Chessy Breene05-11-12

AY462

Médecins Sans Frontières, Biocitizenship, and the Narrative Power of Medical Humanitarianism

Introduction

This paper seeks to explore how relief work is central to the formation of master

aid narrative by which volunteers, doctors, victims, and the global community come to

define and locate themselves. Looking specifically at the non-governmental organization,

Medecines Sans Frontiers, I argue that the ways in which MSF volunteers treat their

patients and utilize media to promote and disseminate information about their projects,

ultimately leads to a damaging process of identity formation. Through employing an

often colonialist discourse which focuses specifically on polarized images of ‘victims’

and ‘heroes’, the organization comes to define, and redefine, the identities and

citizenships of all those that lay claim to the MSF network. Similarly, I argue that not

only does MSF come to shape the identities of its victims through this discourse, but also

the identities of its volunteers, and even the wider global community.

Before delving into this central thesis, I begin my paper with an exploration of the

origins of ‘biocitizenship’ through Foucault’s analysis of bio-power and bodily

governance. I look at the ways in which health and citizenship came to first be

intertwined, and how processes of exclusion and marginalization were built out of this

process. I argue that it is within this environment that humanitarian organizations, like

MSF, were first established, to care for a growing and newly peripheralized group of

‘undesirables’.

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Despite the honorable nature of medical humanitarian work, ultimately, my paper

seeks to reveal the ways in which the rhetoric that MSF employs unfortunately does less

to restore dignity and citizenship to these people, and more to lock them into processes of

‘identity freezing’, which prevent them from escaping from positions of victimization.

Biopower and the Politics of Health

Beginning in 18th century Europe, states began to take an active role in regulating

the health of their citizens. Realizing that a key component in advancing their power was

a robust and healthy population, nations sought to regulate and control the health of their

citizenry, an initiative of surveillance which Michael Foucault has termed ‘biopower’.

Through this movement, “states acquired power over people as biological entities, instead

of simply political subjects. The bodies themselves, and not just what they represented,

became an important concern of the state… Political power took over care of the

biological life of the entire social body [as] biopower [came] to represent the extension of

state power. ” (Youde, 17) With the advent of this new pressure, citizens sought to

conform to new health regulations and perform their health in heightened ways.

Individuals were convinced to alter their health related behaviors in ways that would

demonstrate their commitment to the states enrichment, power, and security. Good

health became the duty of a good citizen, and bad health a deviation from good

citizenship. A clipping from an abstract of a 1925 public school text book reveals this

connection, as it reads:

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“Vital processes of the body are sufficiently emphasized to place before the pupil

his responsibility for looking after his personal habits and health, but not so over-

emphasized as to become mere studies of anatomy and physiology. The emphasis placed

upon the relation of good health to good citizenship is peculiarly advantageous.”

(Andress and Evans)

Similarly, articles published during this time frequently cited health as the duty of

a loyal citizen, one example of which reads, “A typical good citizen possesses the

following qualities: 1. Sound Health: A good citizen is robust and healthy. He is careful

about the rules of health and observes them scrupulously. Only a sound body has a sound

mind.” (Preserve, 1) The control and governance of the individual body, or ‘anatomo-

politics’ (Youde, 18) as Foucault terms it, thus became a new and important phenomenon

of state regulation in the 18th century as nations competed for power in the emergence of

the new world order.

Inextricably linked with this new mechanism of control, were the processes in

which biopower created new categories of inclusion and exclusion. Those who failed to

live up to the desired ideal were made to feel unworthy of belonging or pressured to

change their habits to conform. Citizenship as a concept began to narrow its parameters

for inclusion, as national belonging was no longer enough. In addition, citizens were

asked to also adopt a kind of ‘biopolitical citizenship’ in which their physical health and

well-being defined them as good state subjects. States became “increasingly preoccupied

with the intersection of human biological existence and power. They [relied] more and

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more on health and disease as a social and political marker. A persons status as a citizen

worthy of respect and attention within the international community increasingly

depended upon being healthy and avoiding disease.” (Youde, 8) Those who could not

perform optimally, were marginalized in new ways, and were increasingly denied their

rights to claim full citizenship. State governance of health became a biased and unfair

way in which stigmatized groups came to be further peripheralized and progressively

more vulnerable. Suddenly, parts of people’s lives that had once been incredibly private

came to define their public interactions and performances. In a strange development,

“bodily fluids [became] politically important, indicating ones status as a viable member

of the community… Inebriated, infected, or influenced, [one was] less than a fully

capable and responsible citizens…Illness, in the best of circumstances a private

misfortune, [became] public and political.” (Youde, 9) Far from just pledging mental and

emotional allegiance to one’s state, now one also had to pledge one’s body in a physically

whole and healthy condition, in a sense, offering oneself up for sacrifice in the name of

nationalism.

As new categories of health created new categories of citizens, it was inevitable

that certain groups of people would become targets for nationalist rhetoric. As

governments found it easy to blame shortcomings on those they’d rather not incorporate

into their citizenry, diseases were largely blamed on already marginalized groups, dirty

‘Others’, or foreign blooded immigrants. In San Francisco in the 1890’s, segregationalist

policies were instituted in order to separate the ‘diseased’ Chinese from the white

population, as the plague ran rampant through California. (Echenberg in Youde, 21) The

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same arguments were used to lay the ground for apartheid South Africa, where

government officials convinced whites that it was the nonwhite population who were

bringing plague upon the country. Europe, too, saw the attribution of bubonic plague in

the 1300s fall upon the often disempowered and resented Jewish population. Thus

countless examples in which disease and bad health are attributed to a group of

‘undesired’ citizens reveal the ways in which governments utilized biopower in order to

control their populaces.

The interlinking of health and politics brought with it increased state surveillance

which transformed individual’s thoughts about their well-being. No longer were the

terms ‘healthy’ or ‘sick’ neutral scientific categories, rather they were weighted with

ideas about one’s worth. This new way of classifying oneself as a celebrated, acceptable,

or deviant citizen created an entirely new framework through which governments could

exclude or accept. In this way, “medical surveillance and classification gave society a

powerful tool for imposing order under the guise of scientific objectivity.” (Youde, 6) It

is this fundamental control of individual bodies that Foucault explores more deeply, and

which I will now explore.

Foucault and the Production of Bodies

In his essay, “Knowledge of Bodies, Bodies of Knowledge”, David Armstrong

cites Foucault as writing, “Disciplinary power, is not concerned with repressing, but

creating. It is disciplinary power, through the surveillance and subsequent objectification

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of the body, which actually serve to fabricate the body in the first place.” (Armstrong, 23)

The central premise of Foucault’s argument revolves around the idea of the body as a

fluid entity, constantly being made and reworked by outside forces of control. In

Foucault’s eyes, the body cannot exist as either a natural or neutral object, rather it is

produced and reproduced by different and multiple sets of practices and discourses. It is

within this fundamental process of creating and controlling bodies that governments can

sort their populaces into categories of ‘desirable’ and ‘undesirable’ and instigate social

and political discrimination against constructed groups of ‘bad’ citizens. This “process

of corporal objectification becomes not [merely] an assault on human individuality, but

the very practice through which that individuality is given a literally solid foundation and

manifestation, “ (Armstrong, 22) as identities become constructed by the nation state and

citizens come to be defined by the worth of their bodies.

In his theory of disciplined bodies and surveillance, Foucault also introduces the

concept of self-regulation, arguing that as disciplinary structures become engrained in

individuals processes of self-making, they begin to monitor themselves without the need

for a supra-controlling force. In the realm of health, this kind of self-regulation

materializes itself in annual doctors visits, well-stocked medicine cabinets at home, and

self-quarantining activities which keep us away from others when we are sick and

encourage us to return to our optimal state of health as soon as possible. Crucial to this

kind of self disciplining however, are resources, and our access to them. With the highest

quality health care in the world, the US stands far above most of the globe in its provision

of medicines and health care services. Going beyond regulation of disease and sickness

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within the nation, the US mobilizes thousands of groups annually to explore global

patterns and processes of disease, demonstrating the growing use of health surveillance

on an international level. Youlde attributes this kind of state behavior to a desire to

“engage in panoptic surveillance for the greater good,” (Youlde, 17) yet also reveals how

those deemed ‘sick’ are excluded from membership within the larger global political

community. In monitoring world health, states seek to protect their own, filtering the

‘bad’ bodies from the ‘good’ and creating a much larger community of marginalized

peoples who are not only peripheralized by their own nation states, but also the global

community.

It is alongside the creation of these deviant and vulnerable groups that groups are

formed to serve and aid the ‘undesirables’. Health is “no longer a matter of national

politics; [but] a matter of international politics… It is through surveillance and the

recognition that some countries lack the resources to address their pressing health needs

on their own that other members of the international community have started to

contribute to these efforts,” (Youlde, 37) primarily through the formation of

organizations such as Medecines Sans Frontiers.

Medecines Sans Frontiers – An Introduction

Medecines Sans Frontiers, hereafter MSF, was established by a small group of

French physicians in response to events that occurred during Nigerian civil war of 1967-

1970. Working in Biafra, Nigeria’s newly independent region, French doctors

volunteering with the Red Cross witnessed a military blockade and subsequent mass

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slaughtering of men, women, and children by blockading forces. Despite the mandate of

the Red Cross requiring that workers take an oath of silence and political neutrality when

working in the field, the doctors decided that remaining quiet would make them complicit

in the atrocities. Deciding they had a responsibility to speak out against the violence and

injustices that were occurring, they doctors broke protocol, parted ways with the Red

Cross, and determined that a new organization needed to be formed – one that would

“ignore the political/religious boundaries and prioritize the welfare of victims.”

(Bortolotti) The first version of MSF to be established was The Groupe d'Intervention

Médicale et Chirurgicale en Urgence ("Emergency Medical and Surgical Intervention

Group"), and its mission statement centered around prioritizing victims rights over

neutrality. Simultaneously, another relief group aiming to mobilize doctors for aid,

named Ecours Médical Français ("French Medical Relief"), was founded in response to

the 1970 Bhola cyclone in East Pakistan. In December of 1971, the two organizations

merged and became what is today known as Médecins Sans Frontières. (Bortolotti)

The organization was founded in on the belief that “all people have the right

to medical care regardless of race, religion, creed or political affiliation, and that the

needs of these people outweigh respect for national borders.” (MSF Home Page) Today,

the organization proclaims itself to be an “international, independent, medical

humanitarian organization that delivers emergency aid to people affected by armed

conflict, epidemics, natural disasters and exclusion from healthcare.” A copy of the

founding charter appears below:

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“Médecins Sans Frontières is a private, international association. The

association is made up mainly of doctors and health sector workers and is also open to

all other professions which might help in achieving its aims. All of its members agree to

honor the following principles:

Médecins Sans Frontières provides assistance to populations in distress, to

victims of natural or man-made disasters and to victims of armed conflict. They do so

irrespective of race, religion, creed or political convictions.

Médecins Sans Frontières observes neutrality and impartiality in the name of

universal medical ethics and the right to humanitarian assistance and claims full and

unhindered freedom in the exercise of its functions.

Members undertake to respect their professional code of ethics and maintain

complete independence from all political, economic or religious powers.

As volunteers, members understand the risks and dangers of the missions they

carry out and make no claim for themselves or their assigns for any form of

compensation other than that which the association might be able to afford them.” (MSF

Charter)

MSF engages in field operations today primarily as providers of medical aid,

however, they also work on issues of water purification and nutrition. The organization’s

field teams are made up of medical volunteers - including physicians, surgeons, nurses,

and various other specialists, and non-medical volunteers – including logisticians,

engineers, water/sanitation specialists, and financial/administration experts. A large part

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of their medical activities revolve around the administration of vaccinations for

preventable diseases that plague developing nations such as diphtheria, measles,

meningitis, tetanus, pertussis, yellow fever, polio, and cholera. MSF also concentrates on

administering AIDS treatment and testing, and disseminating information for education,

and awareness.

In 1999, Dr. James Orbinski, President of the Medecines Sans Frontiers

International Council, was awarded the Nobel Peace Prize for the work of MSF

worldwide. In his acceptance speech, he spoke about medical humanitarianism and the

‘duty to interfere’, saying “humanitarian action is more than simple generosity, simple

charity. It aims to build a space of normalcy in the midst of what is profoundly abnormal.

More than offering material assistance, we aim to enable individuals to regain their rights

and dignity as human beings… Our action and our voice is an act of indignation, a refusal

to accept an active or passive assault on the other.” (Dechaine quoting Nobel Peace Prize

Journal, 1999) It is this narrative of aid that the bulk of my paper will now turn too, as I

explore the powerful impact MSF has on shaping the identities and citizenships of those

it seeks to serve, those it recruits, and the global community.

Shaping Victims; The Claiming of New Identities

In its quest to aid the most vulnerable, MSF travels to every corner of the globe

seeking those in need of its services. In this section, I will look at how MSF identifies

those in need and the processes through which one comes to be labeled a ‘victim’. I will

explore this through analyzing the ‘space of victimhood’ which MSF forges, the shift in

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citizenship that occurs for MSF’s ‘victims’, and the effects of media sensationalism on

‘victim’ dislocation. Essentially, I will argue that through being characterized as

‘victims’, these people’s identities are reformed and their lives reduced to fit a common

mold. Rather than empowering and restoring dignity to those it serves, then, I argue that

by forcing them into defined spaces, propelling them into worldview through media, and

subjecting them to disciplinary actions that are often wrought with colonialist undertones,

MSF subconsciously further peripheralizes and marginalizes these people. Rather than

being restored as good citizens able to contribute to their state, these ‘victims’ are thus

further removed from their national citizenry.

The Space of Victimhood

In his essay, “Deterritorialized Territories, Borderless Borders: The New

Geography of International Medical Assistance,” Francois Debrix writes that MSF

“establishes humanitarian sanctuaries, loosely protected zones of relief for populations

which simply become known as the ‘victims’. Like it or not, such a practice requires new

territorial demarcations and, more importantly, new fixations and identifications for the

populations now relieved by humanitarian doctors.” (Debrix, p.829) As MSF seeks out

those in need, it simultaneously creates new categories of people, as individual stories

become less and less significant, and ‘victimhood’ becomes the foremost indentifying

marker of a person. Within this new ‘space’, ‘victim’s’ become accustomed to interacting

with other ‘victims’ and looking to MSF workers for aid and direction on a daily basis.

Their existence in a space of victimhood becomes a tool for social location, and identity

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markers which once held more weight begin to dwindle in importance. As Richard

Jenkins theorizes, “identity is a process that happens between people… social identity is a

game of playing the vis-à-vis. Identities work and are worked,” (Whyte, 7) constantly,

thus ‘victims’ that MSF seeks to identify and serve learn to play the ‘victim’ role in

heightened ways by downplaying other aspects of their lives and ‘playing-up’ their roles

as global victims.

In a sense, it is a solidarity movement, a collection of the world’s vulnerable,

seeking membership in a supportive community that will embrace their suffering through

encouragement rather than exclude them based on their failures as ‘good’ healthy

citizens. By picking up those swept under the rug by their own states, MSF builds these

spaces as appealing and unifying places of refuge. As they experience life as

‘disappeared’ people, excluded and made invisible by the state – what these ‘victims’

gain instead is a ‘biocommunity of patients’. Citing Biehl and Nguyen in her essay on

Health Identities and Subjectivities, Susan Whyte points out that “in such spaces of

support, former noncitizens have unprecedented opportunity to claim new identity around

their politicized biology [as] mobilization appeals to a global therapeutic order.

Therapeutic citizenship’ is a form of stateless citizenship whereby claims are made on a

global order on the basis of ones biomedical condition.” (Whyte,12) By constructing this

‘space of victimhood’, MSF transcends state sovereignties and their exclusive notions of

citizenship to provide ‘victims’ with a new space in which they can belong, and a space

in which they can find companionship and unity. They provide ‘victim’s’ a means

through which they can claim belonging and find some sense of community through their

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suffering. MSF enables these ‘victim’s’ to interact with one another and to observe one

another, thus enabling them to feel inclusion, rather than exclusion, in a group of

common citizens.

Claiming New Citizenship

As MSFs ‘victim’s’ come to relocate themselves in this new space of victimhood,

their notions of citizenship are inevitably redefined. By positing itself as an international,

borderless, humanitarian organization, MSF essentially “challenges the territorial

authority of State apparatuses… and provides a new spatial vision of the international

landscape; the space of an international community.” (Debrix, 833) In doing this, MSF

adopts a stance which opposes exclusive, nationalistic policies and instead fosters the

creation of a space absent of judgment, pressure, or narrowly constructed rhetoric of

citizenship. MSF instead promotes a vision of global citizenship, therapeutic citizenship,

and humanitarian citizenship, in which all people may claim membership too. As a

result, ‘Victim’s’ come to re-imagine themselves as collective parts to the MSF body.

Having been abandoned by their states and not provided with the care or services

they need most, these people are far more inclined to claim membership and even

allegiance to this international NGO and the people it serves. ‘Victims’ come to care for

one another, and join together in community movements that prioritize their commitment

to other ‘victims’ and members of the MSF community over their commitment to a state

which has marginalized them. It is easy to see how this happens, when, for example, an

MSF worker in Liberia tells media sources that MSF owns more than 75% of hospital

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beds in Monrovia, and has more doctors in the city than the ministry of health itself.

(Living in Emergency Documentary)

Media Imagery in Identity Formation

In looking at how MSF enables ‘victims’ to redefine their identities in new spaces

of victimhood and through claims to new forms of citizenship, I will now turn to looking

at the ways in which the identities of ‘victims’ are also reforged by the scope of MSF’s

work, the dissemination of stereotyped images through media, and through the colonialist

discourse that many MSF workers subconsciously adopt in their dealings with local

doctors, nurses, and patients. I will reveal the ways in which MSF is forced to deal with

‘victims’ on such a mass scale that their substantive lives are replaced with numbers.

Then, in exploring the role of the media, I will look at the ways in which MSF utilizes

journalists, photographers, and videographers to advance their cause, with the ultimate

and unfortunate effect of inadvertently stripping agency from those they serve. Similarly,

through an exploration of several case studies documented in the film, “Living In

Emergency”, I will reveal how MSF volunteers often assume authority and leadership in

ways which belittle those they work alongside, and render them, in a sense, socially

immobile.

We are all acutely aware of the humanitarian calls to action we see and hear about

almost daily from NGOs, social media networks, news stations, and radio shows, just to

name a few. The most recent of these, a plea for emergency donations for the food crisis

in the Sahel region of West Africa, bombards my personal Facebook and twitter accounts

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with new statistics, images, and videos each hour. This month I have even received text

messages from UNICEF, asking me to reply with one simply word: FEED. Send those

four letters and immediately my cell phone company adds ten dollars to my bill and ten

dollars worth of therapeutic plumpy nut mix miraculously makes its way to Mali. In a

one-minute texting exchange, I have saved the life of a child. It is hard to criticize a

process which seems so effective at disseminating information, instilling feelings of

empathy, and cultivating potential donors, yet there is no doubt that NGO’s pay a large

price to get the mass responses they desire. That price is the loss of individualism, it is

the reduction of life to a number, and the morphing of every suffering victim into the

nameless, ageless, nationless ‘poster child’ of poverty. Substantive lives are reduced to

pictures, and lives become what Greek philosopher Giorgio Agamben has called, ‘bare’.

Agamben introduces the concept of bare life through an analysis of the Ancient

Greek terms for life: “Zoe, meaning zoological life and the simple fact of living, [vs.].

Bio, or biographical life, a life that is properly formed through events.” (Redfield, 340) In

his most famous work, "Homo Sacer: Sovereign Power and Bare Life," (Agamben, 1998)

he explored the processes by which certain men were set apart and excluded from

meaningful participation in their societies, thus the loss of their lives were

inconsequential. Building on the arguments of Aristotle, who theorized that man is an

animal born to life, but can only exist as a ‘good life’ if he achieves participation in

society, Agamben argued that some men were condemned to exclusion and meaningless

existence.

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In using these concepts in his essay on biopolitics, Redfield reveals how MSF

‘victims’ are reduced to bare life forms, “forms of naked existence without any benefits

of social being… undeniably representing an archetype of all human suffering.”

(Redfield, 341) Far from being intentional in their marginalization of these ‘victims’,

Redfield argues that it is likely the sheer magnitude of MSF’s work which forces them to

deal with human lives in statistics and through rote procedures. As they provide services

to over ten million patients a year, MSF cannot do much to truly acknowledge the

individuality of each patient. Thus, “the more they save bodies within limited conditions,

the starker the contrast between minimal existence and fully formed life… Such is the

problem that MSF both embodies and confronts on a continual basis, acting and reacting

indignantly through conjoined, disjunctive categories of techniques, ethics, and politics

around minimal existence.” (Redfield, 327) In taking the idea of a refugee camp for

example, one can see the ways in which each structure is assembled to deal with mass

numbers in a limited timeframe, usually with insufficient supplies. Images coming out of

Dadaab refugee camp in Northern Kenya portray lines of hundreds of men, women, and

children, waiting to register and receive their small ration of emergency food and a tent to

put over their heads. Individual stories of victims are rare, and when they do make their

way into the media, they are often close copycats of the ‘unique’ story that was told the

month before. In this kind of setting, “human zoology exceeds biography: those whose

dignity and citizenship is most in question find their crucial measurements taken in

calories rather than their ability to voice individual opinions or perform acts of civic

virtue. The species body, individually varied but fundamentally interchangeable, grows

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visible and becomes the focus of attention.” (Redfield, 342) Individual voices are lost,

and personalities ignored, as a collective ‘victim’ identity comes to takes precedence over

the acknowledgment of millions of diverse names, faces, and stories.

Perhaps the best line of reasoning for this is that NGOs like MSF are forced to

save lives with the bare minimum, and consequently, “in [these] exceptional conditions

of displacement, exceptional spaces of preservation open. [Spaces designed] to relieve a

population, if never quiet cure or fully care for it.” (Redfield, 341) Life, becomes reduced

to a physical form that must receive just enough to remain alive, thus all substance and

dignity and human worth is, in a sense, lost. Breath, not meaningful life, is all that

becomes important through this process. Survival becomes about bodies, rather than

beings. Take, for example, MSFs use of ‘The Bracelet of Life’, a paper strip which is

used to measure the upper arm circumference of children and lactating mothers. When

wrapped around the arm, it gives a number, in centimeters, that is designed to indicate the

nutritional health of the subject. This measuring tool is vital for MSF operations

worldwide, but as a life-analyzing tool, it fails to reveal the “gap between distress and

happiness”, (Redfield, 346) or the extent of suffering that the individual is feeling. The

number it gives is clear, statistical, and scientific, yet by any other measure of substantive

life, it is extraordinarily limited in its scope.

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Photo Credit: MSF. Bracelet of Life

Beyond reducing lives to numbers, MSFs use of media also causes the

homogenization of victims, and perhaps more damagingly, desensitizes the global

community to human suffering. Images once designed to instill feelings of shock and

horror in us no longer do their job, as the sheer proliferation of such images has built

within us a kind of immunity to these photos. Without a doubt, it takes far more to upset,

scare, or repulse me through imagery than it once did. Having worked for NGOs dealing

with food crises all over the world in the last three years, an image of a starving child no

longer moves me in the ways it used to. In fact, it was not until I was standing face to

face with a malnourished five year old dying of Tuberculosis in rural Kenya that I felt

truly shocked into action in the same way that photos disseminated by MSF or UNICEF

once affected me. Analyzing my own experiences here is incredibly interesting,

especially as I find that my own photograph is actually far less shocking than some of the

images we receive from MSF.

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Photo Credit: Medecines Sans Frontiers.

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Observing this comparison, I am drawn to conclude that despite the second image

(MSF’s) being far more shaking, my photo invokes more feeling within me because I was

able to see the life in that young boy. I was able to see his suffering, and realize his worth

as a human being precisely because he was more than just another photograph. Images

released by NGOs like MSF remove this relationship and commodity their victims, albeit

unintentionally, rendering these photos almost meaningless. Consequently, we can now

gloss over these pictures in magazines, and the ‘poster child’ of poverty no longer affects

us the way it should. As MSF “offers the victim to the global media eager to produce

more and more sensationalistic images, [the victim] becomes mediarized, presented to

global audiences as a common image of drama, destitution, disease, or death,” (Debrix,

839) and these media tools essentially becomes ineffective.

Not only are we desensitized to these images, but the lives of victims are reduced

yet again, as photos both delocalize and homogenize the individual. Far from knowing

where, when, how old, and in what circumstances the photos are taken, we see the same

black baby with a bloated belly and flies in his eyes as representative of all ‘victims’.

Whether that baby is in famine stricken Somalia or the desert of the Sahel, we are given

no indication of the unique place that the child exists in. As each humanitarian crisis

disseminates the same media imagery, they become “non-events… homogenized visions

of yet another humanitarian crisis with yet another visual landscape of victimhood…

[and] in this fatal condition of the generalized humanitarian accident, the humanitarian

event no longer takes place.” (Debrix, 842) Take this media campaign, for example, a

powerful poster without reference to time, place, or personhood . It reads “THEY

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urgently need medical help,” creating, in a sense, thousands of carbon copies of this

young boy.

The negative consequences of media sensationalism surrounding crises also

become easy to see as we look to specific cases such as the Rwandan Genocide. In

analyzing MSF’s role in raising awareness surrounding the genocide, Debrix criticizes

their campaign harshly, writing:

“In Rwanda, the space of global victimhood created by MSF became the purveyor

or media voyeuristic opportunities. Turned into a media event, the humanitarian

situation and the ‘victims’ disappeared into a succession of similar, interchangeable

catastrophic visual sits… Humanitarianism gave way to consumerism, while the

individual in need became the ‘global victim’”. (843)

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Colonialism Revisited

Having shown how MSF utilizes the media to mobilize a global community of

humanitarians with the unfortunate and unintended consequence of homogenizing

‘victims’ and removing agency and individual identities from them, I will now turn to

looking at the ways in which MSF employs a colonial discourse in many of its

undertakings, which also works in negative ways to freeze locals and victims into narrow,

disempowered identities.

In analyzing the creation of MSF through a critical lense, Peter Redfield argues

that the organization is inevitably reproducing colonial discourse through its very

existence. He writes that “MSF framed itself in reaction to failings of the state-structured

Red Cross, but in practice it evokes general contradictions of postcolonial expatriate life.

To work ‘without’ borders confronts the basic territorial logic of the nation state;

however it also recalls the legacy of imperial expansion. Eight of the ten sites listed on

[the MSF] poster bear the names of former colonies and colonial borderlands of the

European imperial era, mostly in Africa.” (Redfield, 336) Despite the fact that MSF seeks

to train local doctors and improve the medical capacity of the states it serves, there is no

doubt that they do so in an unintentionally patriarchal manner.

It is not hard to understand how the images of white doctors saving black

‘victims’ invoke memories of a colonial European empire. To many, it is unnerving to

see how many parallels can be drawn between the two. The creation of the white hero is a

topic I will delve into in the next section, but it is firstly important to see how the role of

the MSF doctor acts to shape the identities of those around him/her. In the documentary,

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Living in Emergency, we see the conflict these colonialist undertones create in a

confrontation between two doctors, one white, and one black. After disagreeing about the

treatment of one patient, the French says, “I can tell you this, because I know what I’m

talking about,” dismissing the Congolese doctor. After further confrontation, the

Congolese doctor tells a European project manager, “I am angry about the way I am

talked too. Tell your doctors to talk to me like a doctor, not like a schoolboy.” To this,

she responds, “I’m sorry, would you like a coffee?”. He replies angrily, saying, “No I

don’t want coffee, I want to be treated with respect, that is all.” (Living in Emergency)

Throughout the movie there are countless other examples of unintentional racism, and

portrayals of white dominance over blacks. Despite the presence of African doctors, no

decision is made without deferral to the European physician. Only one doctor, Dr.

Arnaud, expresses his sentiments that, “as a young bourgeois from a wealthy country, I

find it incredibly difficult to…. Yea.” Although he trails off in his interview, it is quite

clear that he is speaking about the ways in which white MSF staff order around their local

staff and the discomfort that it instills in him.

Whether meaning to or not, European MSF workers understand that they are in

the Congo, or wherever it may be, to offer a specific skill set that is lacking amidst the

population of that nation. As a result, their identities are those of skilled providers.

Through training, they attempt to help advance local doctors, but in doing so they

inevitably label local doctors as ‘amateurs’ or ‘students’. More often than not, these

locals remain fixed in these inferior positions, learning to construct their identities as

medical ‘assistants’ to the ‘real’ European doctors, and downplaying their skills in

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attempt to properly fulfill their role among the MSF staff. Furthermore, in saving black

Africans “the [white] Doctors who say yes to humanitarian actions may find themselves

replicating colonial patterns and inadvertently contributing to successor global orders..

they achieve a measure of direct power over survival and a measure of indirect

influence… [and] also reserve a measure of final decision over life and death.” (344,

Redfield) The amount of control that these small foreign bodies of doctors have over the

identities of the local doctors and the lives of the nations population is shocking when

analyzed critically. There is no doubt, however, that the colonial undertones present in

the work of MSF are unintended consequences of a difficult situation, and that doctors

knowingly choose to “risk echoing the historical inequities of empire,” (Redfield, 337) in

order to fulfill a greater calling to save lives.

The Making of a ‘Hero’

Turning from the construction of the victim to the construction of the

doctor/volunteer, the next section of my paper will look at the heroic rhetoric MSF adopts

in its mobilization of aid workers. I will look at the role of media in constructing this

discourse, the hypo visibility of the ‘hero’ in MSF’s transversal discourse, and the

construction of a ‘global community of humanitarian citizens’.

Countless examples of the heroism of MSF workers proliferate the NGO’s media

advertisements and website. MSF members are consistently characterized in the popular

press as young, idealistic, ponytailed, stubble-faced “glamour boys and girls of the aid

business” (Dechaine, 356) , a characterization which reinforces the ways in which MSF

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and its activities have become media spectacles. The photos and stories the organization

disseminates very clearly send a specific message to the public, a message about self-

sacrifice and heroism and bravery. It paints pictures of its doctors in war-torn regions,

narrowly escaping the brutality that their patients have themselves suffered through, and

of their nurses tending to malnourished orphans under trees which act as the only shelter

in the surrounding area. Under real life testimonies on the MSF website for example, one

can read about Kathy Mohoney, “a nurse who navigates treacherous Amazonian Rivers,

mountains, and jungles in order to reach desperate villages in need of health care.”

(Mohoney, MSF) This kind of story not only reinforces her heroism, but the image of the

MSF volunteer as a new kind of adventurer, embarking on inspiring journeys of self-

sacrifice. It portrays Kathy as a strong and admirable woman, a role model for young

girls and would-be volunteers around the globe. Volunteers are established as

“courageous, ideologically pure, and morally committed agents of change… the saviors,

champions of the voiceless, who knowingly and willfully face the morally unrighteous

enemies of humanity.” (Dechaine, 358)

What cannot be told in stories, is reinforced through the powerful imagery that

accompanies such tales. A few examples of which are shown below:

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Photo Credit: MSF

Photo Credit: MSF

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Photo Credit: MSF

Not only does MSF disseminate these images, but those who volunteer come to

define themselves by them. In the documentary that follows the lives of three MSF

workers, Living in Emergency, one nurse expresses her perception of her role, saying “I

have 30 people, 30 people who are mine, and I have to save their lives. I take broken

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people and put them back together”. Another doctor talks about his friends reactions

when he arrives back home at the airport, recalling their catcalls and hooting, and more

importantly their words: “There comes Chris, the Hero!”. In the last scene of the

documentary, the project manager explains the toll the job takes on her, likening it to a

car crash. She says “You see a car crash in front of you and you have a duty to stop and

intervene. Well Liberia is one huge car crash. There are car crashes everywhere, all over

Africa. And I feel I have a duty.” These are just a few examples of the rhetoric that

proliferates this documentary. Rhetoric, that undoubtedly, comes in part from the very

charter of the MSF, which hails the MSF field staff who “worldwide give life-saving

medical and technical assistance to people who would otherwise be denied access to

basics such as healthcare, clean water and shelter.” (MSF Home Page) The implications

present in this very statement are incredibly strong, as they insinuate that without MSF

workers, the ‘victims’ of global injustice would have no other form of remedy. The

statement implies that without MSF workers, all would be lost, and that their very

presence and activities are required for some semblance of justice and equality to exist.

Within this statement alone, MSF workers are thus greatly elevated from positions of

volunteerism to positions of heroism.

A Global Community

Not only does it forge the individual identities of its volunteers, but MSF also

“conscripts a powerful ethos of the social imaginary in an attempt to construct an

imagined global community uniting individuals, governments, NGO’s, and international

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institutions” (Dechaine, 354). In forging this community, MSF essentially creates a space

in which vastly different people from all over the globe can come together around a

common cause. In this sense, it deterritorializes national citizens and then reterratorializes

them in a new kind of ‘state’: a state of humanitarianism. It allows for the creation of a

global ethical community which chooses to unify in order to achieve a greater global

objective. What is important about this space is that it transcends traditional notions of

state sovereignty, and instead advocates for a larger, bigger picture kind of citizenship,

focused on ethics and the pursuit of universal social justice.

Perhaps known best for his theories of ‘imagined identity’, Arjun Appadurai is a

useful academic to study in this analysis of MSF’s forged global community. Through its

humanitarian discourse, MSF essentially allows people to claim new identities in this

space of humanitarianism. It allows normal national citizens, to become citizens of a

greater community, to become political humanitarian’s, concerned with advocating

against injustice and indifference. It allows people to claim ownership over an honorable

identity, and thus construct themselves in new, desirable ways. People are given the

chance to be heroes in a small way, to live for something greater than their own

existence, and to identify with an admirable cause. In this sense, MSF gives everyday

citizens the chance to escape to a space in which they can become something greater than

the sum of their individual parts. As they contribute to this space, they are able to also

reconstruct their identities and forge themselves into the kind of person they’d always

imagined themselves to be, or desired to be.

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Benedict Anderson is another Anthropologist who talks about these kinds of

‘imagined communities’ in his writings. Taking MSF as an example of one of these

communities, Anderson would argue that the organization is engaging in the production

of a new society, one which is both stateless and borderless. This new space also allows

individuals to unite with members of a larger social collective, regardless of citizenship

or geographic location. As Anderson says, “its members will likely never know most of

their fellow members, meet them, or even hear of them, yet in the minds of each lives the

image of their communion. (Dechaine, 366) Thus what we see is a new cohesive group

which aligns itself around MSF’s charter and objectives, forming alliances and bonds

with people who may be drastically different from one another.

MSF’s reconstruction of space

In analyzing the construction of the ‘victim’, the ‘hero’, and the ‘global citizen’

character in MSF’s discourse, I have touched briefly on how MSF simultaneously

‘remaps’ territory and space. Looking at the sum of each of these processes however, one

can see more clearly how MSF acts to deterritorialize, reterritorialize, and transverses

spatial constructs. First, in providing a space of victimhood for marginalized populations,

MSF deterritorializes its ‘victims’ by enabling them to claim belonging not to a nation,

but to a borderless community, also in a sense reterritorializing them. Furthermore,

‘victims’ are deterritorialized by media imagery which presents them as dislocated

subjects, lacking nationality. These processes are also at work as MSF works to remap

the space its volunteers work in. Again, by taking workers from all over the world, MSF

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emphasizes the importance of borderless aid, asking its volunteers to construct their

identities primarily as nationless, unpolitically biased aid givers, not Frenchmen or

Englishmen. In this way, it removes state sovereignty over these people and replaces it

with a process of retoerritorialization which remakes and remaps these workers as

transversal beings. Lastly, as it acts to construct a space of global ethical citizenship,

MSF presents the idea of a borderless community over national citizenship, acting yet

again to deterritorialize its supporters to a certain extent, and reterritorialize them as

citizens that identify with a spatial idea rather than a physical concrete nation.

Not only does MSF change the spatial locations of its ‘victims’ and volunteers,

but it also alters the territorial structure of the international landscape. As MSF prescribes

itself to be politically neutral, it also emphasizes its existence as a borderless

organization. In such claims, “neutrality corresponds to the ability to be deterritorial.

This neutral deterritoriality is necessary to move across and beyond borders - with total

disregard for state territorial structures. It [also] becomes necessary in order to perform

one’s medical functions and last, but not least, to promote the deployment of a universal

medical ethic.” (Debrix, 834) Thus what we see is not merely spatial reconstruction as a

result of MSF’s transversal activities, but also as a prerequisite. In order to correctly

deploy their skills and resources, MSF must remove all state and political ties from itself

to move with complete freedom and access populations worldwide. In this sense, they

have both a “moral and medical authority to ‘occupy’ new spaces.” (Debrix, 837)

Furthermore, in reaching ‘victims’ worldwide, MSF is crossing spatial

markations and engaging in “new forms of bordering or marking practice: going where

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no one has gone before to create new zones inside which potential victims can be cured

or taken care of.” (Debrix, 840) By constructing and remapping borders to create their

spaces of victimhood and spaces of humanitarianism, MSF is somehow reorganizing the

international landscape, stressing the importance of cohesive community citizenship over

nationalistic, sovereign state citizenship. In his essay on International Medical

Assistance, Francois Debrix writes that it is this phenomenon of deterritorializing that is

increasingly coming to “define the geography of the global sociopolitical system.”

(Debrix, 844)

MSF’s Narrative Power

In summarizing the arguments I have made, I’d like to turn to the title of my

project: “MSF and the Narrative Power of Medical Humanitarianism. Central to this title

is the idea of the ‘aid story’ and the identities that it creates in its use of the polarized

hero and victim characters. This story, although effective in many when used by media to

quickly raise money for an urgent campaign or increase youth awareness, unfortunately

also locks those it acts upon into a process of ‘identity freezing’. By this I mean, the

young black baby will always be seen as a victim, the white French doctor will always be

seen as a hero, and both subjects learn to operate within these parameters and reproduce

practices which keep them within this framework. The narrative of medical

humanitarianism and organization like MSF is so strong that it can act to actually dictate

life stories, to actually write and rewrite the paths of its volunteers and victims. In this

way, despite MSF’s honorable work and the ways in which it seeks to restore citizenship

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and dignity its ‘victims’, it may in fact dangerously reproduce colonial practices, and

ultimately only further peripheralize and subjugate those it serves.

Moving Forward

It is difficult to know what recommendations to make after reviewing the work of

MSF. There is no doubt that as a medical delivery service, it works in incredible ways to

alleviate the suffering of millions. For this very reason, I cannot argue that they ways in

which they remove agency from their victims and proliferate a dangerous and polarized

discourse ultimately renders their work harmful. In the end, they undoubtedly do more

good than harm. However, I do believe MSF needs to be more critical in the ways it

approaches its medical missions. They need to give local doctors a greater voice, through

approaching them in a manner which shows both respect and mutual appreciation.

Western doctors need to allow local doctors not merely to follow direction, but to give

direction themselves. At times, they need to concede to the recommendations of these

local doctors, enabling them to gain confidence in their own authority and ability to run

medical services once Western doctors have left the country.

I also believe that MSF needs to make a more concerted effort to tell individual

stories. The organization needs to inject life and agency back into its victims. It needs to

give those it serves a voice, not just as global ‘victims’, but as Clementine from Rwanda,

Vicki from Kenya, and Oscar from Tanzania. I believe the most powerful way to do this

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is through video, and media campaigns which target individuals and their stories,

revealing the ways in which each African or Asian or South American is unique. The

struggles and pain these individuals face needs to be uniquely identified and located in a

manner which allows the humanitarian community to feel for them again, to invest in

them and their recovery. The global community needs not just to feel good about

themselves and what they’ve done for the victimized of the world, but to connect with the

vulnerable as individual people, thus returning their agency and substantive lives to them.

In a collection of MSF memoirs written by volunteers, entitled CRASH, one

woman writes, “At which moment does collaboration in the management and control of

an "undesirable" population becomes complicity?” (Chkam, CRASH) This brings me to

my last recommendation for MSF, and that is a more conscious approach to the ways in

which they may be further peripheralizing their ‘victims’. MSF needs to make a

conscious decision to change its rhetoric and the ways in which it refers to victims as the

cast-offs and unwanted of the world. The advertisement below is one such example of

such rhetoric.

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Translated, it reads something like: “Nathalie, 27 years old, is obtaining her

diploma in medicine. In a few weeks, she will leave for Afghanistan. Helen, a 35-year

old nurse, has just returned from Thailand, where she spent 10 months in refugee camps.

Emmanuelle, 25 years old, is not a medical specialist, but he has spent two years in

Bangladesh with Medecines Sans Frontiers. Nathalie, Helen, and Emmanuelle are three

examples of everyday French citizens who have decided to do something for the forgotten

of the world.” (My emphasis)

By reinforcing their heroic nature as saviors of these ‘undesirables’ and ‘ignored’,

MSF is further instilling within global thought the idea that these people have been

rejected from acceptance in the international arena. By moving to a discourse which

focuses on incorporating these ‘victims’ as meaningful contributors to their societies and

lives worth fighting for, MSF would go far to advance the positions of these marginalized

populations.

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