Nine days ago, the humanitarian aid organisation Médecins Sans Frontières/Doctors Without Borders (MSF) posted an opinion piece on their website about an ethical issue facing organisations like itself: at what point does the work of treating the wounds and injuries of war become complicity in that war?
On their work right now in Gaza, Jonathan Whittall writes:
An entire population is trapped in what is essentially an open-air prison. They can’t leave and only the most limited supplies – essential for basic survival – are allowed to enter. The population of the prison have elected representatives and organised social services. Some of the prisoners have organised into armed groups and resist their indefinite detention by firing rockets over the prison wall. However, the prison guards are the ones who have the capacity to launch large scale and highly destructive attacks on the open-air prison.
At what point does MSF’s repeated medical action in an unacceptable situation become complicity to aggression and oppression?
While the blockade on Gaza remains firmly in place, MSF is continuing to work in an open-air prison to patch up prisoners in between their torture sessions.
Another MSF worker, Michaël Neuman, responds below Whittall’s piece, highlighting the crucial issue of consent, and I highly recommend that you read them both.
I don’t feel I can add anything to either of these excellent articles at this point, but reading them brought to mind another element of this, and its implications for humanitarian work: that of silence.
When I worked for a humanitarian relief agency in Darfur in 2005, not long after the peak of the violence that continues to this day, I was informed in no uncertain terms that I could not use the word ‘rape’ in any public communications. If we used that word in public, in relation to what was happening in Darfur, our international staff would be kicked out and our programme shut down. I was told this many times. This is what we had to do to maintain our neutrality, and thus, our ability to work in Darfur. As public communication wasn’t part of my job, this wasn’t something that particularly affected my ability to work day to day, but it was something that stuck.
We could never forget that we were able to provide life-saving interventions in Darfur only by permission of the Government of Sudan, and the array of permits and visas required were always at the government’s right of refusal. Always. One thing the government did not tolerate was any acknowledgement of the widespread use of rape as a weapon of war.
Here in the U.K, rape carries one of the lowest conviction rates of any violent crime. I have no idea what the actual stats on rape convictions are in Sudan, but I do know that for a rape charge to be legally accepted, the victim needs to have three adult male witnesses to verify the rape, and THEN it can go to court where it may or may not result in conviction. I also remember reading a copy of the English language newspaper Sudan Vision in which a victim’s name, photograph and address were published as part of a story about her ‘alleged rape’ as they kept calling it – so I think it’s fair to assume based on these that the rate of conviction for rape in Sudan rounds very easily to zero.
All of the humanitarian workers in Darfur knew that sexual assault was one of the primary strategies of the janjaweed militias, the government-backed proxy troops that burnt and slaughtered their way through the Darfur states. It traumatised individuals, and destroyed communities - all part of the goal. Everyone we knew in the medical clinics talked about the numerous injuries they treated relating to sexual assault. One time, my colleague spoke to fifteen women in one camp about buckets and soap and sanitary towels, and every woman without exception told her that she had been raped. Another time, I was stopped in a camp by a woman who wanted to know if I could help her and her baby, because he had no father, because his father was janjaweed. The evidence was everywhere. Women and girls were often disowned by their families following an assault. Babies were born under horrific circumstances. School-aged boys and girls suddenly forgot how to talk, how to walk, how to control their bladders. It was everywhere.
But we couldn’t talk about it. We’d get kicked out, and the programme would be shut down. I’d go to meetings with government officials and listen to them tell me how we – the humanitarian agencies - were here as invited guests of the government, to help the government, all while the government was supplying logistical and military support to the janjaweed.
Remember: don’t say rape. They’ll kick us out, and if they kick us out, we can’t provide emergency assistance to those who need it. More people will die. Don’t say rape.
In March 2005, MSF published a report called ‘The Crushing Burden of Rape’, detailing the epidemic of sexual violence that was sweeping Darfur. It was drawn from a survey of their patient records at their clinics in Darfur, and was intended to highlight the epidemic.
At the end of May, the MSF head of mission in Sudan and the Darfur regional coordinator were charged with espionage, publishing false information, and undermining Sudanese society. Authorities demanded that they hand over identifying details of their anonymised sources, and when they refused, they were arrested.
After an outcry from the UN, the charges were dropped, and nine years later the whole incident is a footnote in a devastating war that still rolls on.
But I remember that report. I remember reading about it and the statement that the MSF Director made about how it was their duty as medics and as humans to speak up when they witnessed abuses. They spoke out. They said it.
Humanitarian relief – emergency relief in particular - can often require calculated choices about explicitly speaking out against injustice, or staying quietly ‘neutral’ in order to be able to continue helping those who desperately need it. I understand pragmatism and the thinking behind it, I do, but with silence comes the risk of complicity, and right now, I have nothing but absolute admiration for the doctors of MSF who are publicly asking hard questions of themselves and other humanitarian workers, and unwaveringly saying not only what they are witnessing, but what they may be part of.