Humanitarian governance and ethical cultivation: Médecins sans frontières and the advent of the expert-witness

Millennium: Journal of International Studies

Volumn 40, Issue 1, 2011, Pages 43-63

  Givoni, Michal ^a  

^a BEN GURION UNIVERSITY OF THE NEGEV   (Israel)

Author keywords

Advanced liberal government; Humanitarianism; M decins sans fronti res; Practices of the self; Testimony; Witnessing

Indexed keywords

EID: 80052334507     PISSN: 03058298     EISSN: None     Source Type: Journal    
DOI: 10.1177/0305829811406037     Document Type: Article

References (157)

1. Ilana Feldman, 'The Quaker Way: Ethical Labor and Humanitarian Relief', American Ethnologist 34, no. 4 (2007): 689-705.
2. Some of the most notable works are Alex De Waal, Famine Crimes: Politics and the Disaster Relief Industry in Africa (Oxford and Bloomington, IN: African Rights and the International African Institute, in association with James Currey and Indiana University Press, 1997)
3. Fiona Terry, Condemned to Repeat? The Paradox of Humanitarian Action (Ithaca and London: Cornell University Press, 2002)
4. Rony Brauman, Humanitaire: le dilemme. Entretien avec Philippe Petit (Paris: Les editions Textuel, 1996)
5. David Kennedy, The Dark Sides of Virtue: Reassessing International Humanitarianism (Princeton, NJ: Princeton University Press, 2004)
6. David Rieff, A Bed for the Night: Humanitarianism in Crisis (New York: Simon & Schuster, 2002).
7. Mark Duffield, Global Governance and the New Wars: The Merging of Development and Security (London and New York: Zed Books, 2001), 91.
8. For an overview of this humanitarian ethics, see Hugo Slim, 'Doing the Right Thing: Relief Agencies, Moral Dilemmas and Moral Responsibility in Political Emergencies and War', Disasters 21, no. 3 (1997): 244-57.
9. Duffield, Global Governance, 92.
10. On the increasing complexity of what were variously described as 'new wars' and as 'complex humanitarian emergencies', see, respectively
11. Mary Kaldor, New and Old Wars: Organized Violence in a Global Era (Cambridge: Polity Press, 2001)
12. E. Waine Nafziger, Frances Stewart and Raimo Väyrinen, War, Hunger and Displacement: The Origins of Humanitarian Emergencies (Oxford: Oxford University Press, 2000).
13. See Peter Redfield, 'Doctors, Borders, and Life in Crisis', Cultural Anthropology 20, no. 3 (2005): 328-61.
14. The notable exceptions are Feldman, 'The Quaker Way', and, from a more sociological viewpoint
15. Pascal Dauvin, Joanna Siméant and C.A.H.I.E.R, Le travail humanitaire: Les acteurs des ONG, du siège au terrain (Paris: Presses de Sciences Po, 2002).
16. Thomas Osborne, 'Power and Persons: On Ethical Stylization and Person-Centered Medicine', Sociology of Health and Illness 16, (1994): 517.
17. See Arnold I. Davidson, 'Ethics as Ascetics: Foucault, the History of Ethics, and Ancient Thought', in The Cambridge Companion to Foucault (2nd edn), ed. Gary Gutting (Cambridge: Cambridge University Press, 2005), 127.
18. The quote is taken from Michel Foucault, The Hermeneutics of the Subject: Lectures at the Collège de France, 1981-82, ed. Frédéric Gros (Basingstoke: Palgrave Macmillan, 2005), 13.
19. Michel Foucault, 'Technologies of the Self', in Technologies of the Self: A Seminar with Michel Foucault, eds L.H. Martin, H. Gutman and P.H. Hutton (London: Tavistock, 1988), 16-49.
20. On humanitarian action as a politics of pity, see
21. Luc Boltanski, Distant Suffering: Morality, Media and Politics (Cambridge: Cambridge University Press, 1999).
22. See Michel Foucault, The Use of Pleasure (New York: Vintage Books, 1990), 27-8.
23. On care of the self as a way of transcending the self in ancient thought, see Davidson, 'Ethics as Ascetics'. The nexus of ethics and witnessing manifested both in humanitarian activism and in contemporary work of collective memory is characteristic mainly of Western societies. Unlike their European and North American counterparts, practices of witnessing in Latin America, for example, are of a primarily political, rather than ethical, nature.
24. See John Beverley, Testimonio - On the Politics of Truth (Minneapolis and London: University of Minnesota Press, 2004).
25. On the notion of the specific intellectual
26. see Michel Foucault, 'Truth and Power', in Power/Knowledge: Selected Interviews and Other Writings, 1972-1977, ed. Colin Gordon (Brighton: Harvester Press, 1980), 109-33.
27. As Peter Redfield suggests, this figure of a specific intellectual will later give rise to a more ambitious formation of expertise in which truth-claims are essentially the product of a collective, rather than an individual, effort. See Peter Redfield, 'A Less Modest Witness: Collective Advocacy and Motivated Truth in a Medical Humanitarian Movement', American Ethnologist 33, no. 1 (2006): 16.
28. James Dawes, That the World May Know: Bearing Witness to Atrocity (Cambridge, MA and London: Harvard University Press, 2007), 122.
29. Quoted in Graham Burchell, 'Liberal Government and Techniques of the Self', in Foucault and Political Reason, eds A. Barry, T. Osborne and N. Rose (Chicago: University of Chicago Press, 1996), 20.
30. 19. See Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life (Stanford, CA: Stanford University Press, 1998)
31. Jenny Edkins, 'Sovereign Power, Zones of Indistinction, and the Camp', Alternatives 25, no. 1 (2000): 3-25.
32. Didier Fassin, 'Humanitarianism as a Politics of Life', Public Culture 19, no. 3 (2007): 499-520.
33. Thomas Osborne, 'On Anti-Medicine and Clinical Reason', in Reassessing Foucault: Power, Medicine and the Body, eds Colin Jones and Roy Porter (London and New York: Routledge, 1994), 43.
34. On these earlier proclamations, see, respectively
35. Laurence Binet, Famine and Forced Relocations in Ethiopia 1984-1986 (MSF, Internal document, 2005)
36. Judith Soussan, MSF et la protection: une question réglée? (MSF, 2008), 21-2.
37. MSF's statement was reinforced by the fact that, a year later, most of the other aid agencies still working in the camps halted their relief operations there. The violence in, and subsequent dissolution of, the Hutu refugee camps in 1994-6 are associated for this reason with the birth of a new conditionality of aid that marks the 'nadir of a neutral and universal humanitarianism'
38. see Duffield, Global Governance, 81.
39. On the positions of other relief organisations that initially preferred to remain in the camps, see Fiona Terry, Condemned to Repeat, 195-213.
40. See MSF, 'Principes de référence du mouvement Médecins Sans Frontières', 1995.
41. See E.B. Rackley, Bearing Witness: Strategies and Risks (MSF, Centre de Recherche, Operational Center Brussels, November 2001), 1.
42. The term is drawn from Françoise Bouchet-Saulnier, 'Between Humanitarian Law and Principles', 2000. Available at: http://www.msf.org/msfinternational/invoke.cfm?objectid=6589C8A5-DC2C-11D4-B2010060084A6370&component=toolkit.article&method=full_html.
43. This narrative is propagated most notably by Bernard Kouchner
44. see, for example, Bernard Kouchner, 'L'humanitaire a changé le monde', Les Temps Modernes 627 [2004]: 10-21
45. but also informs less embedded accounts such as Olivier Weber, French Doctors: L'épopée des hommes et des femmes qui ont inventé la médecine humanitaire (Paris: Robert Laffont, 1995).
46. Anne Vallaeys, Médecins sans Frontières: la biographie (Paris: Fayard, 2004), 107-26.
47. See Redfield, 'A Less Modest Witness'
48. Didier Fassin, 'The Humanitarian Politics of Testimony: Subjectification through Trauma in the Israeli-Palestinian Conflict', Cultural Anthropology 23, no. 3 (2008): 531-58.
49. The discussion that follows relates, among others, to the views of Philippe Bernier, Tonus journalist who favoured discreet and professional relief operations that would encourage a wide participation of general practitioners and physicians from the province; Bernard Kouchner, one of the leaders of the group of 'Biafrans' whose promotion of an assertive and vocal humanitarian action would lead to the split in MSF in 1979; and Xavier Emmanueli, who regarded humanitarian work as an expression of the broader ethical vocation of medicine.
50. Philippe Bernier, 'La reponse à tous ceux qui doutaient de vous', Tonus, 3 January 1972, 1, 3.
51. Françoise Pradier, 'Médecins sans Frontières, au service de la médecine des catastrophes', Le Quotidien du Médecins, 16 December 1971, 5.
52. The list includes architects, pilots, engineers, dentists, educators, sailors, veterinarians and journalists. A similar view that sees the notion of 'sans frontières' as implying an overcoming of barriers rather than a transgression of national borders is expressed
53. in Redfield, 'Doctors, Borders, and Life in Crisis', 352, n. 13.
54. Philippe Bernier, 'Inde: aider-les à survivre!', Tonus, 15 November 1971, 1, 7.
55. 'Les Médecins sans Frontières', Marie France, October 1974, 18-19.
56. An earlier proposal to launch a publicity campaign was rejected in the second general assembly of MSF in 1973.
57. 'Lettre aux 60.000 médecins', Bulletin Interieur de M.S.F. no. 1, 1974, 4-6.
58. These fund-raising attempts yielded meagre results, with only 280 physicians responding to MSF's appeal
59. see 'Médecins sans Frontières', Médecine Mondiale, 9 May 1974, 23.
60. Xavier Emmanuelli, 'A quoi servons-nous?', Bulletin Médecins Sans Frontières no. 2, January-March 1975, 4.
61. According to Max Récamier, one of MSF's founders. See
62. Armelle Lèfevre, 'Du Biafra à Médecins sans Frontières, Interview du Dr Max Récamier', in Partir: guide pratique de médecine humanitaire, ed. Alain Delbos (Toulouse: Privat, 1985), 121-7.
63. A similar intention is expressed in François Jacquemont, 'Le docteur Pigeon, "La souffrance, partout, c'est l'ennemi"', L'est republicaine, 26 December 1971
64. see also Jean-Christophe Rufin, Le Piège: Quand l'aide humanitaire remplace la guerre (Paris: Jean-Claude Lattés, 1986), 62.
65. 'Les Médecins sans Frontières', Marie France.
66. See Rony Brauman and Joelle Tanguy, 'Volunteering: The Médecins sans Frontières Experience', 1998. Available at: http://www.doctorswithoutborders.org/volunteer/field/themsfexperience.cfm.
67. See Xavier Emmanuelli, Les prédateurs de l'action humanitaire (Paris: Albin Michel, 1991), 215.
68. See Bernard Kouchner, 'Editorial', Bulletin Interieur de M.S.F no. 1 (1974): 1
69. Philippe Bernier, 'Au 1er congres de "Médecins sans Frontières": La médecine d'urgence peut-elle être efficace sans "professionnels"?' Tonus, 18 December 1972, 1, 3
70. 'Corps mondial de secours and Médecins sans Frontières', Ouragan "Fifi", Honduras 1974 [Hors série]
71. Vallaeys, Médecins sans Frontières, 127-30.
72. According to an activity report published in MSF's newsletter in 1974, 16 out of 64 volunteers who had gone on a mission in the preceding two years left for a period of one year or longer.
73. See 'Bilan des activités depuis 2 ans', Annex à Bulletin Interieur de M.S.F. no. 1, 1974.
74. See Kouchner, 'Editorial', and M. Recamier, 'Editorial', Bulletin Médecins sans Frontières 3 (April-July 1975): 3.
75. For an overview of these factors, see, for example
76. Renée C. Fox, 'Medical Humanitarianism and Human Rights: Reflections on Doctors without Borders and Doctors of the World', Social Science and Medicine 41 (1995): 1607-16.
77. This view was expressed by the head of SNMOF, a French association of general practitioners, in its annual congress.
78. See '"Nous ne devons pas être des médecins auxiliaires", déclare Dr Valingot', Tonus 437, 19 October 1970, 1, 2.
79. General practitioners would come to constitute a significant share of the ranks of MSF in the first years of its existence. In 1975, 238 out of 528 MSF members were general practitioners; in 1977, 501 out of 1256
80. see, respectively, Bernard Kouchner, 'Rapport moral de l'Assemblé Générale 22-23 Février 1975', Bulletin Médecins sans Frontières 3 [April-July 1975]: 29-34, 29
81. Bernard Kouchner, Rapport Moral, Assemblé Générale de MSF, 1977.
82. The disparities between general practitioners, with whom Tonus representatives in the executive committee of MSF would be particularly associated, and hospital specialists such as the 'Biafrans', who were mainly interested in pursuing short-term emergency missions, were at the root of some of the prominent tensions within MSF in the early years of its existence
83. see Bernier, 'Au 1er congres de 'Médecins sans Frontières'
84. Vallaeys, Médecins sans Frontières, 159
85. However, it is important to note that both the 'Biafrans' and the physicians associated with Tonus's line expresses a reserved approach toward professional medicine, an attitude that would also be manifested by future members of the organisation. On this latter point
86. see Dauvin et al., Le travail humanitaire, 51-2.
87. Between 1966 and 1968 the number of students admitted to second year in medical schools in France rose sharply, from 8870 to 14,713.
88. See David Wilsford, Doctors and the State: The Politics of Health Care in France and the United States (Durham, NC: Duke University Press, 1991), 97.
89. On the rise of the medicalisation critique in the 1970s
90. see Deborah Lupton, 'Foucault and the Medicalisation Critique', in Foucault, Health and Medicine, eds Alan Petersen and Robin Bunton (London: Routledge, 1997), 94-110.
91. On the anti-medicine discourse in France in that period, see the special issue of the journal La NEF 49 (October-December 1972).
92. See François Steudler, 'Crise des institutions et pouvoir médical', Autrement 9 (1977): 136-49.
93. The concern over what came to be known as the crisis in health care and over state attempts to curb it by reducing health-care costs affected many Western societies during the 1970s.
94. See Claudine Herzlich, 'The Evolution of Relations between French Physicians and the State from 1880 to 1980', Sociology of Health and Illness 4, no. 3 (1982): 251.
95. On the repercussions of the crisis in the US
96. see Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 379-419.
97. These initiatives are surveyed in a special issue of the journal Autrement dedicated to 'Guerillas of Medicine'. The quotation is from an editorial text in the same issue.
98. See Autrement 9 (1977): 84.
99. Philippe Bernier, 'Sommes-nous des mercenaires?', Tonus, 23 November 1970, 1, 6.
100. 'Pakistan: pour qui sonne le glas?', Tonus, 14 December 1970, 1, 6.
101. 'Des morts de la honte', Tonus, 7 December 1970, 1.
102. A similar claim is made by Redfield, 'A Less Modest Witness'.
103. See MSF's first charter
104. 'La Charte de Médecins sans Frontières', Tonus, 3 January 1972
105. 'Statuts de Médecins sans Frontières', 20 December 1971, article 8.
106. Françoise Cordier, 'Médecins sans Frontières', Le Quotidien du Médecin, 16 December 1971, 5.
107. Jacquemont, 'Le docteur Pigeon'
108. see also Vallaeys, Médecins sans Frontières, 125.
109. Philippe Bernier, 'Des M.S.F. témoignent', Tonus, 14 October 1974, 1, 6
110. Marie-Claude Decamps, 'Les médecins de l'Apocalypse', Le Point, 28 October 1974.
111. Isabelle Vichniac, 'Kurdistan: scandale d'un silence', Coopération Bale, 6 March 1975.
112. 'Philippe Delaunes, un Médecin sans Frontières témoigne: "On soignait sous le feu des tireurs d'élite"', Tonus, 14-20 June 1976, 1, 10
113. D. Dumas, 'Liban', Bulletin Médecins sans Frontières 6 (April-July 1977), 44-49
114. 'Le témoignage d'un médecin français: Un effroyable massacre', Le monde, 6 October 1978.
115. Boltanski, Distant Suffering, 77-95.
116. P. Pradier, 'A propos d'une réunion à Bordeaux', Bulletin Médecins sans Frontières 7 (April 1978).
117. Kouchner quoted in 'VIe Congrès de Médecins sans frontières', 28 April 1978, Compte-rendu, archive MSF-France, 27.
118. Debates over what was referred to as 'medical neutrality' were already signalled in MSF's newsletter in early 1975.
119. See Max Recamier, Editorial, Bulletin Médecins sans Frontières 2 (January-March 1975): 3.
120. Bernard Kouchner, 'Rapport moral presenté a l'assemblé générale de MSF', 1977, archive MSF-France.
121. Bernard Kouchner, 'Cinq ans', Bulletin Médecins sans Frontières 6 (April-July 1977): 5.
122. Quoted in Nicole Lauroy, 'Soigner, c'est servir', Femmes d'Aujourd'hui, 16 April 1975.
123. Médecinssans Frontières, 'Qui Êtes Vous? Médecins sans Frontières', undated brochure, 20.
124. Following the change of leadership in MSF in 1979 and the split that led, in the same year, to the foundation of the competing organisation Médecins du Monde (MDM) by Kouchner and some of his colleagues, témoignage began to take on more politicised meanings. Although both MSF and MDM were producing and disseminating bolder statements in that period, presence in emergency zones still remained the dominant form of humanitarian witnessing.
125. MSF, 'Principes de référence du mouvement Médecins sans Frontières'.
126. Soussan, MSF et la protection, 13.
127. Redfield, 'A Less Modest Witness', 7.
128. Emmanuelli, 'A quoi servons-nous?'.
129. Emmanuelli quoted in 'Les médecins de l'Apocalypse', Le Point 110 (28 October 1974): 109.
130. Xavier Emmanuelli, 'L'âge de raison', MSF. Bulletin d'informations de Médecins sans Frontières 2 (April 1979): 1, 8.
131. Similar tensions were reflected in the testimonies of volunteers in MSF's heroic missions in Afghanistan, who variously claimed that the role of the witness does not justify any activity on the ground and that witnessing was meaningful in and of itself.
132. Médecins sans Frontières, Dans Leur Salle d'Attente 2 Milliards d'Hommes (Chêne/Hachette, 1982), Introduction (unpaginated).
133. See, for example, Monique Lefebvre, 'Médecins sans Frontières, dans leur salle d'attente 2 milliards d'hommes', Telerama, 2 March 1977, 28-30.
134. Michel Chauliac, Profil psychologique, sociologique et technique d'un Médecin sans Frontières (Thèse pour le Doctorat en Médecine, 1980)
135. Bernard Kouchner, 'Préface', in Le Devoir d'Ingérence. peut-on les laisser mourir? eds Mario Bettati and Bernard Kouchner (Paris: Denoel, 1987), 9.
136. Similar findings were reported in a comprehensive sociological study of French humanitarian organisations published in 2002.
137. See Dauvin et al., Travail humanitaire, 137-67.
138. Fassin, 'The Humanitarian Politics of Testimony', 554.
139. See Foucault, The Use of Pleasure.
140. See Mark Duffield, 'Governing the Borderlands: Decoding the Power of Aid', Disasters 25, no. 4 (2001): 308-20.
141. This trend was reflected in the overall decline during the 1990s in official development aid as a share of donor countries' wealth and in the concomitant increase in the share of humanitarian assistance channelled through NGOs.
142. See Judith Randel and Tony German, 'Trends in the Financing of Humanitarian Assistance', in The New Humanitarianism: A Review of Policy Trends in Global Humanitarian Action, ed. Joanna Macrae (Humanitarian Policy Group, Report no. 11, April 2002), 19-28.
143. Duffield, 'Governing the Borderlands'.
144. As Vanessa Pupavac has pointed out, this humanitarian governance has increasingly embraced a therapeutic rationality, focusing on traumatic symptoms and targeting individual emotions regarded as politically destabilising.
145. See Vanessa Pupavac, 'War on the Couch: The Emotionology of the New International Security Paradigm', European Journal of Social Theory 7, no. 2 (2004): 149-70.
146. Duffield, 'Governing the Borderlands', 318.
147. On this point, see also B. Steele and J.L. Amoureux, 'NGOs and Monitoring Genocide: The Benefits and Limits to Human Right Panopticism', Millennium 34, no. 2 (2006): 403-32.
148. See David Chandler, 'The Road to Military Humanitarianism: How the Human Rights NGOs Shaped a New Humanitarian Agenda', Human Rights Quarterly 23, no. 3 (2001): 678-700
149. Didier Fassin, 'Humanitarianism: A Nongovernmental Government', in Non Governmental Politics, ed. Michel Feher (New York: Zone Books, 2007), 149-59, 157.
150. Osborne, 'Power and Persons', 532.
151. Nicolas Rose, Powers of Freedom: Reframing Political Thought (Cambridge: Cambridge University Press, 1999), ch. 2.
152. This responsibilisation joins other modes of subjectification fostered by advanced liberal government as a condition for its efficient and frugal functioning, which are similarly operating on a globalised scale. Louiza Odysseos pointed to the role of contemporary human rights discourse in producing a distinct subjectivity that she calls 'homo juridicus', which itself parallels another type of subjectivity, the homo oeconomicus, discussed by Foucault. The humanitarian alignment of political and ethical government should therefore be construed in the larger context of an advanced-liberal formation of government that variously propels individuals to constitute themselves as responsible agents, as holders of rights and as rational beings.
153. See Louiza Odysseos, 'Human Rights, Liberal Ontogenesis and Freedom: Producing a Subject for Neoliberalism?', Millennium 38, no. 1 (2010): 747-71
154. Michel Foucault, The Birth of Biopolitics: Lectures at the College de France, 1978-79 (Palgrave Macmillan, 2008), 267-89.
155. See Rose, Powers of Freedom, 49.
156. See, for example, Lorence Binet, Genocide of Rwandan Tutsis (MSF, Internal document, 2003), Introduction.
157. Annette Wieviorka, L'ère du témoin (Paris: Hachette Littératures, 2002).