Humanitarian action beyond the French doctors

Eleanor Davey – University of Manchester

E. Davey

E. Davey

To inaugurate this section “Perspectives” Eleanor Davey invites us to reread the history of the “French doctors” while going beyond the foundational “moment” of Biafra. This look offered by an Anglo-Saxon researcher on this “French history” will probably shake some hexagonal certainties. It certainly nourishes debate, first objective of Humanitarian Alternatives. Because it invites us to carry our own look further  to embrace all the influences that have occurred since the late 1960s, Eleanor Davey invites the entire humanitarian community to feed a broader understanding of the action it carries and its evolution.

Scholars and commentators are in agreement on the historical and contemporary importance of the “French doctors”. The model of humanitarianism that emerged out of French activist, media and medical circles in the 1970s has had a major impact on the concepts and practices of humanitarian aid in the twentieth and twenty-first centuries. Organisations associated with this model – above all Médecins Sans Frontières (MSF) – and the individuals who have shaped its practice are foremost in current debates and continue to appeal to aid workers, journalists, and academics alike. Yet to look beyond this model when drawing upon history is beneficial not only as a reminder of other developments but also to help understand the contribution of the “French doctors” with more nuance and perspective.

The “French doctors” moment

MSF is without doubt the single most influential incarnation of the “French doctors”, described by aid commentator David Rieff as “the conscience of the humanitarian world” and its most important non-governmental organisation (NGO), and by anthropologist Miriam Ticktin as ‘nearly synonymous with humanitarianism in the contemporary world’.(1) David Rieff, A Bed for the Night: Humanitarianism in Crisis (New York: Simon and Schuster, 2002), 84; Miriam Ticktin, “Where Ethics and Politics Meet: The Violence of Humanitarianism in France”, American Ethnologist 33:1 (2006), 35. Operationally, its position is compelling: while in 2010 only five per cent of international NGOs within the humanitarian system were French in origin, the MSF movement (as its different national sections are collectively known) was amongst the top five organisations worldwide in terms of budget and reach.(2) Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP), State of the Humanitarian System (London: Overseas Development Institute, 2012), 29. The “Without Borders” ethos and epithet has gained attention in France and abroad, influencing a generation of humanitarian organisations as well as other transnational networks. Their insistence on the entitlement of affected populations to access relief over the principle of state sovereignty has found international resonance.

The success of the “French doctors” has also shaped narratives of modern humanitarian action. Many accounts of humanitarian history turn around the Biafra-Nigeria War (1967-70) as a crucial moment, in part precisely because of its significance for those who would become known as the “French doctors”. This conflict – along with the East Pakistan crisis (1970-71) – exposed a key group of volunteers and journalists to the realities and inadequacies of relief practice, leading to the founding of MSF in 1971. Gradually, over time and as its own experience and capacity grew, MSF extended and refined the practice of “témoignage” or “speaking out” which is now viewed as one of the main legacies of the French experience in Biafra. But the war was also profoundly challenging for a number of older organisations including the International Committee of the Red Cross, United Nations (UN) agencies, and other NGOs.(3)Marie-Luce Desgrandchamps, “Dealing with “Genocide”: the ICRC and the UN during the Nigeria-Biafra War, 1967-70”, Journal of Genocide Research 16:2-3 (2014): 281-97; Philippe Ryfman, La question humanitaire (Paris: Ellipses, 1999), 35. Aid provided a propaganda tool and material resources for the secessionist campaign; the relationship between humanitarian action and the mass media was close and at times compromising. For these reasons Biafra often serves as a marker of the most recent era of humanitarianism.

There are, however, other ways of historicising the “French doctors” moment that add depth to this characterisation. The legacies of Biafra and East Pakistan, and of the 1972 earthquake in Peru, not only included témoignage but also a renewed emphasis on logistics, a domain where MSF’s innovations date largely from the second half of the 1970s onwards.(4)See Marc Payet, Logs. Les hommes-orchestres de l’humanitaire (Paris: Editions Alternatives, 1996). Logistical advances could only occur as the movement expanded, but nonetheless hark back to an early aspiration to supply a flexible and fast-moving relief response where one was lacking. This aspiration was not limited to the “French doctors”: the UN also sought to improve its coordination processes after these moments when international aid was found sorely wanting and the World Food Programme began its transformation from a development organisation to an emergency response specialist.(5) Randolph Kent, Anatomy of Disaster Relief: The International Network in Action (London: Pinter Publishers, 1987); D. John Shaw, The World’s Largest Humanitarian Agency: The Transformation of the UN World Food Programme and of Food Aid (London: Palgrave Macmillan, 2011), 52-62.

Beyond the history of humanitarian action as an emergency response, Biafra was a major moment in the post-war history of human rights and responses to atrocity. A significant reason for this was its role in the emergence of a discourse of post-colonial genocide and, more specifically, the invocation of the Holocaust memory. Events in Biafra – again, alongside violence in East Pakistan as well as the crimes of the Khmers Rouges in Cambodia in the second half of the 1970s – were frequently described as “genocide” by European and North American journalists and activists.(6)Karen E. Smith, Genocide and the Europeans (Cambridge: Cambridge University Press, 2010), 65-104. This portrayal of the conflict as genocide, including the use of Holocaust rhetoric, was also encouraged and espoused by the Biafran propaganda services.Those who campaigned for more robust action in response to atrocities often conveyed the urgency and morality of intervention through the use of Holocaust rhetoric. The idea of human rights as a response to atrocities gained momentum in the 1970s and paralleled, indeed at times corresponded with, the “French doctors” emphasis on témoignage. In the words of Bernard Kouchner, co-founder of MSF and Médecins du Monde (MDM), “Auschwitz, the Khmer Rouges, the large-scale massacres: we, humanitarian volunteers, have made them more difficult to perpetrate and the press more difficult to cover up. […] The ‘French doctors’ changed the world’s indignation”.(7)Bernard Kouchner, Le malheur des autres (Paris: Odile Jacob, 1991), 13. In the original French: “Auschwitz, les Khmers Rouges, les grandes hécatombes: nous, volontaires de l’humanitaire, nous les avons rendus plus difficiles à perpétrer et la presse plus ardue à dissimuler. […] Les French doctors ont modifié l’indignation du monde.” At times the convergence of human rights and humanitarianism in this period was explicitly invoked by the latter’s practitioners: they would contribute to change instead of simply patching up wounds, resisting atrocities not simply reacting to them. Utopian aspects like this encourage a reading of the new engagement as a way to challenge the status quo. Yet their moment, influential as it has been, is only part of a much longer history of humanitarianism that includes many other practices, ideas, and influences(8)The following discussion draws upon Eleanor Davey, Beyond the “French Doctors”: The Evolution and Interpretation of Humanitarian Action in France (London: Overseas Development Institute [ODI], 2012) and other publications of the project A Global History of Modern Humanitarian Action, available at: www.odi.org.uk/hpg.

A longer term view

As in English, the words used to describe humanitarian action in French and the meanings ascribed to them have evolved over time. In some usages the English term “humanitarian” was part of theological discussions or meant to design “a concern for the whole of mankind, a compassion and kinship with all living creatures”.(9)Katherine Davies, Continuity, Change and Contest: Meanings of “Humanitarian” from the “Religion of Humanity’” to the Kosovo War (London: ODI, 2012). Similarly, the French word “humanitaire” (humanitarian) has its origins in eighteenth-century philanthropy, with the word “humanisme” emerging in the mid-1760s to describe the “general love of humanity”.(10)Edward D. Seeber, “Humanisme, Humanitisme, and Humanitarisme”, Modern Language Notes 49:8 (1934), 521. Half a century later, the French word was being used as an adjective derivative of “humanité” (humanity), but often in a pejorative manner. Humanitaire in this period was often equivalent to what in contemporary English might be referred to as “bleeding heart liberalism” and in today’s French is captured by the little-used term “humanitarisme”: sentimental, pitying, impractical.(11) Marianne Valentin, “Les infortunes du mot humanitaire”, Vacarme 4-5 (1997).

Scholars who consider humanitarian histories through the lens of motivations and concepts have often emphasised the wide spectrum of humanitarian endeavours in this early period. The abolitionist movement, for instance, is frequently cited as an influential prototype because of the role of associational activity, lobbying and public pressure in the name of “humanity’”. It was in studying the anti-slavery campaign that Thomas Haskell argued humanitarian sentiments form only when there is a perception of the possibility of change, and thus of moral responsibility. A situation newly perceived as intolerable becomes the object of new engagement, precisely because of the shift in how causal relationships were understood.(12) Thomas Haskell, “Capitalism and the Origins of the Humanitarian Sensibility”, The American Historical Review 90:2/3 (1985): 339-61, 547-66.

The legacy of colonialism for humanitarianism is at face value less comfortable than the anti-slavery campaign, because (to adopt Michael Barnett’s terminology) it is more clearly paternalist and less clearly emancipatory.(13)Michael Barnett, Empire of Humanity: A History of Humanitarianism (London; Ithaca: Cornell University Press, 2011). While the “civilising mission” of colonial rule could be conceived as a humanitarian undertaking in that it sought to improve the lives of those in the colonised territories, this was only possible because of the belief that non-Europeans lived in a state of savagery and barbarism. This belief rationalised both caring interventions and punitive ones.

It is therefore not the case that abolitionism stands as positive against the darker story of imperialism – the former is firmly implicated in the latter’s moralism, interventionism and campaign for “civilisation”.(14)Françoise Vergès, Abolir l’esclavage: une utopie colonial. Les ambiguïtés d’une politique humanitaire (Paris: Albin Michel, 2001). Recent scholarship has emphasised that humanitarianism and imperialism are “bound together in a series of mutually constituting histories, in which the ideas and practices associated with imperial politics and administration have both been shaped by and have in themselves informed developing notions of humanitarianism.”(15)Rob Skinner and Alan Lester, “Humanitarianism and Empire: New Research Agendas”, The Journal of Imperial and Commonwealth History 40:5 (2012), 731. Expertise developed in the colonies was also channelled directly into international civil society through the movement of individuals from missionary work and colonial service to international agencies and NGOs. Tracing career pathways continues to be a useful way of considering the relationship between contemporary political, diplomatic, and military systems and national and international civil society.(16)Guillaume Lachenal and Bertrand Taithe, “Une généalogie missionnaire et coloniale de l’humanitaire: le cas Aujoulat au Cameroun, 1935-1973”, Le mouvement social 227 (2009):45-63; David Lewis, “International Development and the ‘Perpetual Present’: Anthropological Approaches to the Re-historicization of Policy,” European Journal of Development Research 21 (2009), 40-42;

A longer term view also helps to place humanitarian action amongst other national and international techniques of rule, reminding us of its relationship with power. Such a perspective is pertinent in light of the struggles of certain humanitarians in recent decades to assert themselves against state power even as the increase of government interest in humanitarian action has been one of the key drivers of the sector’s expansion. Studies in fields cognate to humanitarian history, like the history of internationalism or medicine, illuminate how the idea of cooperation beyond state borders emerged and evolved. They help us to understand how developments in humanitarian governance were part of a whole chorus of similar ideas and initiatives emanating from Europe and later the United States, including trade reforms, socialism, and pacifist movements.(17)Mark Mazower, Governing the World: The History of an Idea (London: Allen Lane, 2012). These connections become particularly evident at times of consolidation and articulation in humanitarian affairs: in international collaboration in the aftermath of the First World War, during the mass relief works in the Second World War, with the stitching together of the post-colonial aid programme, and with reform and coordination efforts since the end of the Cold War.

A wider lens

This long term vision, however, is inherently geared towards Western forms of humanitarian action. It takes us beyond the “French doctors”, but not outside their frame of reference. And yet, as seen in the prominent position of Cuban medical staff in the Ebola epidemic of 2014-15, humanitarian action is not the preserve of those who espouse the “humanitarian principles” first made familiar by the Red Cross/Red Crescent movement. Cuba prefers the language of solidarity and cooperation, not aid, for its international medical and educational programmes.(18) Elena Fiddian-Qasmiyeh, South-South Educational Migration, Humanitarianism and Development: Views from Cuba, North Africa and the Middle East (Oxford: Routledge, 2015).

Recognition of the bias that informs most accounts of the evolution of humanitarian action – a story that often appears, like the one sketched out above, Eurocentric and trans-Atlantic in its orientation – has deepened in recent years. The reason for this lies, somewhat ironically, in what is often a simplistic and short-sighted narrative of geopolitical pressures being brought to bear on humanitarianism since the attacks of 11th September 2001. Although there are earlier examples, criticism of the “humanitarian sector” as a whole for being too bound up in North American and European political agendas gained intensity after this time. A 2006 report by the Feinstein International Center captured the anxiety: “given the new levels of polarization and manipulation to which it is subjected, is there anything truly universal about what we call humanitarian action? In other words, does the predominantly Western nature of the humanitarian apparatus clash with the universalist values that it purports to convey? Does the fact that hu¬manitarianism is ‘of the North’ compromise the ability of humanitarian agencies to function and to be seen as neutral, impartial and independent?”(19)Antonio Donini et al, Humanitarian Agenda 2015: Principles, Power, and Perceptions (Medford: Feinstein International Centre, Tufts University, 2006), 13.

One of the ripples this concern caused was the increase in perception studies. Another was a greater interest in mapping and analysing contributions of various kinds from countries sometimes referred to as “rising global powers”, from regional organisations, faith-based networks, Southern NGOs, national organisations, Diaspora communities, as well as private enterprise and military actors.

In historiographical terms, significant gaps remain in accounts of humanitarianism in general and enormous blind spots regarding Southern histories especially. An insistence on the diversity of “cultures of humanitarianism” is one accessible approach; an attention to practice offers another way of making conceptual and rhetorical differences less daunting and thus helps to recover aspects of humanitarian response often overlooked.(20)See for example Jacinta O’Hagan and Miwa Hirono, “Fragmentation of the International Humanitarian Order? Understanding ‘Cultures of Humanitarianism’ in East Asia”, Ethics & International Affairs 28:4 (2014): 409-24; Pierre Fuller, “North China Famine Revisited: Unsung Native Relief in the Warlord Era, 1920–1921’, Modern Asian Studies 47:3 (2013): 820-50.

But this scholarship is scattered and partial; it is difficult for non-specialists to identify and access and the dominant discourse is a long way from understanding how applying this wider lens might challenge or revise our understandings of global humanitarian action. For these reasons, no doubt to our detriment and despite ambitions to the contrary, we are at risk of perpetuating our reliance on a short view and a narrow frame.

Biography

Eleanor Davey is lecturer in history of humanitarianism. Her PhD thesis, defended at the University of London in 2011, focused on the evolution of French responses in the “third world”, with a focus on Médecins Sans Frontières (MSF). From 2011 to 2014, she worked in the Humanitarian Policy Group (HPG) of the Overseas Development Institute (ODI) on the uses of history in humanitarian practice and policy. She joined the Humanitarian and Conflict Response Institute (HCRI) in May 2014 and teaches in the History Department of the University of Manchester. Published in December 2015 by Cambridge University Press: Idealism beyond Borders. The French Revolutionary Left and the Rise of Humanitarianism, 1954-1988.

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1. David Rieff, A Bed for the Night: Humanitarianism in Crisis (New York: Simon and Schuster, 2002), 84; Miriam Ticktin, “Where Ethics and Politics Meet: The Violence of Humanitarianism in France”, American Ethnologist 33:1 (2006), 35.
2. Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP), State of the Humanitarian System (London: Overseas Development Institute, 2012), 29.
3. Marie-Luce Desgrandchamps, “Dealing with “Genocide”: the ICRC and the UN during the Nigeria-Biafra War, 1967-70”, Journal of Genocide Research 16:2-3 (2014): 281-97; Philippe Ryfman, La question humanitaire (Paris: Ellipses, 1999), 35.
4. See Marc Payet, Logs. Les hommes-orchestres de l’humanitaire (Paris: Editions Alternatives, 1996).
5. Randolph Kent, Anatomy of Disaster Relief: The International Network in Action (London: Pinter Publishers, 1987); D. John Shaw, The World’s Largest Humanitarian Agency: The Transformation of the UN World Food Programme and of Food Aid (London: Palgrave Macmillan, 2011), 52-62.
6. Karen E. Smith, Genocide and the Europeans (Cambridge: Cambridge University Press, 2010), 65-104. This portrayal of the conflict as genocide, including the use of Holocaust rhetoric, was also encouraged and espoused by the Biafran propaganda services.
7. Bernard Kouchner, Le malheur des autres (Paris: Odile Jacob, 1991), 13. In the original French: “Auschwitz, les Khmers Rouges, les grandes hécatombes: nous, volontaires de l’humanitaire, nous les avons rendus plus difficiles à perpétrer et la presse plus ardue à dissimuler. […] Les French doctors ont modifié l’indignation du monde.”
8. The following discussion draws upon Eleanor Davey, Beyond the “French Doctors”: The Evolution and Interpretation of Humanitarian Action in France (London: Overseas Development Institute [ODI], 2012) and other publications of the project A Global History of Modern Humanitarian Action, available at: www.odi.org.uk/hpg
9. Katherine Davies, Continuity, Change and Contest: Meanings of “Humanitarian” from the “Religion of Humanity’” to the Kosovo War (London: ODI, 2012).
10. Edward D. Seeber, “Humanisme, Humanitisme, and Humanitarisme”, Modern Language Notes 49:8 (1934), 521.
11. Marianne Valentin, “Les infortunes du mot humanitaire”, Vacarme 4-5 (1997).
12. Thomas Haskell, “Capitalism and the Origins of the Humanitarian Sensibility”, The American Historical Review 90:2/3 (1985): 339-61, 547-66.
13. Michael Barnett, Empire of Humanity: A History of Humanitarianism (London; Ithaca: Cornell University Press, 2011).
14. Françoise Vergès, Abolir l’esclavage: une utopie colonial. Les ambiguïtés d’une politique humanitaire (Paris: Albin Michel, 2001).
15. Rob Skinner and Alan Lester, “Humanitarianism and Empire: New Research Agendas”, The Journal of Imperial and Commonwealth History 40:5 (2012), 731.
16. Guillaume Lachenal and Bertrand Taithe, “Une généalogie missionnaire et coloniale de l’humanitaire: le cas Aujoulat au Cameroun, 1935-1973”, Le mouvement social 227 (2009):45-63; David Lewis, “International Development and the ‘Perpetual Present’: Anthropological Approaches to the Re-historicization of Policy,” European Journal of Development Research 21 (2009), 40-42;
17. Mark Mazower, Governing the World: The History of an Idea (London: Allen Lane, 2012).
18. Elena Fiddian-Qasmiyeh, South-South Educational Migration, Humanitarianism and Development: Views from Cuba, North Africa and the Middle East (Oxford: Routledge, 2015).
19. Antonio Donini et al, Humanitarian Agenda 2015: Principles, Power, and Perceptions (Medford: Feinstein International Centre, Tufts University, 2006), 13.
20. See for example Jacinta O’Hagan and Miwa Hirono, “Fragmentation of the International Humanitarian Order? Understanding ‘Cultures of Humanitarianism’ in East Asia”, Ethics & International Affairs 28:4 (2014): 409-24; Pierre Fuller, “North China Famine Revisited: Unsung Native Relief in the Warlord Era, 1920–1921’, Modern Asian Studies 47:3 (2013): 820-50.