Summary: confronted with horror and suffering caused by genocide and war, James Orbinski realises that the humanitarian principle of neutrality undermines the need for effective political engagement. This memoir recounts the journey towards that realisation.
Message: the factors that precipitate humanitarian crises are usually political, so it is important to engage on a political level to avoid or resolve these crises. Humanitarian workers responding to the needs of those who suffer or whose lives are threatened is vital, but not sufficient.
Highlights: Orbinski’s descriptions of people he encountered – those he served and those he worked alongside – beautifully display the humanity of both the subject and the author. A particularly stark, if bleak, example of this is found in his description of a women who was raped and severely mutilated during the 1994 genocide in Rwanda. She called him “friend” and encouraged him to take heart as he struggled to retain his composure when treating her injuries.
Limitations: the author seems to embody so much about Médecins Sans Frontières (MSF) that his message risks being pigeonholed as an MSF manifesto rather than being absorbed and applied by humanitarians and politicians alike. To be explicit about what I mean by embodying MSF: Orbinski is an intelligent, compassionate, fiercely independent medical doctor who completed short term missions in dire situations, gave everything he could, and coped with the trauma by drinking and smoking heavily. If one was to create a stereotypical MSF aid worker, they would look like Orbinski. The risk is that politicians would too easily dismiss the message based on MSF’s reputation for activism, and humanitarians working for organisations other than MSF could argue that they will never reach the level of independence that Orbinski promotes, because their own organisation does not have a funding base as large and flexible as that of MSF.
Concluding thoughts: Orbinski’s book caused me to reflect on two themes in particular.
Firstly, compassion must remain at the centre of what drives humanitarians to save lives and relieve suffering. The aid sector has transformed from being driven by big-hearted volunteers to being much more professional, with significantly higher barriers to entry (in terms of specific education and experience, at least). Additionally, there is a new focus on innovative solutions to problems being piloted and then scaled either through public-private partnerships or through adoption into national policy. This transformation should be beneficial, in terms of the quality of services received by people in need. However, a side effect is that humanitarian work has come to represent a steady job for NGO workers; something that applies to workers hired locally and internationally. I believe that compassion is a driving force for providing the best possible services to the people who most need them, but the professionalisation of the sector has arguably led to a net loss in the prevalence of compassion among those involved in the work. This can lead to complacency, to prioritising business continuity over need, and to isolation from people served: their humanity reduced to a cost-per-beneficiary figure.*
Secondly, one cannot escape politics, so it is better for humanitarian workers to be politically aware rather than to be wilfully naïve in the name of maintaining neutrality. Personally, I’m grateful for the core humanitarian principles (humanity, neutrality, impartiality, independence), because in situations where they are understood, they allow access to people in need that would not otherwise be possible. Thus, there’s high value in preserving specialisation within the sector: humanitarians are humanitarians, missionaries are missionaries, and activists are activists. I believe that all do valuable work, but that as far as possible, their work should be kept separate. An Imperfect Offering nudged me to resist the temptation to leave politics to the activists, serving to intensify my desire for a deeper understanding of the local, national, and international politics that influence the situation in eastern DR Congo.
*Cost-per-beneficiary: within humanitarian work, this is key value for money metric, calculated by dividing the amount of money a project will cost by the number of people the project will serve (usually inclusive of the overhead, logistical, staff and supply costs). As an example, the cost-per-beneficiary of a USD 2,000,000 project that serves 160,000 people is USD 12.5. Whether or not that would be considered good value for money depends on the type of services provided and the difficulty of reaching the people served.