The Pulse of Humanitarian Assistance

1. Patients Without Borders

1 Patients Without Borders Bernard Kouchner, M.D. The Birth of a New Concept of Humanitarian Action For many years I have been involved in fields of work that look different but which in fact converge: humanitarian action, politics , and public health. In all three areas I have promoted a now famous medical concept, very easy to state but difficult to set up: better to prevent than to treat. In many occasions, and in various capacities as volunteer or as a government minister, I have been confronted with the same problem: how to take care of poor people ’s health, how to provide them access to prevention and care? Biafra In 1968, I was studying medicine, when the May ’68 movement led by students exploded in France. It was a very restless and creative year. But it was also a very selfish one. Few really cared about ‘‘remote’’ people’s misery. Most Westerners were focused on domestic or personal matters, surely worthy of interest, but with no comparison with the difficulties that were assaulting those whose voice was never heard. France had entered into a new long-lasting period of abundance and mass consumption. That year my personal and decisive shock was the war in Biafra. There, I worked with the International Committees for the Red Cross (ICRC)1 and faced reality. The wounded, the starving children . . . all of them were denied respect and care because of the supposedly protective Geneva agreements. But we were doctors and we wanted to help different people whose pain and poverty we discovered. The profession had the advantage of being productive across borders and serving a quasi-universal ethical interest . If the sick called on us, we would come, especially if it was forbidden, and sometimes when it was impossible. 14 BERNARD KOUCHNER, M.D. The Responsibility of Protection Nationalism was a permanent threat, and indeed often an enemy. In the 1950s and 1960s, the principle that dominated international law was based essentially on the idea of sovereignty of nations . It was therefore out of the question to interfere into the internal politics of states that depended only on existing governments , even if these did not emanate from the sovereignty of the people. Any interference generated unanimous criticism from international law specialists from both Western and Eastern countries. But in Biafra we discovered the necessity of free speech, and we became illegal in order to change the law. The other people’s suffering belonged to no one. It is intolerable for governments to consider themselves as the owners of the suffering that they cause. I respect the power, sovereignty, and the legal power of every state, especially since these are supposed to guarantee the wellbeing of its people. We only demand that these powers be exercised in a manner that is more humanitarian and, therefore, more human. I believe that a government that has nothing to hide could not pull a victim away from the stethoscope of a doctor, or deprive an ordinary man from the advice of a lawyer. Our methods were based on a principle of subsidiarity. It was only after all national resources have been exhausted that external assistance should be provided. This is what led me, with some of my friends, to create, in 1971, Doctors Without Borders, today known as the ‘‘French doctors.’’ We were taken for fools for a long time before being awarded the Nobel Peace Prize in 1999. The French doctors are now fifteen thousand worldwide; they operate in forty countries, and, only for France, its yearly budget amounts to 115.2 million.2 Unfortunately, moving from one humanitarian crisis to the other, we had to face problems of leadership —inside our group, which like any other, soon developed power struggles in its own ranks, but also, of course, within the country, with the political and social system that we were suddenly involved with and which, in turn, had to deal with us. We had to face diversity within our organization—doctors and nurses coming from various religious, philosophical, or political obediences. PATIENTS WITHOUT BORDERS 15 Our challenge was primarily to confront and convince various ethnic groups that did not share our own conception of medicine and health care. In 1981 I founded ‘‘Doctors of the World,’’ which is now present in forty-six countries. In 1987, at a Law and Humanitarian Morality symposium, I proposed , with my friend Mario Bettati...