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How important is neutrality to humanitarian aid agencies?

2007; Elsevier BV; Volume: 370; Issue: 9585 Linguagem: Inglês

10.1016/s0140-6736(07)61177-5

1474-547X

Priya Shetty,

Global Security and Public Health

As western governments wage “humanitarian wars”, maintaining neutrality in providing aid seems increasingly difficult for non-governmental agencies. Priya Shetty investigates the challenges that Médecins Sans Frontières faces in trying to keep its work free of political agenda. Vanessa van Schoor recollects the time she was travelling in a Médecins Sans Frontières (MSF) land cruiser in Sharia, south Darfur, when the jeep was flagged down by African Union peacekeepers, who had confused the vehicle for one of their own. For van Schoor, head of MSF's Darfur mission until 2006, this incident epitomises the growing confusion in distinguishing between military and humanitarian actors in conflict regions—a mix-up that can have fatal consequences for aid workers. The link between military and relief agencies was so deeply felt, says van Schoor, that in 2005, tribal militia in west Darfur threatened MSF that if UN peacekeepers entered the war-torn area, “we would be considered part of that western front, and a jihad would begin”. But this was not the first time MSF had been threatened because of perceived links with US forces. In August, 2004, MSF withdrew from Afghanistan after five of its staff were murdered. The increasingly visible links between aid agencies and coalition forces were blamed for the violence. A Taliban spokesperson claimed responsibility for the murders of the MSF Afghanistan workers saying “Organisations like Médecins Sans Frontières work for American interests and are therefore targets for us”. Not only are military forces increasingly and openly co-opting humanitarian efforts in “hearts and minds” missions, but also several aid agencies have been accused of either willingly collaborating with coalition forces or doing little to disassociate themselves from them—their stance being that it does not matter how political their actions are as long they provide help to those who need it. But MSF, which views independence from political or religious ideology as a cornerstone of its work, believes it does matter, and 35 years after it was founded, the organisation's ability to provide independent medical aid to strife-ridden regions is being severely threatened by the lack of distance between military and relief forces. Western governments had already begun in the 1990s to place humanitarian goals centre stage in military efforts, says Nicolas de Torrente, head of MSF-USA. But it was after Sept 11, 2001, that the ability of humanitarian organisations to remain politically neutral was destroyed. Bush's with-us-or-against-us doctrine “denies the possibility of neutrality by simply vanishing it away. It defines the two sides of the conflict—‘terrorism’ versus ‘freedom’ and ‘civilisation’”, said Oxfam's policy adviser on Iraq, Jo Nickolls. When former US Secretary of State Colin Powell described non-governmental organisations (NGOs) as “force multipliers”, and former UK Prime Minister Tony Blair called for the need for a “military-humanitarian coalition” these views served only to increase the perception that all western NGOs are merely extensions of foreign policy, says MSF's UK director Jean-Michel Piedagnel. MSF does not solely blame the military for the blurring of agendas. Although several MSF staff did not want to name any specific NGO, they said that some aid agencies' actions—travelling with military escorts, advising military troops on where to deploy, or calling for military intervention in certain conflict areas—are confusing the situation further. Why does MSF value independence so strongly? The values of neutrality and independence have an “operational value”, says de Torrente. “They help us gain access and reduce security risks enabling us to deliver much needed assistance in volatile and sensitive environments.” Neutrality, along with independence and impartiality, was a key founding principle of MSF. The agency was created in 1971 by a group of French doctors, some from the ICRC, who challenged the ICRC's mandate that neutrality meant keeping silent. On acceptance of the 1999 Nobel Peace Prize, MSF's then president James Orbinski said “silence has long been confused with neutrality…we are not sure that words can save lives, but we know that silence can certainly kill”. One of the organisation's most political activities has been its Campaign for Access to Essential Medicines, which was launched in 1999 to give people in the developing world access to medicines for diseases—such as HIV/AIDS, tuberculosis, and malaria—that are routinely available in western countries. Despite MSF's reluctance to solve problems—its mandate being to speak out and force governments to take action—those involved in the campaign say the organisation felt it could not stand by and do nothing. The campaign proved to be not only high-profile but also highly successful—the pressure applied to governments and pharmaceutical companies helped to bring down the price of antiretrovirals for developing countries from US$10 000 per year to less than $300. But the organisation struggled to reconcile the overtly political tone of the access campaign with its traditionally neutral stance. Mary Moran, now head of the Pharmaceutical Research and Development Policy Project in Sydney, Australia, joined MSF to help set up the campaign. She recalls the fierce debate within MSF over whether the campaign was in line with the agency's principles. “It never went smoothly within MSF, there were moves to shut the campaign down; it was always under pressure to stay small”, she says. Oxfam, among others, felt compelled to speak out against the USA's plan to go to war with Iraq. Its spokesperson Michael Bailey says “we thought that the consequences for the civilian population would be sufficiently grave, and outweigh the benefits of the military intervention”. But MSF founder Rony Brauman has questioned the merit of such antiwar statements. “Nobody thought to ask these NGOs on what information or strategic analysis they based their assertions, nor what instrument Oxfam and others used to measure the intensity of a humanitarian crisis caused by bombing in comparison to the crisis produced by Saddam Hussein's dictatorship”, he said. For several agencies, remaining non-political in the current highly charged political climate is unrealistic. Paul O'Brien, ex-advocacy coordinator in Afghanistan for aid agency CARE, disagrees with de Torrente's calls for humanitarian aid agencies to remain non-political. Writing in the Harvard Human Rights Journal in 2004, he says that, post 9/11, “politics are too important to be left to politicians. The fiction of humanitarian neutrality…can no longer be relied upon for all humanitarians in highly politicized contexts such as Afghanistan and Iraq. In such environments, politicized humanitarianism is both right and realistic”. Financial independence is key to operational and political independence says de Torrente; more than 80% of MSF's annual budget—about $500 million—comes from private donors as unrestricted funds (ie, not tied to any crisis or country). Although NGOs who accept funding from governments should not be branded as sell-outs, says Bailey, Oxfam would refuse funding that might subject it to political control. It does not take money from USAID, for example, because of the perception of the US government's greater demands—compared with European Union countries—for political allegiance from the aid agencies that it funds. This difference has also led some to speculate whether US NGOs value neutrality less than their European counterparts. For Abby Stoddard, at the Center on International Cooperation, a research and advocacy organisation based in the USA, such differences are philosophical rather than practical. “Both US and European NGOs can and do operate independently of the great power governments on the ground, even those who receive large shares of their funding from them.” But ultimately, she says, “people in dire need tend not to care where the aid comes from as long as it comes”. As for the future, MSF's sole focus is getting aid to those who need it most. Despite concerns over a lack of humanitarian space in Iraq, it re-entered the fray, setting up a new mission in Amman last August. Whether it will return to the heart of conflict is uncertain. “We will continue exploring possibilities”, says MSF's International Council president Christophe Fournier. Afghanistan is still a no-go area until judicial processes surrounding the killing of the MSF workers have been resolved. But returning to the country is high on the agency's agenda, says Vickie Hawkins, head of operations for MSF Afghanistan in 2004. Adhering to its core principles of neutrality, impartiality, and independence is a daily battle, says Piedagnel. “We are continually asking ourselves whether we are compromising, and if we are, is it acceptable?” The wider NGO community might benefit from a reminder of these principles, suggests Bailey, “some of the ideals of humanitarianism need to be re-argued and re-fought”. History, principles, and practice of health and human rightsIndividuals and populations suffer violations of their rights that affect health and wellbeing. Health professionals have a part to play in reduction and prevention of these violations and ensuring that health-related policies and practices promote rights. This needs efforts in terms of advocacy, application of legal standards, and public-health programming. We discuss the changing views of human rights in the context of the HIV/AIDS epidemic and propose further development of the right to health by increased practice, evidence, and action. Full-Text PDF