Life in Crisis: The Ethical Journey of Doctors Without Borders by Peter Redfield (review)

The world of nongovernmental organizations (NGOs) has long been one in which entities come and go. The idealism that motivates their founders inevitably runs up against a series of obstacles: funding, definition of appropriate role(s), leadership succession, relations with other organizations and governments—the list could go on and on. In the human rights arena, the turnover may be especially rapid, given paucity of funding coupled with abundance of enthusiasm, the ephemeral nature of some issues, and the lesser "sexiness" of structural problems. Would-be NGO founders, scholars, and humanitarians need studies such as Peter Redfield's Life in Crisis: The Ethical Journey of Doctors Without Borders.¹

Like all such organizations, Médecins Sans Frontières (Doctors Without Borders, or MSF) has experienced difficult transitions. Few NGOs have enjoyed the kind of detailed, theory-rich historical inquiry that Redfield has brought to MSF. For this reason alone, his book deserves commendation. Having worked within MSF intermittently as an ethnographer for a full decade, Redfield can write with a detailed understanding few analysts of NGOs enjoy. His experience in Northern Uganda provides vivid reminders of the difficulties he and other volunteers confront. Life in Crisis can be characterized as an organizational ethnography, larded with valuable anthropological, historical, humanitarian, and political analysis.

Doctors Without Borders was created in the face of a major humanitarian and political crisis. In 1967, following a series of military coups d'état, the southeastern section of Nigeria seceded, proclaiming itself the "Republic of Biafra." The Nigerian Civil War (1967-1970) lasted nearly three years and cost an estimated 800,000 to over 1 million lives, largely as the result of starvation. It shattered the optimistic visions of leaders around the world about peaceful development in Africa. More important in terms of MSF, the conflict led directly to its creation. A few months after the war ended in Biafra's surrender and reintegration, a small group of concerned persons, primarily former French International Committee of the Red Cross (ICRC) volunteers, assembled in Paris. They created Médecins Sans Frontières. It was shaped largely by its flamboyant figure Bernard Kouchner, who, in Redfield's words, "articulated the group's vision most grandly and left the largest mark."² In fact, Kouchner was not the only architect: his pro-Biafra faction was not the majority within MSF, and he and his group were kicked out in 1979, before the organization's real growth and institutionalization occurred.

How to respond to the crises posed by the Nigerian Civil War had divided the international humanitarian and political communities. As Redfield points out, the ICRC "had never raised and invested so much money. . . . Entering the conflict as a relatively stodgy collective overseeing the Geneva Conventions, it emerged as a full-fledged relief organization."³ Efforts such as these did not go without comment on all sides. For example, the Canadian development consultant Ian Smillie deemed humanitarian aid to Biafra "an act of unfortunate and profound folly."⁴ The academic and humanitarian aid communities were divided as well. Would aid prolong the conflict and thereby result in more casualties, or did what is now called the "Responsibility to Protect" override narrow conceptions of self-interest? Politically, practically all African states supported the Nigerian federal government in its reconquest, as did most governments around the world in its bid to reintegrate the country—irrespective of the economic, regional, and ethnic tensions that marked the civil war. National leaders on the continent feared repercussions for other multi-ethnic societies, for the creation of Biafra was led by and became closely identified with a single ethnic group, the Igbo. Major Western powers similarly looked with disfavor on the secession, believing that a continent free of internal wars (as Africa had largely been during the rapid decolonization of the early 1960s) served the best interests of all. China and Communist-bloc countries stood aside from the conflict, recognizing the...