in the introduction to the President’s Annual Report that, overall, the results in 2003 were good, he also recalls that it is the Board of Director’s role to offer a critical review. It is with this in mind that the following excerpts have been selected, focusing on the current and future key issues that contribute to the construction of responsible, independent humanitarian actions. Nevertheless, given the number of subjects addressed in the President’s report, we strongly recommend reading the full report available on www.msf.fr.

OUR ASSOCIATION’S unaccustomed to moving into countries THE EMERGENCY IN DARFUR ACTIVITIES where an MSF France mission does not (…) In recent months, MSF teams have already exist. We have to pick up located at least 400,000 people > THE DIFFICULTIES OF somewhat in this area but I think that gathered at different sites inside Sudan, INTERVENTION since early 2004, the emergency desk with very little mobilization on the part has really begun to pay close attention of U.N. agencies, the ICRC or other aid (…) We have recently shown ourselves to this issue. organisations. This situation is often to be somewhat reticent about In addition, in countries where we were presented as a new phenomenon. responding to emergencies in countries already well established, we sometimes However, to my knowledge, it has where we are not already present. Two found it difficult to launch an emergency existed since the early 1990s. My examples from 2003 illustrate this response under good conditions. e.g. personal recollection does not reach development. In Iraq, we were very the start of one of the year’s major further back but based on my hesitant about mounting a surgical emergency responses, Liberia, where experience, we have regularly been mission in Baghdad during the U.S. disagreements within the operations involved in this type of situation offensive. During the summer of 2003, department were followed by a delay in –working alone in places where we had difficulty launching a response the operation’s initial phase. We had, extensive aid is required– since the when Algeria needed aid following the however, been working in that country early 1990s. That is why we decided to earthquake. I think we have become for many years. extend the range of our aid to include

P10 messages MSF N°131 Aug-Sept 2004 certain forms of food distribution. This essential issues. We must continue to unrealistic to me. Referring back to the Afghanistan, where we have does not involve general distribution of work to improve our actions. Ituri example, I felt that MSF’s demand misunderstood the kind of aid the full rations, but we are now distributing for international military intervention to population needs and where, a few supplemental rations much more > ANALYSING CONFLICTS pacify the entire province was quite weeks ago, the coalition dropped frequently. Although as a medical unrealistic. MSF is are not capable of leaflets on the Afghan population. Those organisation, our original mission did (…) We sometimes found it difficult to deploying medical aid on a consistent leaflets explained that if people did not not include this activity, the Annual understand conflict dynamics and basis over the entire Ituri province. So join the coalition’s anti-Taliban effort General Meeting and the Board of tended to rely on simplistic ethnic or given this complex situation, how could and the Hamid Karzai government, they Directors decided to incorporate it over religious explanations. This can be seen it possibly be feasible to show up from would not receive humanitarian aid. I ten years ago. At that time, there was within the teams. In this current period in abroad with soldiers, suddenly resolve think we should speak out more clearly already a shortage of organisations international relations, political actors-- all violence and obtain access to aid for on such occasions. working on behalf of populations especially the most radical-- exploit such civilian populations? It would take a suffering the effects of major crises. explanations. We must, therefore, make miracle. We cannot promote such > ARJAN ERKEL’S every effort to avoid replicating these delusions, but our public statements in KIDNAPPING* THE FAILURES IN SOROTI views, which fail to take into account the this area sometimes veer off course. I In the Uganda emergency – 100,000 factors and dynamics that generate do not mean to suggest that there is no As a result of our colleague’s displaced persons who gathered in the armed conflict. These situations cannot relevant criticism to be made about the kidnapping, we limited our operations town of Soroti – our operation began too be reduced, as some would have it -- international military response in Chechnya. We mobilized considerable slowly and was unsuccessful. We including some of us-- to a confrontation (continued insecurity in the town of energy throughout the international consider this a failure among our major between so-called Arabs and so-called Bunia, the limited military effort to movement. emergency operations. The primary black populations in Sudan. These provide massacre victims hospital Last year, I said that Arjan was the reason is that we did not time our aid simplistic analyses also resurfaced access), but the criticism cannot be victim of a political kidnapping. While deployment properly in response to a during the conflict in Ituri (RDC), where understood if presented in this way. searching for him, we were clearly able measles epidemic. (…) We are not the only our teams sometimes fell into the trap of to establish that members of the party responsible for this failure as we this mindset. As an association, we must > THE NOTION OF Russian administration were involved at were not officially in charge of pay careful attention to these points: HUMANITARIAN AID the time of the kidnapping and that vaccinations, but we could have done given the involvement of multiple other administration members were more in this area as well as in the hospital international military, the Ugandans and Médecins Sans Frontières spokespeople— involved in his detention. A member of care of children. This episode resulted in the Rwandans, it is fairly obvious that not just from this section—who have an the Dagestani parliament and a a certain number of avoidable deaths. It is that the Ituri situation cannot be opportunity to speak out should comment Dagestani member of the Russian difficult to be precise because there was summed up as a tribal war. In this more frequently on how commonly that Federation parliament played a part in no scientific evaluation, but to give you an situation, the actors are competing to notion of humanitarian aid [the insistence his kidnapping and detention. We order of magnitude, avoidable deaths grab natural resources. The political and of coalition’s leaders to claim that applied pressure both in meetings with probably totalled 100. Our assessment of social forces at work in this conflict are delivering humanitarian aid is among the diplomats with close relations with the Ugandan health ministry’s teams’ much more complex than so-called goals of their military operations] leads to Russia and by raising the issue in the capacity to perform (with support from interethnic hatred. failure. Indeed, that is what is at stake. press. These public campaigns, which Unicef) was based on the illusions our Aid provided from a position of lasted for a year, led to Arjan’s recent teams had developed, over many years, STAY REALISTIC partisanship represents not only the regarding the Ugandan regime. It is Likewise, during our discussions on non-respect of humanitarian principles important to recognise that some of our conflicts, we have heard renewed calls but above all, in practice, it results in * See also page 22: « Political Kidnapping emergency operations sometimes fail on for international protection. This seems very ineffectual aid. This is the case in and Official Lies ». •••

Cambodia © Espen Rasmussen – February 2004

P11 messages MSF N°131 Aug-Sept 2004 ••• release. I have always been committed DIFFICULT RELATIONS prices, etc. I encourage the teams to be to honest communication within the The last point I would like to make about cautious about the workloads they organisation regarding these types of Arjan Erkel’s kidnapping is that is was create for themselves in these events even when, for obvious reasons, extremely painful to work with the programs. Once again, MSF’s I could not provide all the details. To the international group responsible for commitment to patients under our DOSSIER best of our knowledge, the Dutch handling the matter. I am not referring direct care is to keep an acceptable government paid the Russian to the individuals who were involved on proportion of them alive. If we accept ANNUAL GENERAL government a ransom – a large one – to a daily basis. I have extended my too many, we are unlikely to achieve that MEETING 2004 free Arjan. Now the Dutch government warmest thanks to Thomas Nierle and objective. is demanding reimbursement from us. I Jean-Christophe Azé for the close do not know what the leaders of the cooperation we were able to develop, but > THE CAMPAIGN FOR Swiss section, as the section directly relations with the International Council ACCESS TO ESSENTIAL involved, will decide but I find this and the executive directors’ group were MEDICINES shocking. In the last 10 years, the very difficult. Disagreements run deep federal government of the on the matter of the ransom. Without the THE CAMPAIGN’S OBJECTIVES Commonwealth of Independent States agreement of Rafa (the Spanish section) (…) Discussions on the Campaign’s (CIS) has kidnapped several European or the French section, the executive focus should now take a new turn. Since Union citizens, later “selling them directors’ group chose to pursue a it was founded, the Campaign has faced back” to their countries. I think we have disinformation campaign after Arjan a certain ambiguity, which is becoming to speak out on the issue. Remaining was released. Stupidly, they claimed more pronounced. That same ambiguity silent will not protect our teams. Indeed, that no ransom had been paid. All the has existed for years within MSF across four of our colleagues have been journalists who specialize in covering a range of “medical” issues. A tension kidnapped since 1996, proving that the Caucasus knew this to be untrue. It exists between our responsibility as while silence prevailed, kidnappings was a particularly harmful course of humanitarian doctors and our increased. Although Arjan was able to action. In general, disinformation responsibility for public health. We are get out, many people are still held campaigns are a bad idea. They are an seeing an increasing temptation (…) to against their will today in the Caucasus. even worse idea for a humanitarian “cover” medical needs at the provincial organisation like ours. In practical level and whole parts of countries, and terms, I consider it a disaster for our for MSF to assume what are ultimately teams’ security. We managed to defend political responsibilities, like those of a Arjan by relying on public information provincial physician, a director-general campaigns. We were able to do that for health or a health minister. I thought because the media and the reporters that in recent years, our positive who deliver the messages trust us. If influence on other actors, including they become convinced that we are those in the political sphere, resulted taking this kind of line – betraying their from taking the opposite approach. Our confidence – we may not be able to get success in pushing things forward did our message across in the future when not come from co-administering we find ourselves in other very difficult national protocols with authorities. situations. Instead, we moved away from the protocols. We were innovative and > COMMITMENTS AND ahead of the curve, at least slightly RESPONSIBILITIES ahead (let’s not go overboard). In any TOWARDS AIDS PATIENTS event, when we broke with prevailing practice we succeeded in influencing (…) We have a hard time addressing the other actors. needs of the patients waiting in our To my way of thinking, adopting a active lines. That is why, although mindset that calls for co-managing daring to launch the use of change with public health players in the antiretrovirals was a success in itself, I countries where we respond will would like to say (…) that while the first prevent us from being a force for goal may have been to begin, the change and continuing innovation. second is to keep patients alive. I do not This will be a key issue in discussions think we are there yet. This is a highly within the Campaign because that complex situation. We are dealing with temptation is strong. I was particularly the following: children; pregnant disappointed, for example, to see that women; treatment of tuberculosis and, we organized a conference on malaria more generally, opportunistic in cooperation with Unicef in New York, infections; preparing to change giving the impression that we agree treatments if the patient cannot tolerate with Unicef on these issues. I thought first-line antiretrovirals; detecting that the reality in recent years was just resistance and setting up second-line the opposite. Indeed, Unicef’s policy has treatments; and obtaining diagnostic been an obstacle to effective treatment. > Cambodia, HIV Treatment © Espen Rasmussen - February 2004 tests and treatments at affordable These and many other signs indicate

P12 messages MSF N°131 Aug-Sept 2004 that we are once again tempted to take ministry of health, and who receive a INTEGRATION OF NATIONAL STAFF * on a responsibility that belongs to stipend from us; and daily contract As Board members, the final point that health officials in the political sphere, workers in our employ. requires progress is in formally not to us. (…) (…) It is obvious that the daily workers integrating national staff members who are not paid adequately. Given the wide- already hold positions of responsibility STAY ON COURSE ranging economic and social contexts into the decision-making teams (i.e. (…) I would like to call your attention to a shift within the Campaign that I found quite troubling. I think the Campaign’s communication adopted a lobbying approach. That is, the goal of winning the issue took precedence over making > National staff contract our point of view known. If the official contact we spoke to did not accede to our request, we punished that person “The contracts are not by issuing a very critical press release. “up-to-date and are of poor However, if the person agreed with us— quality. People who work for example, if the World Health for us must do so under Organization responded positively on terms that respect their fixed-dose combination of ARVs--then rights and their dignity.” we spoke more positively about the WHO. Our communications served either to “ punish or reward. In simple terms, the result was that instead of expressing our ideas on certain issues, we handed out points for good and bad behaviour. When WHO appeared to make a few small concessions during World AIDS Day, MSF issued a very favourable statement about the organisation on > Russia, Arjan Erkel released © Reuters - 11 April 2004 December 1, muting our criticism of > Medical coverage WHO’s 3X5 plan. According to this plan, 3 million people would be placed on in which we work, it is impossible to set within the sacrosanct field teams, antiretroviral drugs in two years. We an international standard, but there are typically composed of expatriates, and (…) the Board of Directors’ find that to be an unrealistic goal, some guideposts. Income of $1.00 per within the equally sacrosanct capital “policy regarding medical especially given that WHO’s action plan person/day is the threshold of extreme teams). There has been some progress does not mention whether treatments poverty for international institutions. on this issue, but also considerable coverage for all our national will be free and does not raise the issue This can only serve as a point of resistance. (…) This does not involve personnel is barely being of the price of generic medicines. The reference, given how situations vary. But replacing international staff with implemented. (…) We must conditions for success of these actions overall, we should try to increase national staff. Rather, it is a matter of give priority to implemen- are missing. We carefully avoided salaries. Médecins Sans Frontières involving colleagues, who already have ting this policy, as well to highlighting this because on the evening employs some daily-workers full-time, responsibilities, in decision making and the issue of contracts and of November 31, a WHO official made a over several months, and we pay them a evaluating operational results. In a the treatment of daily very tactical concession, over the salary--to put it in concrete terms--that word, this means involving them in workers telephone, regarding fixed-dose often does not cover their children’s guiding operations in the field as well combinations. school fees and expenses. That is as in the capital. In my opinion, the Campaign’s unacceptable. “ Excerpt from the annual report communications should once again I know that it is standard practice to It also seems to me that this is what it focus on getting MSF’s positions out and exploit daily workers, especially in means to work for a non-profit abandon this opportunistic and Africa. When you do not take advantage organization, where a staff member is politically ambiguous approach. of them, or take less advantage of them, not just an employee who takes orders you stand out and are criticized. But I from a boss, but someone who can help would like to warn our coordinators define objectives and share THE STATE OF –the coordinators of our missions– that responsibility for results –successes as THE ASSOCIATION some of these situations constitute well as failures. In my opinion, what can reasonably be called labour Médecins Sans Frontières draws > NATIONAL STAFF exploitation. This results in considerable strength from this. (…) unacceptable humans costs and limits (…) I am going to give you estimates the quality of work. Last fall, I met 500 ••• because these staff members fall into day-workers in Liberia who were three large categories: stable personnel working for MSF. I have to say that I was * See also the summary of the debate under contract; individuals employed not very proud of how we treated them. on the integration of national staff principally by another entity, e.g. the Frankly, I was ashamed. on pages 36 et 37.

P13 messages MSF N°131 Aug-Sept 2004 •••

> ABUSE a part of regular management centres. We believe that the third strategy, accusing colleagues of member of the capital team understood One of the final points I would like to stealing MSF material that he had that he had failed in his duty and had address is how abuses are handled. taken, sexually abusing minor girls demonstrated negligence. He received DOSSIER Managing an institution also means including some for whom he was a written reprimand. managing internal discipline. At the acting ‘in loco parentis’ and the capital Since we are also committed to being ANNUAL GENERAL time of the scandal in the West Africa team’s failure to respond—we made as transparent as possible on these MEETING 2004 camps two years ago, we tried to the following decisions. Obviously, this difficult matters, here is an example clarify our ideas in this area. logistician no longer works for MSF. of abuses. The Board of Directors I would like to tell you a story, We also decided to notify the legal insisted that at least one example be although I will not name the country authorities in France of his relations presented to you. Every year we will or the people involved. I will briefly with minors because he is a French try to consolidate our reporting back explain what happened and will review citizen. on this aspect of our decisions. the management committee’s > On abus… decisions, which the Board of There was a similar case several years I would like to add another word Directors supported. ago, which I have mentioned. Around regarding this matter. Some members In an African country, we had a 10 years ago, Brigitte Vasset, then of the team involved explained their Failing to understand that “ logistician, a member of the operations director, reported one of behaviour in terms that I believe certain acts are unaccepta- international staff, whose method of our members to legal authorities expressed tremendous contempt for ble both for national and managing national staff consisted of because of acts committed outside the young people, young women, young international staff is incom- using sexually suggestive insults. He country against foreign persons. African women and, in particular, patible with carrying out thought that using such words on a young poor African women. This responsibilities in the daily basis in the work environment Concerning the three members of the ideological background explains, in capital. I advise everyone— reflected attitudes in that country. capital team involved, two did not part, why a certain number of field coordinators, heads of Second, he stole MSF supplies and appear to understand that it was behaviours are still common in the mission and program third, he had repeated sexual relations unacceptable to look the other way places where we respond, especially managers—to be vigilant in with minors. This continued for a when witnessing abuses. We told them in Africa. In the letters I wrote to some this area certain period of time. Fourth, the that they were not to apply for positions of these people, I explained, politely coordinators in the capital did not pay of responsibility in a capital again. We but firmly, that we do not share this adequate attention to this serious are not removing them from the vision of Africa, women and young Excerpt from “ situation. association or from missions. We have people in difficult circumstances. the Annual Report When we became aware of this notified them that we will transmit this These beliefs are incompatible with behaviour—insulting national staff as instruction to the other operational our work. ■

1. Philippe Houdart, Treasurer 2. Cécile Serre-Combe, Vice-President 3. Sylvie Lemmet, Deputy-Treasurer 4. German Casas (coopté), 5. Pascale Noterdaeme Van Den Ostende, 6. Jean-Paul Dixmeras, 7. Jean-Hervé Bradol, President 8. Jacques Allix, 9. Marie-Pierre Allié, 10. Elise Klement, 11. Michel Agier, 12. François Bourdillon, Vice-President

Absent from the photo: Marie-Christine Ferir (general secretary), > The new Board of Directors © Didier Lefèvre – May 2004 Virginie Raisson (deputy general secretary)

P14 messages MSF N°131 Aug-Sept 2004 THE 2003 ACCOUNTS Deciphering … MSF/June 2004/Marc Sauvagnac, Finanical Director, Ann Avril, Head of Fundraising

MSF is responsible for providing its donors with a record of accounts to show that its activities are in line with its social mission and its objectives. The annual financial report was an opportunity to examine the framework of the organization as well as how the association’s uses its funds in more detail. Clarification.

MSF’s statutes stipulate its social members on the management teams dedicated to the projects that 2002 and 2003 accounts take these missions: “to unite (…) capable of the satellites (boards of directors or encouraged their donations in the first modifications into consideration, so as persons (…) to bring assistance to management committees, depending place. This measure is expressed by to provide comparison. populations in distress, to victims of on their legal status). the ‘social missions’ ratio, which natural or man-made disasters and to compares the percentage of funds > EXPENSES RELATED victims of armed conflict (…), to make > COMBINED ACCOUNTS spent on social missions to the total TO A PROJECT use of all physical and material means amount spent. to help those populations (…), to Combination is a complex operation, While it may provide a view of the inform and raise awareness (…) which groups together the accounts of > DEVELOPMENTS IN 2003 association’s objectives (social among the public, association donors, all the entities controlled by the mission, fundraising and and the various institutions whose association. MSF chose this method administrative functions), as well as support determines our activities…”. with the aim of transparency and evaluate the financial independence of accountability, as it provides for one While it may provide a view of the the association, the statement of > THE SOCIAL MISSIONS single economic unit, and thus reflects association’s objectives (…), as financial activities does not provide the financial flows and assets of the well as evaluate the financial any additional information with If programs are at the heart of MSF’s group. Also, since MSF France is a independence of the association, respect to the nature of projects social missions, there are many other member of an international the statement of financial activities carried out in the field. activities that are also instrumental: movement, it must provide a financial does not provide any additional For the last two years, MSF has information with respect to the - Operational support, which is an report in keeping with the format of compiled a typology grid of its nature of projects carried out in integral part of our programmes, and international non-profit organizations the field. operations, which provides a better which allows the coordination of and that is also compatible with appreciation of its objectives. The activities with teams in the field. This international accounting standards. typology highlights the main events support includes all personnel, affecting populations, which have led whether operational or technical, who > ORIGIN, DESTINATION In 2003, we decided to modify the to the opening of various projects. We collaborate on the definition and AND DIVISION OF FUNDS presentation of the statement of thus have a view of our program implementation of projects in the field. financial activities, with the aim of expenses which is more comparable - Informing and raising awareness As a supplement to the mandatory reporting better to our donors the use with the definition of the association’s among the general public, which yearly financial reports issued by of the collected funds, adapting the operational project as well as to the includes making the public aware of businesses and private organizations, reports so that they more closely context of our interventions.■ those events to which vulnerable publicly funded organizations must resembled those of an international populations become victims. provide a statement of financial non-profit organization, and to bring - Activities linked to the social activities, which clearly lays out the them in line with international mission, including in particular the use of donors’ funds as well as accounting standards. Campaign for Access to Essential whether or not those uses conform to The main focus of these modifications The financial report Medicines, the DNDi or the purchase the organization’s social mission. was to register the costs of mailings is available on www.msf.fr of medical and logistical materials The combined statement of financial and canvassing as fundraising costs, For further information: destined for programs in other activities shows the origin of funds, since mailings play a significant role [email protected] sections of the movement or NGOs. both from private donors (collected in in raising awareness (in previous France, by the partner sections of MSF years, part of the costs of the mailings > THE SATELLITES France or quid pro quo for activities was budgeted for as a field mission for carried out for other sections) and this exact reason). In order to improve the efficiency of its from public institutional donors of However, the losses and gains on assistance, MSF has created individual countries or the European exchange rates are from now on to be independent satellite entities (see box Union. The percentage of institutional excluded from the income and page 17). Although they work mainly funding reflects the independence of expenses used and will therefore also for the French section of Médecins the organizations’ politics and actions. be excluded from the calculation of the Sans Frontières, they also provide The combined statement of financial ‘social mission’ and ‘private funds’ their expertise and services to other activities also details the allocation of ratios. Nevertheless, they are still sections of the movement as well as to these funds: for MSF’s social counted in the total income and other non-profit organizations. MSF missions, for fundraising or for expenses and are therefore included controls these entities through the administrative costs. It allows donors in the calculation of the results. In the presence of a majority of its board to measure the percentage of funds 2003 financial report presentation, the

P15 messages MSF N°131 Aug-Sept 2004 THE 2003 ACCOUNTS The Financial Report

MSF/June 2004/Marc Sauvagnac, Financial Director, Ann Avril, Head of Fundraising. DOSSIER A closer look at the key trends of the 2003 financial report, presented at MSF’s 33rd ANNUAL GENERAL Annual General Meeting. MEETING 2004

> EXPENSES

In 2003, MSF’s combined used expenses amounted to 93.7 million euros (M€), an increase of 5.4 % (+ 4.8 M€) from 2002. The social mission expenses represent 87 % of combined used expenses and have increased by 7 % (+5.2 M€) from 2002. Expenses related to fundraising have decreased by 9 % (-0.7 M€) and administrative costs have increased by 8 % (+0.3 M€).

5% Combined Expenses (in millions of euros) 2003 2002 8% 1. Mission expenses in France and abroad 59,3 M€ 63 % 56,0 M€ 63 % 6 2. Operational support Paris 7,5 M€ 8 % 6,9 M€ 8% 5 3. Informing and raising awareness among the public 1,3 M€ 1 % 1,2 M€ 1% 4. Other activities linked to the social mission 13,7 M€ 15 % 12,5 M€ 14 % 15% 4 Social mission Expenses 81,8 M€ 87 % 76,7 M€ 86 %

5. Cost of fundraising 7,4 M€ 8 % 8,1 M€ 9 % 6. Administrative costs 4,4 M€ 5 % 4,1 M€ 5 % 3 1% Used expenses 93,7 M€ 100 % 88,9 M€ 100 % 2 1 Exchange losses 4,8 M€ 4,8 M€ 8% Surplus 2,5 M€ Grand total 98,5 M€ 96,2 M€ 63%

> RESOURCES

Combined resources (in millions of euros) 2003 2002

12 % 1. Private donations collected in France 30,8 M€ 32 % 31,3 M€ 33 % 2. Bequests and life insurances 3,2 M€ 3 % 3,6 M€ 4% 2 % 7 3. Private donations collected by partner sections 32 % (USA/Japan/United Arab Emirates) 29,1 M€ 31 % 30,6 M€ 32 % 6 4. Other private resources from fundraising activities 1 (subscriptions, company donations, greeting cards etc.) 2,6 M€ 3% 2,0 M€ 2% 17 % 5. Resources from activities linked to the social mission 16,2 M€ 17 % 15,1 M€ 16 % 5 6. Other resources: sales, balance of unused earmarked resources(1) 1,6 M€ 2 % 2,6 M€ 3% 4 Total private resources 83,7 M€ 88 % 85,1 M€ 89 % 2 7. Institutional resource 11,7 M€ 12 % 10,4 M€ 11 % 3 % 3 3 % Total used resources 95,4 M€ 100 % 95,5 M€ 100 % Exchange gains 0,9 M€ 0,7 M€ Deficit 2,2 M€ 31 % Grand total 98,5 M€ 96,2 M€

(1) balance = + use of unused earmarked resources from previous balance – unused earmarked resources collected this year

P16 messages MSF N°131 Aug-Sept 2004 The combined used income held at a several years, proves its important steady level (95.4 M€ in 2003 THE DOLLAR IS PLAYING TRICKS ON US role in these situations. It allows us to compared to 95.5 M€ in 2002). Private put aside a set portion of our MSF maintains financial reserves to allow for immediate reaction to resources and retain the ability to emergency situations without waiting for the reaction of institutional react to emergency situations, while donors or the media. These reserves also guarantee continuity in our In 2003, we implemented large- simultaneously developing more long- scale emergency operations that programmes should there be a decrease in financial contributions. For that term projects. required very considerable reason, we set aside a significant portion of our funds in dollars, the resources, particularly in Liberia, currency of reference in the countries in which we intervene. Given that our For the last two years, as a result of Côte d’Ivoire and Sudan , though accounts are presented in euros, the apparent value of our treasury varies the drastic increase in the costs of we were not able to incite the depending on fluctuations in the exchange rate between the euro and the projects, MSF chose to re-launch same level of donor generosity. . dollar. These exchange rate fluctuations do not, however, have a significant funding from institutional donors. This impact on the cost of our purchases in either dollars or local currency return does not jeopardize MSF’s (which are strongly correlated with the dollar). complete political and financial funds represent 88 % of the total independence as well as its For more information or to download our complete financial report: combined used resources. Funding independence of action. In fact, in www.msf.fr. from institutional donors increased by 2003, only 12 % of funds came from 1.3 M€ (+13 %) while funding from institutional donors. private donors decreased by 1.4 M€ from our donors and from the general Liberia, Côte d’Ivoire and Sudan (see (-2 %), a drop resulting directly from a public in France. In 2003, we following page), though we were not Before exchange differentials, MSF decrease in funds collected in France. implemented large-scale emergency able to incite the same level of donor shows a surplus of 1.7 M€. After the In 2002, the famine in Angola resulted operations that required very generosity. The “One Euro a Week” exchange differential, MSF shows a in a dramatic outpouring of generosity considerable resources, particularly in operation, which has been running for deficit of 2.2 M€. (See sidebar) ■

THE 2003 ACCOUNTS Spotlight on the Social missions

MSF/June 2004/Marc Sauvagnac, Financial Director, Ann Avril, Head of Fundraising.

In 2003, our social mission accounted for 87% of our expenses. What exactly do those expenses cover?

> OPERATIONAL EXPENSES: 59.3 M€ THE MSF SATELLITES

These are program expenses Aside from its headquarters and field missions, Médecins Sans Frontières has a network of regional offices and (medicines, medical and logistical an office in the United Arab Emirates. Other entities – the satellites– work in close association with MSF. What materials, freight and transport, are they and what role do they play? salaries and stipends, miscellaneous costs) as well as the costs of program - MSF Logistique, located in Bordeaux-Mérignac, is a humanitarian supply centre. Its goal is to guaranty the coordination in the field (teams and quality, availability and delivery of the medicines as well as medical and logistical materials that are required for interventions. It also supports and advises teams in the field with respect to compiling orders, customs associated expenses, in the capitals of clearance etc. MSF Logistique sells its goods and products to MSF France, to other MSF sections and to several the countries in which we intervene). other organizations. It employs approximately 60 people and recorded 23 M€ in revenues in 2003. These programs are run by the French - Located in Paris, Epicentre’s mission is to carry out consultations and epidemiological research with the ultimate section or in cooperation with other goal of analyzing and documenting MSF’s medical activity, as well as participating in the improvement of the sections of the movement. quality and content of medical treatments and protocols. Epicentre sells its services to MSF France and to other MSF sections. > OPERATIONAL SUPPORT: 7,5 M€ - The MSF Foundation, also located in Paris, is home to a research centre that provides MSF operational support by bringing its expertise in humanitarian action issues as well as analysing changing contexts. The MSF Foundation is also home to the Campaign for Access to Essential Medicines, an international project supported Humanitarian action is the fruit of the by the various sections of the MSF movement. labour carried out in cooperation - Etat d’Urgence Production produces photographs and films for MSF France as well as for other sections of the between teams in the field and movement, which then distribute them to the media and use them for personnel training. Some films are co- personnel based at headquarters. produced with television stations. Operational support, organised into - The Société Civile Immobilière MSF (SCI MSF) and the SCI Sabin are legal entities that own the buildings which desks, participates in environmental house MSF. and contextual analysis, coordinates - MSF Assistance is the entity charged with collecting and tracking all expenses and revenues related to sales the evaluation of needs and the activities (cards, etc.) and partnerships with for-profit private companies. definition of objectives, adjusts MSF’s responses to different situations, visits

P17 messages MSF N°131 Aug-Sept 2004 missions on a regular basis and, when the aim of raising awareness and activities, and the expenses they incur, needed, redirects MSF’s actions. The inciting action and responsibility on are an integral part of MSF’s social desks gather together all the the part of other actors. Raising mission. The MSF Foundation also necessary competencies which are awareness and informing the public organizes conferences and debates necessary for the definition and takes many different forms: press and produces reference materials with DOSSIER coordination of operations: releases, media articles, reports, the aim of raising awareness about operational, human resources, personal witness reports, films, humanitarian issues. Through its ANNUAL GENERAL medical, logistical, financial, and books, exhibitions, internet sites, etc. research work (misappropriation of MEETING 2004 communication resources. They also The costs of these actions, along with aid, relations with armed forces, etc.) guarantee the quality of aid missions, the salaries of the personnel who help the Foundation contributes to the particularly the medical action. produce them, are included in the provision of more effective and Furthermore, operational support social missions expenses. influential aid to populations. > Excerpt from the ensures volunteer training in such Finally, programs like the Campaign for Annual Report areas as nutrition and vaccine, > OTHER ACTIVITIES Access to Essential Medicines or the logistics, and providing assistance to RELATED TO ITS SOCIAL Drugs for Neglected Diseases initiative populations in precarious conditions. MISSION: (DNDi) aim to support the research, € “We are currently working 13,7 M development and distribution of high “in around 30 countries. In > RAISING AWARENESS quality medicines at low cost to AND INFORMING 2003, we ran 110 field In order to improve the efficiency of its deprived patients and those suffering THE PUBLIC: assistance, MSF has created from neglected diseases. The projects. (…) Aid to Indivi- 1,3 M€ independent satellite entities (see box Campaign for Access to Essential duals Affected by Armed page 17). Although they work mainly Medicines played a large part in Conflict (…) absorbs 60% of Since its beginning, MSF has endorsed for the French section of Médecins drastically reducing the cost of HAART field expenses. Liberia, bearing witness and advocacy – Sans Frontières (in this event for AIDS patients – in some countries, Democratic Republic of témoignage – as a fundamental expenses are broken down into the costs dropped by as much as 300%. Congo, Côte d’Ivoire, element of its humanitarian actions. operational expenses and mission These advances are continually Chechnya, Palestine… 33% MSF has chosen to make the public support expenses), they also provide improving the quality of MSF’s of these projects are aware of its actions and to draw their expertise and services to other programs. The various sections of the emergency programmes. (…) attention to certain situations its sections of the movement as well as to MSF movement cover the expenses 54% of project expenses in volunteers face while in the field, with other non-profit organizations. These incurred by these initiatives. ■ conflict situations (36 projects out of 110) addressed the needs of refugees and displaced THE 2003 ACCOUNTS persons. (…) Programs targeted at patients affected by Mission Expenses epidemics and large-scale endemics represented 23% MSF/June 2004/Marc Sauvagnac, Finanical Director, Ann Avril, Head of Fundraising. of 2003 project expenses (26 projects out of 110), but The presentation of the accounts in the form of a statement of financial activities is activities in our other field mandatory for associations that call on public generosity. However, because is does projects also focused on not clearly outline the nature of the programs, a classification by project type allows them. AIDS and tuberculo- for a better understanding of the goals that guide our interventions in the field, as sis represented three- well as evaluating the impact on the division of funds dedicated for programs. quarters of expenses associated with these acute food crisis specialized projects.”

“ 8% > VICTIMS OF CONFLICTS refugees, displaced persons and victims of direct violence. 2003 was collapse of health 16% refugees structures or displaced 61 PROJECTS highlighted by our emergency 60 % OF MISSION EXPENSES interventions in Liberia, Côte d’Ivoire, 22% 54% the Democratic Republic of Congo, and As in previous years, MSF’s actions are Sudan, which required the mobilization direct violence primarily focused on populations of major resources (surgery, shelter, towards populations victims of conflicts, particularly drinking water, vaccination, etc…).

P18 messages MSF N°131 Aug-Sept 2004 Other: Measles, Meningitis, > EPIDEMICS – ENDEMICS the efforts of our Campaign for Access Yellow Fever, Cholera to Essential Medicines. Sleeping Sickness 25 PROJECTS Elsewhere, the number of malaria 23 % OF MISSION EXPENSES projects increased and our teams had 7% In line with the objectives we set to deal with two large-scale epidemics 6% ourselves, we were able to provide care in southern Sudan and in Ethiopia. The for a greater number of AIDS patients. use of diagnostic tests and treatments, 13% The number of patients benefiting from especially of Artemesin-based Malaria HAART increased from 1,700 at the end Combination Therapy (ACT) - which are of 2002 to 6,000 at the end of 2003. We more effective but more expensive than Tuberculosis – AIDS will continue this effort in 2004, those currently used in countries 74% attempting to secure a decrease in the where we work – was one of our key costs of treatment, particularly through objectives this year.

Children and young people in difficulty

> EXCLUSION in China, in Madagascar, Armenia, Sudan, and Guatemala. It also 36% 21 PROJECTS includes projects for those excluded 17 % OF MISSION EXPENSES from health care and rights, in France, These projects primarily address Georgia, Sudan, Guinea, and Nigeria. children and young people in difficulty 64% Exclusion from health care

> Darfur, Mornay © Francesco Zizola/Magnum Photos - May 2004

P19 messages MSF N°131 Aug-Sept 2004 AFGHANISTAN Afghanistan: DEBATES Humanitarianism Under Attack MSF/June 30 2004/Pierre Salignon, General Director and Dr. Marie-Madeleine Leplomb, Program Manager.

On June 2, five volunteers from Médecins Sans Frontières (MSF) were assassinated on a road between Khairkhana and Qala-I-Naw in the Badghis province of northwestern Afghanistan. One month after this horrific murder, we are trying to make sense of the attack. The analysis is far from simple, but it is critical that we understand what happened if we are to envisage further activities in the country.

Our team was the victim of a targeted Taliban spokesman Mullah Abdul Faced with attacks against our and planned attack. Our colleagues Hakim Latifi has claimed organization, there could be no were shot several times. Bullet holes responsibility for the murder on two ambiguity. MSF has decided to studded the front and back bumpers occasions. The first was on the BBC cease all activities in Afghanistan. and the front passenger-seat window immediately following the of their car, and shrapnel was assassination. The second was a few embedded in one of the sides, days later, on June 11, after 11 can all organizations who do not work suggesting that a grenade had Chinese citizens who were working on for the United States.” He added, “The exploded. The victims had been a building site were killed in the UNAMA (United Nations Assistance working for the Dutch section of MSF northeast region of Kunduz. In an AFP Mission in Afghanistan) works directly in this rural region setting up, among report, he stated, “At the slightest under American orders and pursues others, a tuberculosis program. They incident, the government and the the same goals as the United States were Hélène de Beir (Belgian, Northern Alliance (the former anti- (…). Other organizations like Médecins program coordinator), Fasil Ahmad Taliban coalition that controls the Sans Frontières also work for For further information on (Afghan, translator), Besmillah current government) accuse us. When American interests, and are targets MSF in Afghanistan contact (Afghan, driver), Egil Tynaes we act, we always inform we are for us,” he concluded. [email protected] (Norwegian, doctor), and Willem Kwint responsible. In this particular case, we These statements that deliberately (Dutch, logistician). are not responsible (…). Chinese associate our volunteers with Whereas official investigations are still reconstruction companies can American soldiers are both ridiculous underway in the Badghis region, continue to work in Afghanistan, as and dishonourable for our organization that has been working alongside the Afghani people for more than 20 years. But the worst part is that in the current context, they are a call to arms. As far as we know, this is the first time a call to arms has been launched in Afghanistan against MSF. The fact that it didn’t receive much attention from the Afghani, regional or international press doesn’t matter. The Taliban spokesman is targeting our organization and is calling for action against our representatives. This call to arms must be taken seriously. Such threats against NGOs are nothing new. Since the fall of the Taliban regime and the military intervention of the American-led coalition, the confusion between military and humanitarian organisation is total. NGOs have been seen by many Afghans as serving the goals of the “occupation” regime run by the

P20 messages MSF N°131 Aug-Sept 2004 Americans and their allies, including province of Oruzgan. On November 16, With the help of the management the United Nations. They have been 2003, Bettina Goislard, a French committee and the board of directors, accused of espionage and corruption, employee of the United Nations High we studied the possible options: and of not doing their work. This Commissioner for Refugees (UNHCR) discontinuing all activities, suspending feeling has been strengthened by the was assassinated at a market in them for a set length of time, or attitude of the American army and Ghazni, in the southeast. Then, the five maintaining a minimal level of activity. some humanitarians who are closely MSF volunteers were assassinated on Faced with attacks against our Besmillah linked to the coalition forces through June 2. organization, there could be no their financing and the way they ambiguity. MSF has decided to cease operate. The confusion has also been Over the past few months, MSF had all activities in Afghanistan. fed by American propaganda. For decreased its activities in Afghanistan It is essential to evaluate our recent example, GIs have been handing out because of the insecurity and risks working methods in Afghanistan, and tracts in southern Afghanistan asking associated with the conflict between if possible, establish contact, both citizens to “give the coalition forces coalition forces and opposing groups. inside and outside the country, with any information related to the Taliban, communities who can explain who we Al-Qaeda, or Gulbuddin Hekmatyar” if are and what we do. We must ask Egil Tynaes they want to “continue to receive It seems like both sides of this those responsible for the killings to lift humanitarian aid.” The handouts, “war against terrorism” want us to their call to arms. With this in mind, showing a picture of young girl choose sides. We refuse to do so. in order to make our actions and our carrying a sack of wheat, are a clear position known, we are assessing attempt to use humanitarian aid for ways to develop political contacts military ends. As humanitarians, we outside the crisis and build up denounce this. It attacks the very For example, we withdrew our staff communication in the Arab and principles that guide our actions, and from the city of Ghazni, where we work Muslim world as well as in Central Fasil Ahmad is unacceptable. with the regional hospital and a care Asia. All of this will be necessary Apparently, the people who are behind centre for tuberculosis patients. before we can even think of resuming this blackmail don’t care that it is Because the risks are high for operations with a minimum guarantee undermining the very foundations of humanitarian groups, we had of safety. humanitarianism. The result is that designated several “no go areas.” MSF However there is a specific threat against MSF that we need to understand and analyze. MIX-UP OF GENRES… In Afghanistan, the area open to humanitarian action keeps getting Hélène de Beir Extract from the Francophone newspaper, “Les nouvelles de Kaboul,” smaller and smaller, if it even still June, Kabul exists at all. Some extremist groups “Afghans call them the French Doctors in memory of the doctors who helped them all through the war. They are doctors from the French military have chosen a “headlong flight” health service. In Afghanistan, they are a separate unit and have become a strategy, targeting anyone who, myth for the people. An encounter with these compassionate comba- according to them, is working in the tants...” interests of the west, the coalition or the government of Hamid Karzaï. In itself, this is nothing new, but the some Afghans are no longer receiving teams had continued to work in situation is getting worse and worse, Willem Kwint aid because they’re on the “wrong calmer areas where it “seemed” conflict is intensifying, Afghani side.” Yesterday, the Afghani people easier to operate and where we elections are approaching, and the were “in danger.” Yet in today’s war thought we were less exposed to risks. regional and international climate is On June 2nd 2004 Besmillah, against terrorism, they have become In total, 70 international MSF extremely tense. Egil Tynaes, Fasil Ahmad, “dangerous.” It is in this context that volunteers were still in the country in In addition, we are faced with the Hélène de Beir and Willem Kwint, radical groups, using the frustration of early June. However, after our increasing confusion between western all volunteers working for the Afghani people to spread their colleagues were assassinated, all NGOs—this is how we’re viewed—and the Dutch section of MSF, influence and to carry out guerrilla activities were suspended for a period western armed forces, which has been were assasinated in Afghanistan. operations throughout the country, of mourning, and our teams have been further reinforced by “military Our thoughts are with their family are targeting humanitarian workers. significantly reduced. Only one humanitarian” operations like those I and loved ones. Since 2003, many organizations have international team remained in Kabul, mentioned earlier. Radical groups are been targets of attacks, mainly in the the capital. stirring things up and creating a south. More than 30 Afghan With the assassination of our hostile atmosphere for foreign humanitarian workers have already colleagues and the Taliban’s claiming ‘infidels’. We need to keep in mind that been killed over these last few responsibility, we believe a line has Afghanistan has been torn apart by a months. Hostility towards foreigners been crossed. We have had to examine succession of wars for over 25 years. is on the rise. On March 27, 2003, a our activities in Afghanistan and The “brutalization” of this society is a Salvadorian delegate from the evaluate the safety of our teams reality. International Committee of the Red (international and national). We asked Cross (ICRC) was beaten and killed on our volunteers to regroup in Paris to It seems like both sides of this “war a road between the province of assess the situation, and our Afghani against terrorism” want us to choose Kandahar in the south and the central colleagues participated in these talks. sides. We refuse to do so. ■

P21 messages MSF N°131 Aug-Sept 2004 ARJAN ERKEL Political Kidnapping and Official Lies DEBATES MSF/June 2004/Dr. Jean-Hervé Bradol, President of MSF and Pierre Salignon, General Director of MSF

During a press conference on Friday, May 28, 2004, Mr. Van Wulfften Palthe, Director General for Consular Affairs of the Dutch Ministry of Foreign Affairs, announced that his government had asked Médecins Sans Frontières to reimburse a ‘loan’ that the Dutch embassy in Moscow claims it paid as ransom to free Arjan Erkel, MSF Switzerland’s head of mission in Daghestan, kidnapped on August 12, 2002. This statement by the director of consular affairs is an official lie.

To grasp the recent developments in a payment to the association to defray 2004, had been transmitted over political kidnapping that played out its expenses. Concerned above all for several months in reports and oral over more than 20 months, we must our colleague’s safe return to his communication to the Erkel family, the take a brief step back in time. After family, we agreed, given the lack of Russian and Dagestan administrations, Arjan disappeared, we had to wait six political mobilization, to pursue that the United Nations, the European months for the first proof that he was route and released the cash required Union and the Dutch government still alive and nearly one year before for that mission. Because our team (specifically to Mr. Van Wulfften Palthe). being approached to negotiate for his was already facing numerous threats and because holding such a However, despite accumulated considerable sum of cash would only evidence to the contrary, over a 20- increase its security risk, the team month period, the Dutch foreign requested to place a certain amount affairs ministry persisted in treating of money (250 000 euros) in the safe Arjan Erkel’s kidnapping as a criminal at the Dutch embassy for safekeeping. matter falling under the purview of the consular affairs department. Dutch But from July to December 2003, each government spokespeople regularly time an agreement was reached announced that they were satisfied regarding the practical details of with the actions of the Russian making an exchange, our contacts administration in this matter. For a full notified us at the last minute that the year, the Ministry of Foreign Affairs operation had been canceled. The last refused to meet with us. On several attempt occurred in December. Once occasions, this attitude provoked more, it ended in failure. At that time, considerable tension between Dutch 1_ years after the kidnapping, we were government representatives and MSF, > Germany © Thomas Stolze - March 2003 deeply concerned for our colleague’s life and completely demoralized by the freedom. We were forced to wait these sudden disappearance of every Such events deserve dual legisla- long months despite numerous concrete opportunity to move closer to tive investigation—Dutch and dangerous and costly efforts to make winning his freedom. At that time, Mr. European—so that democratic contact with the kidnappers. For us, Van Wulfften Palthe encouraged us to controls can be exercised over this wait indicates that money was be patient, to prepare the Erkel family practices that blur the line never the kidnappers’ primary for the worst and to remain silent. between politics and crime, motivation in this affair. giving free rein to unlimited violence against the Chechens In early March 2004, we had no and those who try to help them. In spring 2003, nearly one year after contacts, no serious proposals for our colleague was kidnapped, we negotiation and had been warned that mounted an information campaign Arjan was ill and threatened with directed at diplomats and journalists, execution. We then launched a new the latter criticizing the former for condemning the Russian authorities’ information campaign aimed at failing to exert any diplomatic flagrant lack of will to pursue an diplomats and the media. During that pressure to obtain Arjan’s freedom. investigation and the Dutch campaign, we communicated some of government’s inertia. In early summer the information gathered over 19 On April 8th, 2004, while MSF had not 2003, the “association of intelligence months of investigation, showing that received a serious proposal of an service veterans” offered to help us members of the Russian and exchange for months, the Dutch find out whether Arjan was still alive Dagestan administrations were government informed us that it was and to facilitate his release, indicating involved in every phase of this affair. negotiating for Arjan Erkel’s release that we would certainly have to pay a All this information, which was and for the first time, asked us to ransom to the kidnappers and make a published in Le Monde on March 9, “reimburse” it for the ransom amount.

P22 messages MSF N°131 Aug-Sept 2004 That sum was four times greater than government representatives had to the last proposal MSF had received in make a large cash payment. December 2003. The MSF represen- tative answered that it was not the We refuse to allow funds intended for moment to have financial discussions humanitarian activities to be diverted and that the only priority was to find so that the Dutch government can our colleague. Pressed by the Dutch avoid accountability in this matter. This government official to commit himself, story reflects poorly on a country that the MSF represen-tative answered currently holds the position of NATO that such a decision could not be secretary-general, president of the made without referring to his Council of Europe and European colleagues. A few days later, when coordinator in the fight against Arjan was finally freed on April 11, terrorism. 2004, MSF expressed its unwillingness to pay a ransom negotiated and paid The Dutch government’s attitude can not by MSF, but by the Dutch be better understood in the context of government and under less than international passivity in the face of transparent conditions. crimes committed by Russian troops in Chechnya. Arbitrary execution, Irritated by this position, during a May rape, torture, capture and sale of 3, 2004 meeting at the ministry, Mr. Van human beings, the sale of torture Wulfften Palthe and Mr. Willem André victims’ bodies to their relatives and demanded that MSF representatives looting are used widely by a country pay the ransom amount, in cash if that is a member of the Council of possible or in any form that would allow Europe. Over a 10-year period, the legal accounting obligations to be Chechen population has been circumvented. To back up this request, decimated, more than 100,000 people > Paris © MSF - November 2003 the two Dutch government represen- have died in a republic of 1 million, and tatives threatened MSF with direct and dozens of independent journalists, indirect financial reprisals, promising human rights activists and to use their country’s influence within humanitarian aid workers have been the European Union to that end. victims of political violence (assassi- nation, kidnapping, rape and violent The Dutch government organized a robbery). During that time, the U.N. hurried press conference in response Security Council has never bothered to an article in the May 29, 2004 issue to put this situation on its agenda. of Le Monde revealing that it was Europe and the U.N. have chosen to demanding that MSF repay the avoid offending Russia at all cost, even ransom it had had to pay and backing if the price of this choice is their own up that demand with threats. During disgrace. the press conference, Mr. Van Wulffen Palthe told reporters that he had Unfortunately, Arjan Erkel’s kidnapping made a large cash loan to MSF and is not an isolated case, but the latest in was now demanding its repayment. a long series. Since 1994, several > United States, New-York © Kris Torgeson-MSF / September 2003 The director of consular affairs did not western countries and international even bother to produce, or even refer organizations have paid the price of to the existence of, an I.O.U. to such manipulation in the course of demonstrate that his demand was kidnappings. Such events deserve dual credible. He did not explain why he legislative investigation—Dutch and wanted this sum in cash, much less to European—so that democratic controls whom the money had been paid. He can be exercised over practices that did not provide the reporters a specific blur the line between politics and sum. crime, giving free rein to unlimited violence against the Chechens and Who can believe that the Dutch those who try to help them. government would lend MSF such a large amount of cash without a paper This is the call we are issuing to the trail? The truth is both simple and Netherlands, which will assume the difficult for a Dutch government presidency of the European Union this representative to state without losing summer, and to the new parliament of face. To win the freedom of their a reunified Europe. ■ > Holland © Peter Boer - March 2003 national, Arjan Erkel, Dutch

P23 messages MSF N°131 Aug-Sept 2004 THE EXACTIONS OF THE COALITION War Crimes « in the shadow of just wars » DEBATES MSF/May 2004/Information compiled by Rémi Vallet

Following revelations of torture carried out by American soldiers in Iraq, Jean-Hervé Bradol, president of Médecins Sans Frontières, strongly criticizes the coalition forces’ conduct of the Iraq war and their breach of the Geneva Conventions

“(…) the coalition’s leaders have claimed that delivering humanitarian aid is among the goals of their military operations. That should encourage us to participate more in international public debate and to explain how different our vision of humanitarian action is.

Dr. Jean-Hervé Bradol, excerpt from the Annual “ Report

> Iraq, Sadr City in the suburbs of Bagdad © Andrew Stern - June 2003

> The torture of Iraqi prisoners by United Nations and the International debate possible: the success of the US-UK coalition soldiers has been Committee of the Red Cross for their Iraqi opposition army; the political in all the media the last two weeks. lack of action. Until the summer of climate in the United States itself, Do you have any comments on these 2003 however, it was difficult to marked by candidate John Kerry’s revelations? initiate talks on this subject. criticism of the Bush administration; and the development of relations It is not the first time credible infor- between the United States and their mation has emerged regarding close partners, particularly since the coalition war crimes in the war on The demonisation of the enemy attack on the United Nations terrorism. At the end of 2001 news has been taken to the extreme by headquarters in Baghdad last August. all belligerent parties. They have came out about the massacre, in the thus exempted themselves from presence of American soldiers, of > Why the long silence concerning the usual rules of war from the hundreds of prisoners of war in the outset, opening up the way for these issues? north of Afghanistan by local allies of criminal practices. the US-led military coalition. Reports Taking an intellectual stance on the and images, taken at the fall of war on terrorism curbs thought and Kunduz, of the sad fate of certain silences criticism. Since September prisoners have been emerging for the The reason the torture in Iraq has 11th, the beginning of this war, the last two years. At that time I wrote extensive media coverage today is demonisation of the enemy has been that an international enquiry on that political conditions for raising taken to the extreme by all belligerent crimes against non-combatants(1) this issue are finally right. There are parties. They have thus exempted was necessary and criticized the several factors that make public themselves from the usual rules of

P24 messages MSF N°131 Aug-Sept 2004 war from the outset, opening up the certainly does not mean that humani- rapes; pillaging and burning of way for criminal practices. tarian organisations can give in to the villages, causing the displacement of call for arms. hundreds of thousands of civilians. To speak publicly about the crimes 90% of the people at the Zelinge committed by US-led coalition forces > The United Nations has talked displacement site are there because is to provoke a head-on collision with about ethnic cleansing and genocide their village was burnt. Between the most powerful state in the world in the current conflict in the west- November 2003 and March 2004, and one of the main providers of inter- Sudanese province of Darfur. The several hundred villagers out of a national aid. The prospect of possible head of the World Food Programme total population of 33,000(2) were retaliation made plausible by intimi- (WFP) is even in favour of an interna- killed. dation tactics and aggressive tional presence. Do you agree with American propaganda encourages this stance? But rather than talking about self-censorship. For example, during genocide, the United Nations should an internal meeting in 2003, I was There is no need to resort to the explain why their major emergency Giving political visibility to surprised to hear my colleagues using excessive declarations of the United aid agencies took so long to mobilise “the intolerable and refuting the word ‘abuse’ to describe war Nations to draw attention to crimes in Darfur, thus contributing to a food statements that describe it crimes committed in the name of the being committed in Darfur. Is there a shortage in the displacement camps. war on terrorism! Through overuse of genocide situation in Darfur? The To prevent the food shortage from as a ‘natural’ evil that we euphemisms, we end up ignoring the answer is no. We are not witnessing turning into a famine and a much should resign ourselves to reality. an attempt to exterminate an entire larger catastrophe within the next few are essential steps to trans- human group. What we have is a months, pro-government militia forming the unacceptable > As president of MSF, why do you central power which, through its violence against civilians must stop. into a political problem that think it is necessary to speak out militia, is conducting a repression The authorities must continue to calls for political responses. about this issue? campaign against a section of the grant international aid workers the It is not that the crimes committed by population who are accused of necessary authorisations, but UN and Fabrice Weissman in the US-led coalition are more signifi- Red Cross aid must also be more in “L’Humanitaire et la tentation cant or less known than those of line with the urgency of the situation. “ des armes” numerous military forces in the world We are against humanitarian –Review Les Temps today, but its determination in intervention gun in hand. Modernes no.627 claiming that it is acting in the name ‘Humanitarian wars’ do not exist; April—May—June 2004 lives are not saved by killing of humanitarianism forces us to 1 - “Questions gênantes à une coalition people. clarify our position. au-dessus de tous soupcons,” (Embarrassing questions for a coalition In Afghanistan, the coalition distribu- above all suspicion), Jean-Hervé Bradol, tes leaflets promising humanitarian supporting the two guerrilla column published in La Croix aid in return for information leading to movements in the west of the country. on 23 January 2002, which can be the capture of the Taliban. It is down These movements are dissatisfied downloaded from the MSF website. to us to draw attention to the ineffec- with the current status of power and http://www.msf.fr/documents/afghanis- tiveness of this ‘humanitarian aid’ wealth sharing agreements between tan/2001-12-17-Bradol.pdf granted according to military and Sudanese parties. The repression is 2 – Information taken from a field study political imperatives and not ferocious: killings, sometimes conducted by Epicentre, according to the needs of the popula- massacres, of thousands of people; MSF’s epidemiological research centre. tions.

Very recently, ‘providing humanitarian aid to inhabitants’ was one of the main goals of the American offensive against Falluja in Iraq, for which the death toll reached several hundred in the town. We are against humanita- rian intervention gun in hand. ‘Humanitarian wars’ do not exist; lives are not saved by killing people.

The humanitarian aid worker is a pacifist in his/her methods, even if he/she is not a pacifist in the political sense of the word. Indeed, we do not deny that in certain cases military action contributes to improving the fate of a population. However, this does not mean that armies can relieve themselves of the obligation to respect the Geneva Conventions. It > Inhabitants of Bagdad in front of a wall sprayed with gunfire © Geert van Kesteren - May 2003

P25 messages MSF N°131 Aug-Sept 2004 AGM DEBATES The Integration of National Staff DEBATES MSF/June 2004/summary of the debate by Remi Vallet

With regards to internal organization, improving the management of national personnel is a priority for the association. The annual meeting provided an opportu- nity to gather a number of participants in a round table discussion on the issues, followed by a debate.

> AN ISOLATED CASE OR SOCIAL ISSUE?

The compellingly similar stories force us to go to the root of the problem. “We see the same pheno- menon in different countries and different contexts. The problem is not related simply to an individual, it is a social issue: this must be analyzed as such, before we try to find solutions”, explained Karim.

Rony began the round table discus- sion by underlining that humanita-

« When you go into a country to help, you are automatically in an asymmetric dominant-dominee- red relation. It’s the donor versus > MSF hospital in Kailahun, Sierra Leone © Doris Burtscher/MSF -March 2004 the receiver. We must not delude ourselves that this can be elimi- > WHAT ARE THE ISSUES? always consulted before hiring nated, but we have to be aware of nursing staff. As Nafissa put it, “I it and try to contain it. » Similar points were brought up by all work with nurses and nurses-aids the national staff participants. For everyday and I know who the most some, it is the frustration that comes competent ones are, while interna- rian work is intrinsically linked to with the lack of shared responsibili- tional recruiters tend to choose expatriate status. “It’s their ties between expatriates and those they like”. passport, not just their moral virtue national staff; for others, it is the which allows them to work in a war lack of confidence that can go so far This lack of objective hiring zone without being suspected of as to be insulting. For example, practices by expatriates is resented being involved in the conflict”, he Nafissa spoke of the suspicious by national personnel, especially as reminded us, explaining that MSF attitude of some of the expatriates in the turn-over rate among expatria- was developed on this concept Niger who regularly search national tes creates instability. Jeff experien- largely copied from the ICRC. “This staff at the end of the work-day. But ced this personally when he was development is not unfounded, and it without going to extremes, Blaise forced to leave MSF after working has its merits”, he added. But this summed it up as, “local staff are for the movement for the past ten extra-territorial status almost simply there to carry out the tasks, years. He strongly disagreed with an automatically create hierarchies. and not to be partners.” Their expatriate, who was on mission for “When you go into a country to help, knowledge of the political, cultural only six months, about the way the you are automatically in an asymme- and social context is rarely used. logistics were being managed. “I tric dominant-domineered relation. Their familiarity with the mission is often saw people praised by one It’s the donor versus the receiver. We also not used as it should, even team, only to be degraded by must not delude ourselves that this though they have been with the same another”, Karim added. In addition can be eliminated, but we have to be program much longer than the to favoritism, it is mainly the aware of it and try to contain it. That expatriates. Only expatriates are inconsistency in the way missions is why it is necessary to question the invited to closed-door meetings. In are conducted which poses a pre-conceived notions that interna- addition, national doctors are not problem. tional volunteers arrive with.

P26 messages MSF N°131 Aug-Sept 2004 > WORKING TOWARDS A ments for fear of losing their job, experience the social realities of BETTER BALANCE even if there is the risk that they no the country. longer perform their role as inter- After having worked on these issues In his presentation, Karim attempted mediaries with the local population. for the past six months, Cecile to clarify some of the terms in order Aujaleu presented the priorities that to understand the divide between Not everyone agreed with Karim’s she has arrived at. (see box belw). expatriates and national employees. position, and some considered it too Facilitator Philippe Houdart voiced The expatriate “comes from an radical. Rony however defended the his concern over being too technical affluent country with a colonial past, utility of such an approach in the with the solutions, to the detriment > On the expatriation of which not so long ago thought of discussion, as tackling a problem of an in-depth study. “It is not national personnel itself as the centre of the universe, from a sociological perspective will through bureaucracy that we will where progress reigns and which affect its solution. “It is not true that succeed in overcoming the lack of therefore feels it has to help others, nothing can be done.” insists Karim. trust”, he declared. “Organizational “MSF does not push national who of course less advanced”. In “Finding a solution to a sociological measures which are not bureaucra- personnel to expatriate. contrast, the national employee problem, involves instituting tic can have a real impact”, replied Expatriation is not “lives in a country either at war, or something”, he added. Several Rony Brauman. Praising Cecile’s the fulfilment of one’s just over one, a nation that was suggestions were put forward during firm position on this point, he previously colonized, where local the discussion: suggested that “it is by encouraging professional life, but rather cultures were so denigrated that collaboration between expatriates a personal choice. people ended up internalizing their and the locals that trust in each On the other hand, feelings of inferiority”. The expatria- other will build, rather than waiting what we have to improve ted who is “disinterested, with a « It is not true that nothing can be for more humane reactions”. ■ is how applications from certain aura” alongside the national done.” insists Karim. “Finding a national staff are being solution to a sociological problem, employee who “is there to earn involves instituting something”, processed, which currently enough to support his family”. * Facilatator: Philippe Houdart, of the he added. Board of Directors. Participants were is much too slow.” Karim Rahem, Doctorate in Anthropology Karim believes that the work and member of MSF Foundation; Rony environment in which expatriates Cecile Aujaleu, Brauman, former president and member “ and nationals exist is not conducive - Promote intellectual curiosity by National Staff Coordinator of MSF Foundation; and Cecile Aujaleu, to creating equal partnerships. integrating a cultural dimension Coordinator of national personnel, MSF Whether because of work overload, during the briefings of expatriates human resources department. Five or because they are financially at headquarters national staff also attended: Blaise better off, or because they are not - Organize a briefing by national Maoumou, assistant administrator, intellectually curious, it is rare to personnel when the expatriate Guinea; Jeff Yogo, logistician, Democratic see expatriates on mission develop arrives on mission Republic of Congo; Nafissa Dan Bouzoua, relationships with locals beyond the - Promote expatriates to exercise physician, Niger; Martin Okonji Oguk, strictly professional context. At the more independence during their laboratory technician, Kenya; and same time, local employees often stay on a mission (housing, Ezatullah Sayed, Ghazni field coordinator, prefer not to voice their disagree- transportation, etc.) so that they Afghanistan.

HUMAN RESOURCES PRIORITIES

Guarantee a correct contract and salary framework in all missions more than half of the missions’ internal regulations, and rarely The priority is to prevent unacceptable situations (i.e. daily worker promoted by the medical teams. We will have to decide at the end of status renewed indefinitely, without time off for holidays, etc.). In the year if the document approved by the board needs to be updated. large missions, this will be implemented by reinforcing the adminis- trative teams, in particular by creating human resources positions. Work on the composition of field teams Three of these posts have already been created and more will follow. The aim of this, in collaboration with the desks and the support Elsewhere, two ‘non-fixed’ administrator posts in charge of national departments, is to improve the integration of national staff into the staff will be created. They will be able to help field administrators decision teams. The objective is to include some of the national staff revise and apply internal regulations, review salary scales, redefine in the annual process of defining future objectives, because in many job profiles, and improve performance evaluation procedures. This countries, national staff currently carry out their tasks without should solve the problem of inconsistent rules at the change of each knowing what the objectives are. expatriate. For this to happen, the first task is to get to know the national staff. Ensure that the MSF medical policy approved three years ago by the At the moment, we don’t even know how many people work for us. A Board of Directors is applied data base is being developed to keep track of the competencies and In theory, this guarantees decent medical coverage for the national experience of national employees. This will help the human staff employed by MSF in the field. In practice, the policy is rarely resources department in Paris improve team composition. The implemented in the field, few are familiar with it, it is absent from objective is to have this tool ready by the beginning of next year.

P27 messages MSF N°131 Aug-Sept 2004 Ne les laissons pas mourir de faim © Dieter Telemans Ils ont besoin de votre aide

Été 2004, Darfour, ouest du Soudan. Envoyez vos dons Un million de personnes ont été chassées par la violence, les massacres URGENCE DARFOUR et les pillages. Ceux qui ont survécu à la BP 2000-75011 PARIS terreur et à l’exode sont aujourd’hui www.msf.fr menacés par la famine. Les Médecins Sans Frontières sont mobilisés pour leur apporter des soins, de l’eau et de la nourriture, des abris. RESSOURCESRESOURCES

EXHIBITION « ACTEURS D’URGENCE » MSF hits the streets again

MSF/July 2004/Alain Fredaigue, Events Coordinator

In support of the latest donor recruiting campaign, MSF has developed a new mobile exhibition. Acteurs d’Urgence aims to shed light on the daily activities carried out in the field by MSF.

After the Camp de réfugiés exhibition, There, an MSF volunteer assigns a be presented at festivals including which plunged the public into the role to every visitor, handing him or Etonnants Voyageurs and the Festival world of aid workers, after Enfances her each a portable tape player. Three du Vent, as well as at any other events Volées / Enfances Perdues, which distinct journeys symbolizing the work where people may be willing to listen allowed children to give voice to their of doctors, nurses, or logisticians are to the message. daily struggles, and after Trop Pauvre offered. pour être Soigné, which invited In Acteurs d’Urgence we see the visitors to assume the role of a sick After a briefing and an outline of the technical characteristics first seen in person in a poor country, Acteurs context, visitors embark on their Pris au Piège, which allows it perfect d’Urgence gives participants the journeys through a transport truck mobility: its planning scheduled to run For further information opportunity to experience the daily life transformed into a veritable labyrinth. until the end of the year is proof. on the exhibition of a volunteer through a variety of Five steps await each “new volunteer”: ‘Acteurs d’urgence’ situations typical of an aid mission. shelter construction, a first aid post, Head to the back of the truck, and get contact water distribution, a nutrition centre, ready for a journey unlike any other… ■ [email protected] Open to the public, the exhibition’s and a cholera centre. The scene is goal is to link the overall perception of created at each step using props. The major crises as presented by the audiotape alternates between media, and the actual aid work carried narration, realistic background noises, DATES OF THE EXHIBITION out by the thousands of MSF volun- and dialogue from Médecins Sans teers every day. Frontières volunteers in the field. After MONTH TOWN DATES 10 minutes, visitors end their journey JULY To achieve this goal, the exhibition is at the spot where it began, no doubt NANCY place carnot 06 - 10 REIMS cour d'erlon 15 - 17 divided into two distinct parts. On the with a new view on the involvement of BORDEAUX quinquonce 20 - 24 outside, passers-by in the various humanitarian volunteers. DAX esplanade gnl de gaulle 27 - 31 cities along the exhibition’s tour will AUGUST BAYONNE quai edmond foy 03 - 07 discover a retrospective covering 30 This interactive exhibition was BIARRITZ 10 - 14 years of human conflicts, as captured developed in support of the new donor PERPIGNAN 17 - 21 PAU place d’Espagne 28/08 - 12/09 by photojournalists from the Magnum recruiting campaign called “Un euro Agency (Depardon, Vink, Steele- par semaine”. Thus, the end of the visit SEPTEMBER PERPIGNAN 28/08 - 12/09 Perkins, Zizola, …): a view of also serves as the occasion to give NARBONNE 14 - 16 CARCASSONNE 17 - 19 emergency situations through the use participants the opportunity of BASTIA 21 - 25 to be confirmed of giant street-sized photographs. extending their involvement by AJACTIO 28/09 - 02/10 to be confirmed committing to concrete support. OCTOBER MARSEILLE 05 - 09 to be confirmed Access to the second part is only AVIGNON 12 - 16 to be confirmed AIX 19 - 23 to be confirmed possible by crossing a boundary line, Acteurs d’Urgence is above all else an LYON 26 - 30 to be confirmed symbolized by a hut and a barrier. awareness-raising exhibition, and will

P29 messages MSF N°131 Aug-Sept 2004 PORTRAIT : ISMAËL FOUAD Home sweet « Homme »

MSF / June 2004 / Olivier Falhun RESOURCES

I had been living in hiding “for four years- never more than one month at any one place. But that night, unfortunately I did not know where to go. I was having a hard time trying to decide until about half-an-hour before curfew. But it was too late. “ Ismael Fouad, currently Director of the Médecins His answering machine comes on and the message simply says « Fou Fou Ismael », as Sans Frontières office in the though poking fun at his “crazy” 40 years of life. Although, his life is somewhat less United Arab Emirates frantic since age 32, when he found himself suddenly in the driver’s seat of his overtur- ned car, thus putting an end to years of homelessness and lawlessness.

“Can you believe it, I am 40 years old. Not even 14 years old, Fouad found In 1978, a new kind of nightmare, the Do I look it,?” To be honest, I was too himself on his own in a country where “red terror”, was added to Mao’s little embarrassed to answer. It’s true, his a dictatorship was about to unfold. The red book. Several of his friends ended face is still smooth, but his life story is DERG nationalist party was declai- up in prison during that time. Four or full of furrows… ming “Ethiopia first” everywhere, five of them were executed in the Fouad was born in Ethiopia, the son of while many Ethiopians bowed their street. A note, written in their blood, a mother from the north and a father heads. Fouad found friends to live was pinned to their bodies with the from the south, a cultural mix that epitaph “the anti-revolutionaries will wouldn’t escape social pressures for perish”. “There were new bodies on long. Especially the mother… who was Not even 14 years old, Fouad the street every morning. It was criticized for the marriage. “She died found himself on his own in a traumatic and at the same time a time when I was 6 months old, from what I country where a dictatorship was of amazing luck…” don’t know. I didn’t learn of her death about to unfold. The DERG natio- until I was 13”. When he was 8 years nalist party was declaiming Fouad was stopped twice in fact, but old, Fouad was sent away to the Addis “Ethiopia first” everywhere, he was released both times. The first Abeba boarding school and his while many Ethiopians bowed time he was released because he their heads. diplomat father was transferred to knew the person in charge of the Sudan. “I used to visit him during the Kebele (district) who released him holidays, and it was in Khartoum that I right away. “He just asked me to go had a major confrontation with him with, officially however, he did not and find my papers.” The second time when he told me about my mother’s existent as he was not registered was at night just before curfew time. “I death which he had hidden from me anywhere. Political committees hadn’t played my cards right. I had all that time. I never went back to see turned to communism and terror lied been living in hiding for four years- him. “ dormant, fomenting revolution in never more than one month at any one people’s minds. “My name was not on place. But that night, unfortunately I A new life started. Mengistu came to the Regional Committee’s list, so I was did not know where to go. I was having power and the boarding school closed. considered as an anti-revolutionary”. a hard time trying to decide until about

P30 messages MSF N°131 Aug-Sept 2004 half-an-hour before curfew. But it was buried himself in the library, pushed MSF offered him the post of deputy The opportunity to study the famine in too late. I was picked up by their Volks- himself, and earned money by working assistant representative to the Ogaden presented itself and he wagen van and they asked me where I as a waiter in cafes and grape harves- Ethiopian mission. “It was a weird returned to MSF. At the end of 2000, he was going. I gave them the address ting. But, he admits that during that position. What status do you give an met Pierre Salignon, then director of and I was taken immediately to the time he “was not unhappy”. expatriate member of the national the Palestine project. The goal of the corresponding Kebele.” He was kept team who is about to manage the RH, project was to provide medical, in prison for 15 days and no one came His big break came when he landed a finances, and accounting? A key post, psychological and social assistance to to see him or get him out. There was job with the Bioforce Institute, that perhaps, but what kind? It was agreed the neediest people exposed to no way of obtaining food, except for allowed him to remain in France and that I would remain as a member of violence. “He offered me the post of what the other detainees would share earn a living. “It had never occurred to the national staff, administrator head of mission and that night I didn’t with him. “Nevertheless, I found a way me to do humanitarian work. In the without portfolio, without keys or the sleep a wink. The mission frightened of getting a message to my employer beginning it was a means of obtaining authority to sign cheques. That’s how me, especially the international at the restaurant where I was working my resident’s permit.” A handicap it was then…” Quickly outgrowing his dimension of the conflict, but I admit at the time. His son was brave enough which led him ironically to an associa- role, Fouad took the opportunity the country had always intrigued me.” to come and plead for me and obtained tion of the same name. In 1988, he during a visit to Paris to resolve the But, for the first time, his nationality my release by paying a fine of 15 Birr moved to Djibouti, as a representative problem. His first meeting with the worked in his favour. The Palestinians (Ethiopian currency), explaining that for Handicap. But it did not take long then director of operations, Jean- considered him one of theirs and he put me up from time to time. I had for his past to catch up with him. He Herve Bradol allowed him to return Israelis saw him as a brother. (Many made a good impression. It’s true that was asked to leave the country. The more motivated than ever “this time, Ethiopian Jews live in Israel). He was reason - no Ethiopians allowed in such with the keys in hand…”. With Luc initiated to the Territories by the a position. But the NGO stood up to Frejacques, he integrates the stones of the second Intifada, and by them. “The director of operations even national staff into the decision team. the visit to a Palestinian family in a As he criss-crosses the country he finds that getting food to made a special trip to come and “This enriched our discussions: on house occupied by soldiers, 15 days people is an almost impossible support me with an ultimatum in hand the one hand the memory, working after his arrival, in front of television task. “I saw the absurdity of the “If Mr. Fouad goes, Handicap goes culture, and on the other the cameras. In addition to having the food aid program, the shortages, too.” Fouad was allowed to stay. He technical side. Feeling enriched by so detailed everyday coordination of the the incredible and grotesque remained there for three years, long many experiences, he answered an teams- mainly in the area of security-, hierarchy » enough to watch the Mengistu regime ad in Message, for a director position he implemented the awareness fall. in the Emirates…He was hired but building campaign among the Israelis. they never sent for him… “Feeling From Jerusalem to Hebron, Gaza to Eleven years passed before he bitter about the whole thing, I went to Jenin, there was no limit to how Fouad I took my work seriously.” Luck helps returned to Ethiopia. This time it was work for the United Nations on a responded to the escalating conflict, sometimes, hard work always … as the on an exploratory mission. He arrived year’s pilot project re-building and he paid the price for it. In July saying goes. Sometimes you have to with a report under lock and key which Somalia. We took many risks, but the 2002, his mission came to an abrupt believe in adages, but sometimes you described the U.S.A.’s support for the info that was passed up through the stop when the car he was driving have to just pack your bags. Meles clan, the new party in power. ranks never made it back down, at rolled over onto its roof in a tragic At 18, he fled from Ethiopia. First to But the report fell into the wrong least not in the way we would have accident. “I found myself at the bottom Djibouti, then to Saudi Arabia shortly hands and everything fell apart… “I liked”. of a ravine after I had lost control of after, where he remained in hiding for think I cried that day. I felt like my the wheel from fatigue. I thought I a year. Stress was a bit easier to previous life had never left me. A letter would be left to die, but lo and behold handle with the odd job here and there of apology was mailed off. Then I left, it was the Israeli army and settlers and in the hostel for young Somalians traveling to Eritrea, Somalia, and He was initiated to the Terri- who rescued me”. He came out of it where he lived, but “life for over there Djibouti…but not to Ethiopia”. tories by the stones of the with a crushed vertebral column. And was so morooooose…” he confides second Intifada, and by the visit Marie-Helene came to fill in for him. with arms stretching out the syllable. Appointed regional coordinator for the to a Palestinian family in a house “She was wonderful, respecting my So, he took off to Morocco to live with Horn of Africa, he spent most of his occupied by soldiers, 15 days wish to continue”. He was sent back to an uncle. He returned to school, time in the air traveling before moving after his arrival, in front of France and continued to work from his obtained his baccalaureate and ended to Lyons where he spent two years in television cameras. hospital bed. “I almost wiped out my up in France in 1984, thanks to a the head office. While there, he studied savings with telephone calls.” So as network of student friends. “I community development. He left not to be cut off… developed a thick skin able to Handicap in 1994, to invest in a Today, Fouad is director of the United withstand anything. I was completely development project which unfortuna- During his first vacation ever, he Arab Emirates office, continues to independent and nothing could stop tely never materialised because of traveled back to his country of origin. recuperate from his accident and me.” Not even borders. He went to insufficient funding. “I wanted to invest Here he met a friend who offered him continues to always dream of Ethiopia. study at Grenoble University, “a short in a business of building materials a consultant position with the “Maybe “in spite of themselves” I will course which suited my financial and which would make the cost of building European Union to work on the food no longer be a stranger…” he says. He visa situation”. France in its infinite houses in Djibouti at the time two to aid program in Ethiopia. He finds his also co-produces the MSF newsletter goodness told him that “the renewal of three times cheaper”. Understandable work conditions unbelievable, and as for the Emirates. Its title is “Embrace”, your visa will depend on the success of for someone who had never owned a he criss-crosses the country he finds a message he wants to convey of your studies”. “My priority was not to home, but his business disappeared that getting food to people is an Médecins Sans Frontières. But it is a fail, because I would have been sent as did his savings. Fouad returned to almost impossible task. “I saw the lot more than a message, it is a way of back to my country of origin if I did not Ethiopia penniless. “And like other absurdity of the food aid program, the life for him, for each time he sees us, succeed, and that was my biggest times, life smiled at me …” he said shortages, the incredible and he puts his arms out. And today is one fear.” So Fouad took things in hand, without smiling. grotesque hierarchy”. of those times. Fouad embraces you.■

P31 messages MSF N°131 Aug-Sept 2004 SUDAN/DARFUR Darfur: a Path FROM THE FIELD of Destruction MSF / May 2004 / Aurélie Grémaud

The ruined path that winds and stretches between Mornay and Zalingei, in West Darfour, is but a long “My husband was killed in trail of towns and villages ravaged by “ flames, destroyed with precision, Mornay, a short time after right down to the scores of clay pots, our arrival in December. the “quola” for fresh water that lie They caught him while he blackened by fire, upturned, was fetching water from the shattered. wadi. They beat him so The road between Zalingei and much that he died. Mornay crosses through the hearts of (…) Here, since my the villages. The houses lining the husband’s death, life has path have had their iron doors evisce- been very difficult. I have no rated and frameworks scorched, and family in Mornay. My hut is open out onto the raid scenes: shelves very small and all my overturned, the ground strewn with energy is taken up with the empty boxes, the remains of a stall or daily search for food for my grocery stand. Chairs lie on their and sienna earth, one can glimpse the accompanied by one or two keepers, sides, stools on crumbled legs, white white stains of herds of sheep and who are most often children. Intermit- two children who are looked enamel bowls decorated with large goats, accompanied by young boys. tently, several of these villages, or after by the TFC and the blue or orange flowers, are scattered The now abandoned fields serve as what remains of them, are once again SCF. through the village lanes; evidence of pasture for the cattle stolen from the set alight to demonstrate to those I spend all my time looking the sudden departure of the villagers: along with the destruction residents who might have the audacity for food for them, even if I residents, evidence of the anarchic of the towns was the systematic to return, that this would be unthinka- only eat once a day. I violence of the attackers. ble. Few or none of the residents of haven’t been able to save Not one house was saved. the villages attacked between anything and I don’t have The small hedges of wattle or other Intermittently, several of these November and March have ventured the means to have a more thorny bushes that ordinarily villages, or what remains of into the deserted lanes to retrieve the solid house built, with a surround the houses, marking out the them, are once again set alight to few pieces of crockery that escaped roof strong enough for the gardens, are now nothing more than demonstrate to those residents the flames. The endeavour would be who might have the audacity to rainy season, for I would black rows of ash. too dangerous; they would be risking The course winds through the village return, that this would be their lives. have to pay for the material of Sura which according to its unthinkable. and the labour to build it. I residents, was “incomparable to the Between two villages are scattered have to leave my children others”, owing to its wealth, its “forests” of majestic mahogany. But with my neighbour, because dynamism, the beauty of its like those lining the path, the most every two days I have to set fields…Today, almost nothing remains pilfering of their cattle. In the camps, beautiful branches of these trees have off early to get grass and of this large town by the roadside. the displaced recite the precise been mutilated, gashed; lying at the wood outside the town. It is Like the others, except with perhaps number of animals stolen from them: foot of the trunks, leaves on the very dangerous, I have even more precision, this village was 56 goats, 34 sheep, 11 long-horned ground like a myriad of tiny triangular already been caught and destroyed. As the path bends, a flock cows…It is this same mantra in each tents. Donkeys, horses and camels beaten by the militiamen. of tiny pink and white birds with wings makeshift, roofless home, occupying gather together and devour the green All my children have is me. no larger than a butterfly’s, is lost in even the tiniest space of empty land in leaves. I do not know what will their screeching and the whirring of the cities where they have sought Just before arriving at Zalingei, the their wings. Behind the thorny shrub refuge. path levels slightly and becomes less happen to them if I am (a wattle perhaps?) that serves as disordered. The trees are more beaten to death like my their refuge, stirring with an insolent Along this path of destruction, the numerous, there is water nearby. husband.” nonchalance at the sound of an only encounters are with cattle There are more frequent encounters engine, are five dromedaries. accompanied by one or two keepers, also: barefooted children in torn “ Although they seem to be the masters who are most often children. clothing of uncertain colours walk F. is 40, ruling over the charred village, their Along this path of destruction, the hastily despite the harsh sun, despite she comes from Waraya. keeper is never far away. In the near only encounters are with herds of the even harsher wind; thin bundles of Interview by Aurélie distance at the base of the ochre hills cows, camels, goats and ewes, sticks balanced on their heads. Often Grémaud

P32 messages MSF N°131 Aug-Sept 2004 that the animals’ ears can barely be and traders. Now they are held mashed sorgho. Her 30 year-old son seen. Beside them are women and prisoners in tiny, roofless shacks, cannot leave town, the risk is too children, who with batons in hand, piled up on each other along dirt paths great: ”If they see a man outside of wave big hellos crying, “Khawaja! that serve as gutters for both animals the town, they shoot him and leave the Khawaja!” (Rich! Rich!). These are the and humans. Their only preoccupation body right there to rot. We’re not families of the militia and its consorts, is finding water and food, which they allowed to bury our dead”. Her who can leave the village without must struggle to find every day. husband was killed by the militia men fearing for their lives. It is midday. An old woman welcomes us in her a little before they attacked her They return to the city to sell their straw shelter. She invites us to sit in village. He refused to get off his harvest at the market, to the residents the most comfortable spot, on a donkey and give it to the armed men; of the devastated villages, who are mattress in the corner that is for this he paid with his life. His son, kept prisoners there. protected by a roof, which is made of who studied in Khartoum, came back Behind, the traveller glimpses by the two twisted branches planted in the to the village to be with his mother. riverbed in the distance, at the edge of With great pride, he sows us his photo the last village destroyed, an ochre- album: pictures of himself with his coloured column that takes flight and friends at a party, at the university… whirls wildly in the blue sky, always Her husband was killed by the He also shows us his diplomas, that militia men a little before they blue, never anything but blue. It is a are preciously kept folded in an attacked her village. He refused Hoboub, a small tornado of sand and to get off his donkey and give it to envelope at the bottom of his bag. harsh wind which traverses the the armed men; for this he paid Then there’s the 13 year-old boy who village. There is nothing more to with his life. arrives at the hospital with his 10 destroy, to upturn, to annihilate, year-old brother. At the height of the > Sudan/Darfur except perhaps a stool, a broken attacks on the villages, the boy was © Ton Koene mirror, or a tinplated spoon to blanket wounded. A wide scar runs across his April 2004 in a shroud of white sand. ground. She offers us water from the back from shoulder to shoulder. His wadi. In spite of the impressive water little brother was shot in the forearm. Like in Mornay, and in fact the rest of system set up by the MSF logistics Today, they are coming for his they have walked more than six hours Darfur, Zalingei remains closed off team, which provides half a million bandage. Three months ago, when to bring these treasures to their from the rest of the world, and the litres of water a day, not all the they first arrived in Mornay after the parents. These few branches of wood region’s inhabitants can only wait in displaced people have daily access to attack on their village, they were are an inestimable wealth for the hope of aid and assistance. The drinking water. treated by the MSF team. The little displaced of Zalingei: sold at the displaced population still regularly boy, whose forearm was ripped off by market, they are their sole source of undergoes violence, however the form She sits on the ground, and apologi- a bullet, needed an emergency revenue and also enable the cooking of this violence has changed. Before zes for not being more animated. She operation in order to regain at least of asida, a millet puree constituting they were targets for attack; now feels tired, she’s only just come home part of the motricity in his right hand. the only meal of the day; they can they’re all held as prisoners by the from a night out gathering grass and He was sent to the state hospital Al further be used to patch up the pieces militias. They can’t eat, they can’t wood outside town. She left last night Geneina. After having waited for many of straw serving as walls in the build themselves a shelter for the at midnight, “I go at night because it’s weeks to be operated, the child and makeshift houses without roofs, rainy season, they can’t even fetch less dangerous, the militia men are his family finally went back to Mornay. which for more than six months have water without risking their lives. asleep. And it’s easier to hide”. She He comes every week to have his been their homes. Thus each Before, these people were farmers will use the wood to cook asida, bandage changed. ■ morning, well before dawn, children leave to search for wooden branches or straw. The men cannot go with them, even though they could collect the greatest quantities, for they would be killed. The women do not go if it can be avoided, and send children or the elderly: if they are seized by the army militia, they will be raped. Thus, it is the children and the elderly who perform this daily task; they leave a little after midnight since they walk more slowly, each time travelling a little further to where there is still grass and wood remaining. They only risk being beaten, or whipped. They leave at night, when they can better conceal themselves and the risk of being caught is not as great. > Sudan/Darfur © [email protected] Also crossing this road at the edge of April 2004 Zalingei, are herds of donkeys, so heavily loaded with bundles of grass

P33 messages MSF N°131 Aug-Sept 2004 DEBATE WITH DAVID REIFF Humanitarianism in crisis

MSF / June 2004 / summary of the debate, by Rémi Vallet INFOS PRATIQUES WATCH AND READ On Wednesday, May 26 David Rieff*came to MSF to present his book “A Bed For the Night: Humanitarianism

MSF / July 2004 / Christine in Crisis,” a harsh critique of the humanitarian movement Dufour and Andrea Bussotti and its abuses. “What’s lost is lost. The dream of an independent humanitarianism, a minority even within the Available in the larger humanitarian movement, never had much chance documentation centre of succeeding,” he writes at the end of his book. What and soon on the follows is a summary of the debates that were inspired by database: his pessimistic analysis.

> AFGHANISTAN (Kabul: Darste Barshi ; Mazar-i-Sharif), November David Rieff: Humanitarian organiza- David Rieff: I’ve just returned from 2003, Heidi Holzer tions are currently faced with two Geneva, where I had the occasion to major challenges. On the one hand, meet Mark Laity, NATO spokesman, > FRANCE (Paris : Malaria press they’re facing attempts to convert who claims that “humanitarianism is conference), April 2004, them into mere subcontractors of too important to be left in the hands of Andrea Bussotti / MSF governments and international NGOs.” His approach is “we pay, so we institutions. On the other hand, they decide.” Andrew Natsios, the head of What worries me right now is > GUINEA have changed focus and are USAID, the second biggest sponsor in that the High Commissioner for (Surgery - Macenta), April associating more and more with the world, agrees. To the NGOs who 2004, Xavier Lassalle Refugees is relying more and human rights movements. Such an work with USAID, he says, “you are more heavily on the American alliance can definitely work to the part of American foreign policy. If I see government, which provides 35% > NEPAL advantage of human rights movements that you are not supporting this policy, of its budget, to survive. And the (TB ward - Rukum), April 2004, Colin Morand / MSF that benefit from the presence of I will withdraw our funding.” United States may be ready to humanitarians in regions where human In short, humanitarianism is like increase that percentage. > PALESTINE rights are the most endangered. But in Ulysses caught between Charybdis (Rafah), mars 2004, my opinion, this can only work against and Scylla: on the one side is the isle Philippe Conti humanitarianism. of subcontracting, and on the other, that of human rights. > SIERRA LEONE It’s true that as far as human rights - (Kailahun hospital), March are concerned, a normative revolution > Guillermo Bertoletti, deputy 2004, Doris Burtscher has taken place, through the Geneva > Moderator: Has the director of operations for MSF - (Tobanda - Refugee camp), April 2004, Alberto Cristina conventions, the Universal Declaration post-September 11 war against France: Shouldn’t we put / MSF of Human Rights, and in particular, terrorism changed things for restrictions on the use of the label the more recent definition of the humanitarianism? ‘humanitarian’? > SUDAN International Criminal Court’s - (Darfur : Mornay), April statutes. But I’m extremely David Rieff: The war against terrorism David Rieff : Quite honestly, I don’t see 2004, Francisco Diaz / MSF pessimistic about the likelihood that has changed things for all those who how to make independent (in theory, - (Darfur : Mornay, El this revolution will lead to any real depend on American money, such as not in practice) humanitarian agencies Genina), April 2004, Stefan Pleger changes in the field. It’s more likely to the International Rescue Committee stop using the term ‘humanitarian.’ - (Darfur : Mornay, Zalingei), widen the gap between norms and (IRC), just to cite one example. What But of course, the term is used May 2004, Sibylle Gerstl / facts. Or else, the only practical way worries me right now is that the High without rhyme or reason. I agree 100% MSF to impose these new norms would be Commissioner for Refugees is relying with Rony Brauman when he says that to recolonize, which would be a big more and more heavily on the nowadays, unfortunately, the UN mistake. To impose human rights, American government, which provides would use the expression military intervention would have to be 35% of its budget, to survive. And the “humanitarian crisis” to refer to used systematically or, at the very United States may be ready to Auschwitz. least, a gentle form of imperialism increase that percentage. Dennis that Joseph Nye calls “soft power.” McNamara, the second most But this issue reflects the fantasy, important figure in the HCR, has said extremely widespread at MSF, that not > Moderator: Can you explain why himself that if Europeans don’t pay, only those who receive aid, but also you say that NGOs are becoming the HCR will become a subcontractor the public in the countries which mere subcontractors? of American foreign policy. support its activities, are actually able

P34 messages MSF N°131 Aug-Sept 2004 to differentiate between truly is free to use that money as it likes, independent NGOs and the others, whereas Europe, supplying 23% of its Governments have decided that between MSF and the IRC. MSF is finances, gives earmarked funds. humanitarianism as a moral caught up in a humanitarian system value is much too precious to be that it cannot ignore. It’s in the same Jean-Hervé Bradol, President of left to humanitarians. damn mess as everyone else! (…) The MSF: At the same time, I’d like to parallel between humanitarianism point out that while silence does give and politics has always existed. At one the ICRC a certain independence, it they want to put pressure on Robert PRESS point, some people thought that civil also makes it, to a certain extent, Mugabe in Zimbabwe, governments society could constitute a pocket of powerless. Current public debate is aren’t going to say that his regime is REVUE resistance to states and government fascist. They’ll say that Robert Mugabe MSF/July 2004/Phoïba Monteiro power. Either that was an illusion, or is committing crimes against humanity. they lost. (...) nothing is forcing the ICRC to Over these past few years, governments remain silent. Silence is not one > Darfur have decided that humanitarianism as a of the principles of humanitaria- In the last two months, various I should add that governments haven’t moral value is much too precious to be nism. international political actors always worked to take on the mantle left to humanitarians. Colin Powell and have visited the Darfur region, of humanitarianism. Thirty years ago, The European Union alike use including American secretary there was no talk of humanitarian humanitarianism as a tool. of state Colin Powell and UN wars, of humanitarian intervention, or On the other hand, there are the secretary general Kofi Annan. of humanitarian ‘ingérence’. But now, going to help improve the lot of the frustrated humanitarian players However in practical terms, the word ‘humanitarian’ embodies prisoners in Iraq much more than because the world is not getting any the situation on the field is hope, which is why it’s used by visits from the ICRC! The problem is better, and they wonder sometimes if worsening as the rainy season is settling in, bringing with it a governments. that the ICRC has given itself a rule of humanitarianism is not just a utopian host of epidemic diseases. silence that isn’t included anywhere in dream. One of Médecins Sans “The system as it stands today its mandate. The ICRC’s mandate is to Frontières’ old slogans proclaimed: simply cannot face a crisis of > Moderator: In your book, you promote respect for the Geneva “We have two million people in our such a scope and such an criticize the ICRC. You blame it for Conventions and international waiting room.” Many volunteers are emergency”, stresses J-H its silence on the nazi concentration humanitarian law, while observing a attracted to this humanitarian Bradol in alarm, just back camps during the Second World principle of neutrality. But nothing is propaganda, and really believe that from Darfur, in the daily paper War, on the Serbian internment forcing the ICRC to remain silent. they are going to be able to provide La Croix (July 2nd 2004). camps during the war in Bosnia, and Silence is not one of the principles of care for all. Thus, those who want to Indeed, whilst PAM has distri- buted some foodstuffs, its now on Iraqi prisons. But at the humanitarianism. see radical change turn to human endeavour is completely same time, you write that the ICRC rights, thinking that if human rights dwarfed by the task at hand: is the only organization capable of It seems to me that the ICRC’s attitude were respected everywhere, the world with the spread of diarrhoea, surviving the humanitarian crisis is destructive. In Iraq, and in the larger would be a fairer place. But, and I mortality is steadily increasing and preserving its independence. Arab world, the ICRC has lost a lot of insist on this, this is a mistake, amongst both adults and How can you reconcile this optimism its credibility. What stands out in because it leads to recolonization in children. with your critiques? Does this mean people’s minds is that the ICRC knew the name of human rights. ■ that organizations have to remain about the abuse that was being silent in order to remain inflicted on Iraqi prisoners, and wasn’t independent? able to protect them. They don’t care * An American journalist born in 1952, that the ICRC applies the same rule David Rieff writes for the New York everywhere, whether it’s in prisons in Times, the Los Angeles Times, Mother David Rieff : If I were to write the book Peru, Iraq, or elsewhere. Jones and other American newspapers today, I would delete the first of the two and magazines. He has covered the statements I made about the ICRC. conflict in the Balkans and genocide in This is because the organization’s > Moderator: Can you summarize Rwanda, among other topics. Throughout confidentiality rules are a way for it to for us why you maintain that his career, he has often crossed paths preserve its independence. independent humanitarian action is with humanitarian action. After As for the ICRC’s position on the dead? Slaughterhouse: Bosnia and the Failures scandal of Iraqi prisoners tortured by of the West, and Crimes of War: What the American soldiers, it’s not fair to say David Rieff : I think it’s important to Public Should Know, a collective work that this attests to the ICRC’s emphasize that humanitarianism as that he co-edited, A Bed for the Night is allegiance to the United States. It’s an idea is very valuable to his third book dedicated to true that the United States is the governments wanting to justify humanitarianism. He also wrote a ICRC’s leading backer, contributing intervention, war, or a less intrusive chapter about Kosovo in the most recent 26% of its annual budget. But the ICRC policy of pressure. For example, when edition of Populations in Danger.

P35 messages MSF N°131 Aug-Sept 2004 A COLLECTION OF TEXTS BY FRANÇOIS JEAN From Ethiopia to Chechnya MSF/March 2004/Introduction

INFOS François Jean, a key Médecins Sans Frontières figure who left us in 1999, made a major contribution in the field of international aid through his numerous publications. This WATCH AND READ collection of texts illustrates the relevance of his questions and critical reflection today. PRESS This collection includes texts that Refugees, Famine, Conflicts, Liberté REVUE (CONT.) appeared in journals, magazines and Sans Frontières and Miscellaneous. newspapers* as well as in MSF Articles considered repetitive were internal publications: Messages, omitted, but can all be found in > Aids Médecins Sans Frontières info. There specialised or general journals: The 15th international confe- are articles and chapters from books Populations en Danger 1992; Popula- rence on AIDS took place in written by François, as well as inter- tions en Danger 1996; Face aux Bangkok, Thailand, from the views, debates and notes from crises…, Etat du Monde. Works and 11th to the 16th of July; its seminars in which he participated. publications not included in the In the chapters dedicated to famine, main theme was “Access to These publications have been collection are referenced in an refugees and Liberté Sans Frontiè- Healthcare for All”. In its July organised, not without an element of appendix. res, each text is relevant to the title 12th edition, the daily paper randomness, into five chapters: theme. The ‘Conflicts’ chapter, on the Les Echos points out that “antiretroviral treatment has ••• brought hope to people living with AIDS, but this medication LES TEMPS MODERNES N°. 627 APRIL-MAY-JUNE 2004 remains inaccessible in countries in the South. That’s why this conference is much Humanitarianism more a political rather than MSF/July 2004/Olivier Falhun scientific event”.

In this latest issue of Temps violence or massacres that, in the > Ingushetia Modernes devoted to humanitaria- case of Kibeho, “are responsible for “In the past few months, not nism, Fabrice Weissman writes about probably as many deaths as the Al- only have the Ingush authori- “Humanitarianism and the temptation Qaida attacks of September 11, 2001.” ties closed down all the tent camps that welcomed of arms.” Using the example of Chechen refugees, but they Liberia, the author explains why Didier Fassin looks at “the cause of have also orchestrated what humanitarians need to resist calling victims,” basing his article on the they wanted most of all: the for armed intervention, even if, Israeli-Palestinian conflict and a accelerated departure of the according to him, there are some comparative analysis of the reports refugees” (Libération, July extreme situations (the genocide in and report published respectively by 8th). The last camp (Satsita) Rwanda, for example) where “it is Médecins du Monde and Médecins Contents: was closed down on June impossible to remain humanitarian Sans Frontières. He compares the Claude Lanzmann: Humanitarianism and 10th. Security has worsened to without taking sides.” language of human rights and the tragedy of history - Bernard Kouchner: such a point that some do not hesitate to talk of the “cheche- humanitarian law (emphasizing the Humanitarianism has changed the world nisation” of Ingushetia. In the face of the current crises, this differences in two reports on the Eric Dachy: Humanitarian action: analysis still fuels our internal reflec- same context published by MDM. The Realities and Representations - tion, but perhaps less through the first was in conjunction with the IFHR Jean-Claude Milner: The wheel of questions it asks us than through the and looked at Palestinian populations humanitarianism - Fabrice Weissman: questions we are asked. In the who are victims of “war crimes,” and Humanitarianism and the temptation of chapter entitled “Humanitarians: the second was on attacks against arms - Didier Fassin: The cause of victims witnesses for history,” Claudine Vidal Israeli populations qualified by MDM - Claudine Vidal: Humanitarians: writes about Rwanda, and about the as “war crimes,” and even sometimes witnesses for history - Kibeho massacre one year after the “crimes against humanity”). He also Iegor Gran: The tyranny of goodness - genocide of the Rwandan tutsis, to points out the limits of neutrality, Michel Agier: The side of the vulnerable - illustrate the fundamental historical supporting the thesis that humanita- Françoise Duroch: Rape, a war weapon: dimension—often unconscious, or rian action is “neither above ethics, Humanitarianism in disarray - even denied—of independent humani- nor outside of politics.” These are Joël Van Cauter: Campaigns against anti- tarians. The latter are often the only some of the subjects treated in this staff mines and for access to medicine - or among the few witnesses of acts of issue compiled by Eric Dachy. ■ Claude Lanzmann: A passing survivor

P36 messages MSF N°131 Aug-Sept 2004 ••• other hand, requires a few comments; following the 1994 war, are included we were undecided, it was better to it groups together all the texts in in this chapter. The ‘Miscellaneous’ include rather than omit the text in PRESS which François Jean analyses armed chapter includes works that do not question. conflicts. Several issues are thus logically fit into the other sections. All the publications in this collection, REVUE (CONT.) dealt with, ranging from the study of Articles published in English have as well as those which are not the actual conflict (privatisation and been included in the collection included, are available at the > DRC criminalisation of conflicts) to the without translation. Texts are in Médecins Sans Frontières documen- In order to avoid for the crisis study of the political effects of a chronological order of publication tation centre. ■ that erupted east of the country media explosion, the interaction within each chapter. Some of them on June 2nd, 2004, between humanitarian and bellige- may seem repetitive, but this is to spread yet again in the region, rent parties (security, humanitarian because we considered that where * Le Monde, Libération, Esprit, Tiers “peace negotiations between the space, harnessing of aid, etc.) and Mondes, Le Soir, L’Hebdo, Politique Congolese and the Rwandan consequences for aid teams. Internationale, Commentaire, Cahiers presidents have been organised in Nigeria, a result of mounting > Collection Les cahiers du Santé, Croissance, La Lettre de pressure, particularly from Great CRASH (Centre de réflexion sur We have included publications which Reporters sans frontières, Le Temps, Britain and the United States.” broach the subject of conflicts in a l'action et les savoirs humanitaires), La Vie, Le Front du refuge, (Le Monde, June 26th). purely incidental manner, such as a collection, published by the Panoramiques, La Provence, On this occasion, the Congolese debate between François Jean and Médecins Sans Frontières Relations Internationales Stratégiques, president chose to play down the Mario Bettati concerning ‘humanita- Foundation - 8, rue Saint-sabin - Central Asian Survey, Catholica, risk of war with Rwanda. rian intervention’. All publications 75011 Paris. Tel : 01 40 21 29 29. le Journal des Expositions, concerning Chechnya, to which Copies are available on demand. Recherches et Documents, François Jean dedicated a lot of time Harvard International Review > Ivory Coast “The pursuance of the Marcous- sis agreements, signed in LITERATURE January 2003 under France’s strict supervision, has grinded to a complete stop. In late June, Les routes fantômes Ivorian president Laurent Gbagbo and several other A novel, a treasure hunt, or a poem? opposition leaders agreed to a calendar for reform, in order MSF/July 2004/Aurélie Grémaud give the morbid peace process a boost” states Libération in its Denis Lemasson, ARP at MSF’s headquarters, has just July 1st edition. published his first novel; Les routes fantômes, in the Folies d’Encre collection, published by Eden. After numerous field missions in Afghanistan, Liberia, Madagascar, Ethiopia, and France, Denis has “set up camp” at MSF’s headquarters.

An hour or two of reading, of relaxing, conversations, their histories, their of dreaming. Les routes fantômes is a thoughts, and through others as well, series of journeys during which readers those met briefly in a bistro, in the find and then lose themselves, where street, at the airport. they discover, little by little, the depth There are excerpts that must be read and complexity of the two characters, out loud to fully understand them; preparing for an improbable rendez- subtle winks only perceived by the vous in the midst of a cacophony of most attentive reader; mysteries not s’il n’avait rien dit, elle ne serait pas western and urban noises. Geographic understood until later, their explana- partie. » meanderings of self-discovery. Laxalt tions woven into the pages, and still [There was a time, Laxalt was in love is white, has travelled extensively in others that only the author can reveal, with a woman. One day, he uttered Africa, and discovers the city. Aminata weaving them into a conversation, if something that horrified her. She took is black, and dreams of Africa as yet he really wants you to know. her things and left. He has always unknown to her. Some sentences resonate long after been convinced that if he hadn’t said One story, of two people on a search. the book has been put down. anything, she would never have left.] In search of each other, escaping « Autrefois, Laxalt avait aimé une themselves, escaping each other, in femme. Un jour, il avait prononcé une And so, we wait for the next one. ■ search of themselves. Almost against phrase qui lui avait fait horreur. Elle their will, readers discover who these avait pris ses affaires, s’était enfuie. Il « Les routes fantômes » Denis Lemasson, characters truly are, through their a toujours eu l’intime conviction que, collection Folies d’Encre, Eden Productions.

P37 messages MSF N°131 Aug-Sept 2004 WATCH AND READ New books available in the documentation centre (June-July 2004) INFOS MSF / Alix Minvielle

WATCH AND READ > MEDICAL FOR ESSENTIAL PRACTICE / WHO, LES MULTINATIONALES DU CŒUR : UNE MÉDECINE INHOSPITALIÈRE : UNFPA, UNICEF, The World Bank LES ONG, LA POLITIQUE ET LE LES DIFFICILES RELATIONS ENTRE Group.- Geneva: OMS, 2003. MARCHÉ / Thierry Pech et Marc- SOIGNANTS ET SOIGNÉS DANS CINQ Olivier Padis.- Paris : Seuil et la CAPITALES D’AFRIQUE DE L’OUEST / > GEOPOLITICAL République des Idées, 2004, 95 p. Y. Jaffré et J-P Olivier de Sardan L’ENFANT VULNÉRABLE : PSYCHO- (dir.).- Marseille : Apad et Paris : THÉRAPIE TRANSCULTURELLE EN SOLIDARITÉ INTERNATIONALE : Karthala, 2003, 462 p. PAYS KANAK (NOUVELLE-CALÉDONIE) RÉPERTOIRE DES ACTEURS 2004 / / Yoram Mouchenik.- Grenoble : La Commission Coopération Développe- PREGNANCY, CHILDBIRTH, POSTPAR- Pensée Sauvage, 2004, 255 p ment. – Paris : RITIMO, 2004, 237 p. TUM AND NEWBORN CARE : A GUIDE

> NEWS FROM EUP AND AUDIOVISUAL

ARV, WHAT NEXT?... . legislative settings are very different, this third film 2 hours(original version) 52 mins (short version). poses the simple yet essential question - What next? Available in French and English, on VHS, DVD and CD. Over the past 4 years, MSF has shown that it is A YEAR IN FOCUS 2003-04 possible to treat people living with HIV/AIDS in 17 mins. Available in French and English, on VHS and developing countries. However, MSF teams are now CD. This film looks back at Médecins Sans Frontiè- confronted with new uncertainties: res’ major and most emblematic interventions over How to provide good quality treatment on a large the past year. scale; How to hand over case management to local health structures; How to cope with drug-resis- MENINGITIS : RAPID DIAGNOSTIC TESTS tance... 21 mins. Available in French and English, on VHS and CD. A training film presenting the biological tests Looking at the MSF programmes in Guatemala, that enable medical teams to confirm the strain Thailand and Malawi where the economic, social and responsible for a meningitis epidemic.

TRAINING (EPICENTRE) > POPULATIONS IN PRECARIOUS SITUATIONS

From 19th September till 3rd October 2004 in Saint-Prix (Val d’Oise) Duration : 12 days Language: English

> GOAL OF THE PSP Train participants to answer to medical humanitarian emergency situations in an appropriate way and in accordance with MSF policies.

> TARGET POPULATION - Priority to expatriate medical personnel who are or could become field coordinator and national deputy coordinators (field or capital coordination) - Second line of recruitment : medical coordinators and head of mission - Between 12 and 20 months of MSF experience within at least two different types of intervention. - Committed for at least another 12 months (for the expatriate in one or several missions).

> TRAINING OBJECTIVES : By the end of the PSP trainees should be able to: - Evaluate the population needs (medical and essential: Watsan, shelter, food, security) - Define intervention strategies adapted to health problems, to the context, to the population and to MSF objectives and policies - Plan the implementation of program’s activities - Ensure follow up of population health status - Ensure program monitoring and re-orientation according to context evolution

For further information and to apply: contact your desk or Epicentre: Isabelle Beauquesne (01 40 21 29 27) or Danielle Michel (01 40 21 29 48)

P38 messages MSF N°131 Aug-Sept 2004 To Nicolas The Epicentre team and Medecins sans Frontieres join Vincent Brown, Director of Epicentre, in remembering Nicolas Nathan, who died Sunday, May 23rd 2004 at the age of 34.

Dear Nico, Condolences from around the world and from all never wasted your time, and you always played your You arrived at Epicentre with that unique look of yours walks of life speak of fond memories. Your colleagues cards with ease in the games that faced you each day. and that warm, unforgettable smile. will never forget how you always found the time to talk What will happen now that you have left us, Nico? You couldn’t wait to see who did what and meet your matters through with them. Everything you did, you did with such altruism. You new colleagues. Fresh from your studies in public You applied your research skills to meningitis in parti- also prepared new recruits for their role as team health and epidemiology, you tackled your new duties cular. In partnership with colleagues at Epicentre, members before they left for difficult projects. You at Epicentre with confidence and self-assurance. Medecins sans Frontieres and national and internatio- followed them through to the end of the projects, with Right from the start, you were always available for nal institutions, you conducted and successfully a watchful eye, a professional conscience and true complicated epidemiological missions in humanita- completed your research on the epidemic thresholds friendship. rian projects. of meningitis. Your work is an important contribution I wish time could stand still Nico, I wish we could go Your involvement and work during these missions to the treatment and control of meningitis epidemics, back to that time before Sunday afternoon, May 23, were remarkable, Nico, no matter how much time it especially in Sub-Saharan Africa. In your absence 2004, when the heart decided to give way… took! You were always ready to go the extra mile for a Nico, we will do everything we can to make sure your It was that big heart of yours Nico! good cause. You shared your knowledge gladly, an work continues. Let’s always remember your love and strength of life, aptitude immensely appreciated by those who were You loved life, Nico, and even after these many Nicolas. lucky enough to work with you. The proof -- the dozens missions, you made time for your friends and loved Standing there before us, you toss your hair back from of messages of sympathy, regret, and shock received ones, always careful to keep up your relationships. It your forehead, smile and pause. ■ after the news of your death. The messages speak of was your way of re-charging your batteries and your warmth, skilfulness, and your “savoir vivre”. maintaining a positive outlook on life around you. You Your friend and colleague, Vincent Brown, Epicentre.

TURN OVER AT HEADQUARTERS

GENERAL MANAGEMENT > Dr. Karim LAOUABDIA Karim was appointed director of the Access to Essential Medicines Campaign on May 11th 2004.

OPERATIONS > Guillaume LE GALLAIS After 4 years, Guillaume is leaving his position as Director of Operations. > Dr. Guillermo BERTOLETTI After having been Deputy Director of Operations for 3 years, Guillermo is replacing Guilllaume as Directorof Operations starting June 21st. > Dr. Catherine HEWISON Catherine joined the operations department as ARP on June 21st. > Dr. Christophe FOURNIER Christophe is leaving to work in the MSF USA office and is therfore leaving his position as RP on July 15th. > Dr. Jean-Clément CABROL Jean-Clément is leaving MSF after being head of the emergency desk for 6 years.

MEDICAL DEPARTMENT > Claire REYNAUD Claire will be working as psychologist in the medical dept. for one year.

LOGISTICS DEPT. > Gille ISARD After 4 years, Gilles is leaving his position as Director of Logistics. > Francisco DIAZ after 4 years as WATSAN specialist, Francisco is taking over as director of the logistics department - replacing Gilles ISARD. > Véronique MULLONI Will be working, for a fixed term, as WATSAN specialist starting May 17th. > Thierry HUAUMÉ has replaced Eric BOIVIN as logistics supervisor. > Eric BOIVIN Eric left MSF at the end of May after having worked at headquarters as logistics supervisor for 5 years.

ADMINISTRATION AND HUMAN RESOURCES AT HEADQUARTERS > Olivier LESREL (reminder) since January 1st, Olivier is director of administration and human resources at headquarters. > Cécile FAVARD Cécile is replacing Jeanne GAUTIER (Field Pay Officer) during her maternity leave. > Agnès JOIGNY Agnès is replacing Cécile FAVARD (see above) as administrative secretary in the personnel dept.

P39 messages MSF N°131 Aug-Sept 2004 TURN OVER SIÈGE (SUITE)

ADMINISTRATION AND HUMAN RESOURCES AT HEADQUARTERS > Abdeljalil Abdeljalil will be working in the general services dept from May 17th to November 30th. > Ariane CHARDIN Ariane started working in the general services dept on May 3rd on a fixed RESOURCES term contract. > Denis LE GOFF Denis decided to leave Paris and thus left his position at MSF on April 1st.

FIELD HUMAN RESOURCES > Arnaud LAURENT Arnaud is replacing Amanda HARVEY as Director of Field Human Recourses during her maternity leave. > Christophe CANEVET After many years in the field, Christophe joined the department as Human URGENT : Resources Officer in May. There are several vacancies > Marie KERNEC Marie left her position as Human Resources Officer in May. (HRO) in the field human FUNDRAISING AND COMMUNICATIONS resources dept. For more information, > Aïcha MONTIEL Aïcha left her position at fundraising department on March 15 th 2004. > Emmanuelle BAYLE Emmanuelle started working in the fundraising department on a short term contact: contract on May 3rd. [email protected] > Bénédicte JEANNEROD Bénédicte has been appointed Deputy Director of Communications replacing [email protected] Anne Fouchard. > Alix MINVIELLE Alix is replacing Christine PINTO at the Documentation centre during her maternity leave.

FONDATION > Xavier CROMBÉ Xavier will be working at the Foundation from April 13th until December 12th.

POSITIONS TO FILL > FIELD VACANCIES

> ASAP - Medical (gynaecologist/obstetrician), - Nutrition nurse, Northern Sudan, months - Head of mission/Medical coordinator, Burundi, Makamba, 6 months Zalinguei,3-6 months - Chemist, Liberia, Monrovia, 6 months Angola, Luanda, 1 year - Medical, Malawi, Chiradzulu, 1 year - Logistician, Northern Sudan, Zalinguei, - Logistician, Northern Sudan Khartoum, - Medical coordinator (med experienced), - Medical, Sierra Leone, Bo, 6 months 3-6 months 3-6 months DRC, Kin/Lubum, 1 year - Lab assistant, Uganda, Arua, 6 months - Logistician, Northern Sudan, El Jemina, - Capitale logistician, DRC, Kinshasa, 3-6 - Head of mission (nurse), Malawi, - Chemist, Uganda, Arua, 9 months 3-6 months months Blantyre, 1 year - Wid-wife, Liberia, Lofa, 6 months - Logistician, Northern Sudan, Zalinguei, - Logistician,, DRC, Ankoro, 6 months - Head of mission (med), Guinea, - Nurse, Sierra Leone, Bo - Taima, 6 3-6 months - Administrator logistician, DRC, Conakry, 1 year months - Logistician, Northern Sudan, Mornay, Kitengue, 3-6 months - Medical coordinator, Cambodia, Pong - Logistician field co, Burma, Clinics Mob, 3-6 months - Administrator logistician, Burundi, Phen, 1 year 6 months > AUGUST Makamba, 6 months - Medical coordinator, Georgia, Tbilissi, 1 - Administrator logistician, Uganda, - Head of mission, DRC, Beni, 6 months - Logistician field co, DRC, Beni, 6-9 year Soroti, 6 months - Head of mission, Ivory Coast, Abidjan, 1 months - Medical coordinator, Armenia, Erevan, - Logistician field co, Angola, Camaba- year - Logistician, Ethiopia, Galaha, 6 months 6 months tela, 1 year - Medical coordinator, Ivory Coast, - Logistician, Uganda, Arua, 12 months - Medical field co, RDC, Ankoro, 6 months - Administrator logistician, Angola, Abidjan, 9 months - Administrator, Guinea, Conakry, 6 - Nurse field co, Iran, Zadehan, 9 months Camabatela, 6 months - Medical/Nurse field co, Northern months - Nurse field co, Madagascar, hurricane, - Logistician, Armenia, Erevan, 6 months Sudan, El Jemina, 3-6 months - Field administrator, DRC, Ankoro, 1 3 months - Logistician, Occuped Territories, Gaza, - Medical, DRC, Kayna, 6 months year - Nurse field co, Ivory Coast, Bouake, 6-9 2-3 months - Medical, Northern Sudan, Bentiu, 6 > DARFUR AUGUST months > DARFUR months - Medical, Northern Sudan, Zalinguei, 3-6 - Nurse field co, Burundi, Kinama, 6-9 - Medical field co, Northern Sudan, - Medical, Ethiopia, Galaha, 6 months months months Mornay, 3-6 months - Medical, Occuped Territories, Gaza, 6 - Nurse OPD, Northern Sudan, Mornay, - Log field co, Liberia, Lofa, 3-6 months - Nurse field co, Northern Sudan, months 3-6 months - Medical/nurse field co, Congo, Zalinguei, 3-6 months - TB lab assistant, Kenya, Mathare, 3 - Nurse, Northern Sudan, Zalinguei, 3-6 Mindouli, 6 months - Medical, Northern Sudan, Kerenig, 3-6 months months - Nurse field co, Guinea, Macenta, 6 months - Psychologist, Occuped Territories, - Nurse, Northern Sudan, Kerenig, 3-6 months - Nutrition nurse, Northern Sudan, Jenine, 6 months months - Nurse field co, DRC, Kayna, 6 months Mornay, 3-6 months - TB lab assistant, Armenia, Erevan, 6 - Administrator, Tchad, Adre, 6 months - Medical, Burundi, Makamba, 6 months - Nurse, Northern Sudan, Darfour, 3-6 months - psychologist, Corea, Seoul, 6 months months - Nurse, Northern Sudan, Bentiu, 6

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P40 messages MSF N°131 Aug-Sept 2004