Harvard Book Store; WGBH Forum Network; An Imperfect Offering: Humanitarian Action for the Twenty-First Century

James Urbinski is a physician and a humanitarian activist. He worked for many years with mid-Sansompholtae in Peru, Somalia, Afghanistan, and Rwanda during the Rwandan genocide. He served as president of MSF from 1998-2001, during which time the organization was awarded a Noel Peace Prize. As many here know. He is currently a research scientist at St. Michael's Hospital and an associate professor of medicine at the University of Toronto. Of an imperfect offering, the UK's Guardian writes Urbinski tells his extraordinary story in unpretentious, carefully weighed prose, but pulls no punches when describing his disgust at the failure of the international community in so many of the situations where he has served. In Kirkus Review writes, a doctor who has witnessed the worst forms of inhumanity and hotspots around the globe takes an unflinching look at the political and economic forces that provoke human suffering and offers a moving meditation on the nature of humanitarianism. Please welcome Dr. James Urbinski.

Well thank you Melissa for your introduction. I'd also like to just thank Heather Gain and Rachel Cass for inviting me here today. I was just sitting upstairs actually and I saw on the staff desk copy of Don Coyote and I just glibly opened it to see what I might find. And chapter 39, I find the following title which I think is a perfect beginning for my brief comments tonight. The title is, in which the captive tells the story of his life and his adventures. And I don't know if I'll be able to tell you all of what I have experienced over the last 20 years in a few brief minutes, but I do want to touch briefly on some of the major issues that I explore in the book. I met a person just in the book store just outside the book store about 15 minutes ago and she asked

me how I actually came to write the book. And the answer that I gave her was that I came to it really quite reluctantly. It took me nearly five years to write and I did it as I worked at my full-time job. I had three children in that five-year period. I was working with a new not-for-profit drug development company that I was involved in starting the Drugs for Neglective Diseases Initiative. And I also started another new organization called Dignitas International which focuses on developing new models of community-based care for people living with HIV and TB in the developing world. And actually the invitation to write the book came after I had given a public lecture at the University of Toronto one week after the 2003 invasion of Iraq. And it was an invasion that I stated quite explicitly then and obviously would repeat now that was predicated on lies, that was illegal, that was unjust, and that was

immoral. And in the lecture in 2003 I publicly excoriated Canadian, American, and Western governments for an illegal use of force in Iraq. And for what I described then as a profiteous mixing of humanitarian principles and practice with politics and with political objectives and military action in both Afghanistan and Iraq. And in the audience there was a literary agent Bruce Westwood, well-known in Canada, who over several dinners and several bottles of wine convinced me to actually write this book. And the book is very much a deeply personal and political reflection on the meaning, if you will, and the place of humanitarianism and of citizenship in the post-Cold War and now post 9-11 world. And in the book I revisit many of the experiences

that I've had over the years, and my many good and bad choices, and my many good and bad actions as a humanitarian doctor, and also the good and bad actions and choices of the many organizations that I've worked with and been involved with in one way or another over the last 20 years. The one that I'm most familiar with has made sense off from CEO of Doctors of the Borders and MSF, or as it's known internationally, or Doctors of the Borders as it's known in North America, is the world's largest independent medical humanitarian organization. 88% of its funding comes from private citizens like you all over the world. And it has some 400 different projects in more than 80 different countries around the world. The majority of those projects focus on delivery of humanitarian assistance in war, in famine, in epidemic disease, and in situations

of natural disaster. And I worked with MSF in the field for many years and then became was elected international president in 1998 and served as president for three years and then as chair of this working group that established the pharmaceutical company that I told you about a moment ago. And now over that 20 years of work, I have worked directly in situations of war, directly in situations of genocide, directly in situations of famine and natural disaster. But tonight I just want to speak very briefly about genocide and about AIDS and about climate change. And I use these three examples because they are contemporary issues that confront us today even more starkly, I believe, than they did through the 90s and the early part of the 21st century. And in talking about these three issues, I want to explore what I call the central importance of dignity and the central importance of voice and the necessity of a very particular kind of

humanitarianism and the necessity of a very particular kind of politics. And let me begin by noting that in my view, like humanitarianism, politics is very much an imperfect project except when we believe the delusion that it is perfect. And this in fact, if you'll forgive the colloquialism is when politics is least perfect. And Rwanda in 1994, I was MSF's head of mission in Kigali, which is the country's capital city. And I was there as a humanitarian doctor. And the country, not just the city of Kigali, was a place of a very particular kind of politics. And it was the criminal politics of genocide. And it was to state it in the most clear terms possible, a brutal and a horrible time. And it was a place of rational, state-planned evil. And one million people, virtually all of them tootsies, were butchered to death in 14 short weeks.

And I witnessed every single day bodies that filled the streets of the capital city. And on several days, the gutters alongside our hospital, the one that we managed to open, those gutters literally ran red with human blood. And one night, after many long hours of surgery, a small girl, about nine years old, told me through an interpreter how she had escaped murder at the hands of the Inter-Hamway killing squads. And the squads were very much part of a organized government plan to erase the very existence of the Tootsie people from the country of Rwanda. And I watched this little girl as she told me through an interpreter the following. I'm going to quote for you, my mother hid me in the latrine. And I saw through the hole. And I watched them hit her with machetes. And I watched my mother's arm fall into my father's

blood on the floor. And I cried without noise in the toilet. Now, in Rwanda at that time throughout the country, people often paid to have their children shot in open pit latrines, rather than to see them murdered by being hacked to death with a machete. Now, for years before the genocide, the French government trained and armed the Rwandan soldiers. And all the way through the genocide, the French government supplied those soldiers with arms, with mercenaries and with active military intelligence. MSF and other NGOs, like Oxfam, repeatedly called for you in military intervention. But as the genocide proceeded, the governments of Belgium, of France, and the United States of America actively paralyzed the United Nations,

which abandoned a UN peacekeeping force that was already on the ground. And each of these governments knowingly pursued their foreign policies through genocide. And theirs, in my mind, is a complicity that is revealed rather starkly by the remarks of then president François Mitterrand of France, who said to an aid in the summer of 1994, only 10 or so days after the genocide was over. He said, quote, that genocide is irrelevant in such places. Now, the genocide in Rwanda was politics, as we as human beings, can choose and did choose to live our politics. Now, I ask in the book, in various ways, through stories that explore war, famine, epidemic disease, natural disaster, in Africa, in South America, in Russia, in Cambodia, I ask, how do you have hope in the face of

a situation like genocide? How do you see possibility? Well, I explore in great detail in the book, the conclusion that it doesn't lie, hope, it does not lie in naive utopian dreams, but it lies in what we do. Now, many of you here will be familiar with Hannah Arrent, who was a Jew, and who, as a young woman, escaped the Nazi Reich to France, and then to New York, and she was one of the great political philosophers of the 20th century, and she escaped Hitler's Holocaust of 6 million Jews that was carried out in extermination camps across Europe, and camps that were also used to exterminate another or an additional 6 million gypsies, homosexuals, and political moderates, and who opposed the Reich. And Arrent spent

her entire life as an academic, trying to understand how was it possible that the 2000-year history of Western political thought and experience could have given rise to the totalitarian regimes of Hitler's Reich and Stalin's communist Russia, and she came to several important conclusions, and among them she concluded that neither religion nor philosophy will save us from the possibility of this kind of political criminality, but she also concluded that the right kind of politics can lessen the possibility of this kind of criminality. And she said that the first political act is to speak, and one speaks with the intention of being heard, and one speaks as well with the intention of listening for a reply, and for Arrent to speak is also to listen, which is the first kind of initiative as she puts it, and the first kind of human doing.

Now many have described genocide and similar human cruelties as unspeakable, but they are as unspeakable as they are undueable, as human beings we do genocide. And doctors like myself and humanitarian organizations like MSF cannot stop this kind of crime, and there is no humanitarian response to the political crime of genocide. The little girl that I told you about, she had no voice, but we as an organization had an ability to respond, to give voice to what we knew, to what we were seeing, to what we were experiencing. And we did. We had a responsibility to speak out from what we knew, and we spoke with a clear intent in a campaign that we organized a beginning in May of 1994, around the world, to rouse the outrage of public consciousness and to demand a politics that pursues justice by putting the dignity of the victim at its center.

And I don't think it's an understatement to say that if there is silence, there can be no justice, but revenge, which is the lowest form of justice, but a form of justice nonetheless, is the only certainty. And when July 4 of 1994, the day that the genocide of Tutsi's and moderate Hutus in Rwanda ended, that's the day that I left Rwanda. Few on the planet, least of all me, could have imagined that 15 years later, an international criminal court, however imperfect that court may be, would actually exist, and let alone issue an arrest warrant for a sitting head of state, Mr. Omar Al-Bashir of Sudan. Now, for the first time in our human history, those who violate the laws of war can be held to account if their own governments fail to hold

them to account. Now, the International Criminal Court came into being because citizens and civil society organizations like Amnesty International and thousands and thousands and thousands of others in churches, in schools, in community clubs, on university campuses like Harvard. They brought together, they organized, they spoke, they pursued ideas, they brought together academics, jurists, some of the best political and legal minds in the world, and they formulated, and they engaged in a rigorous, public debate, and a rigorous policy analysis, and they explored practical alternatives. All spoke, listened, demanded a better politics, and sought out courageous politicians who came to the point where it was impossible to ignore the voice and the choice of citizens. Now, in my view, the

creation of the International Criminal Court, however imperfect it is, and it is, in my estimation, a deeply imperfect institution. Even with that, it is a seminal human achievement. No government, and no one, not even a sitting head of state, can claim to be above the law. That's what the court represents. Now, Hannah Arrent also wrote that we're not born equal, that equality and equity are the result of choice and of human organization. Now, respecting and actually pursuing equity is the practical hallmark of our respect for human dignity, and the basic principle of equity is very simple. It's that people in similar situations should be treated similarly, and it requires that there be no distinction, that no distinction exists in treatment on ground

such as race or gender, ethnicity, religion, or economic status. But for billions of people today, the lack of equity is, in fact, a politically determined choice. Our world today faces a confluence of crises, or 6.9 billion people. We're in the midst, or perhaps in hopefully optimistically, in the final phases of the most significant financial crisis since the great depression. We face a food crisis. There are more than 1.1 billion people, 1.1 of 6.8 billion people who go to bed hungry every single night on this planet. In the last year, because in the face of the international financial crisis, that number has gone up by 120 million people around the world. When people are hungry, they have few choices. They either riot, they migrate, or they starve. In 30 countries around the world last year,

as food prices increased by 24% relative to prices in 2006, food riots erupted in 30 countries around the world. In Haiti, the Prime Minister was deposed because of food riots and because of the rising cost of food for people. The fuel crisis, apparently, a crisis that we may be able to find our way through, actually, in my view, represents peak oil. There's no question that we are in a condition of peak oil. And the drop in prices that we've seen over the last year will only actually increase as our financial stability increases. And the rising prices that we saw toward the end of 2007 and early 2008 will only return and increase even more significantly. We are also in the midst of the, in my view, the most significant crisis of all, a climate change

crisis. In the face of these circumstances, in June of this year, the World Food Program Representative Josette Shiran said that a hungry world is a dangerous world. And without food, people, as I said earlier, have only three auctions. They riot, they emigrate, or they die. And the director of the UN Food and Agricultural Organization, one of the most conservative organizations in the world, no parenthetically, said also in June of this year, that 1,000 million empty bellies accuse us and shame us and are a threat to world peace and security. And he is right on all counts. And one year ago, the World Food Program went begging among donor states, so as to cope with an additional 120 million people that were being pushed into hunger and

starvation because of the rising price of food commodities. That very week, bears and stirons got its first allocate of your tax dollars, a $700 million bailout from the U.S. government. In the second half of 2008, and now well into the final months of 2009, we've seen the unfolding of, in fact, the most significant financial crisis since the Great Depression. And we've also seen globally $13 trillion of public money, of your tax dollars, of tax dollars from citizens all over the world that has been mobilized to underwrite a collapsing international financial architecture. And during that same time, 120 million more people have been pushed into starvation. Now, how do you pursue equity in that kind of context? Well, humanitarianism is a beginning,

but it's not enough. Humanitarianism, in my view, in my experience is about direct and immediate actions that seek to relieve human suffering. And the drive for equity is rooted in my view in a solidarity that emerges from our common dignity as human beings. And for me, the humanitarian act is rooted in the experience of compassion as solidarity. Now, solidarity is not the same thing as compassion. So it derives from compassion, but in a very particular way. And too often, we see the suffering of others as somehow separate from ourselves, and we can choose to take pity on those who suffer. And sometimes, we take charitable actions towards the relief of that suffering. However, when one literally sees the other as equal in worth and dignity,

when one literally sees them in the same way as one sees oneself, then compassion leads not to pity or to simply charity, but to solidarity that works with people to relieve suffering. And it's a solidarity that takes human suffering seriously, and that at its most basic logic refuses to accept the unacceptable. Now, in January of 2000, I was in South Africa at a MSF AIDS clinic, and I was examining a 20-year-old man or boy, really. And if he were here in Boston or in Toronto or any other major western city, he would be just starting his life. But there his life was nearly over. He had AIDS, and he weighed less than a hundred pounds. Now patented drugs to treat AIDS were available in the Western world, but at a cost then of more than $15,000 US dollars a year for treatment using patented anti-riture virus. There wasn't a hope in hell that he,

or the millions of people like him in the developing world, would get access to those medicines. Now, that young man was so weak that his mother and his grandmother had to actually help him onto the examining table. And as he sat there, he asked me some very simple questions, then questions that I think get to the heart of inequity around the HIV AIDS pandemic and other pandemics and other issues germane to global health. And he asked me, and I'm going to quote again, why do you come here with only kindness when what I need is medicine to stop this AIDS? Your kindness is good, but it will not help this AIDS. They have such medicines in your countries. Why not here in South Africa for people like me? Now, as you know, AIDS is a fully treatable disease. It says treatable as diabetes. And AIDS is not, as you know, just an African problem. The Caribbean, India, China, and much of Asia are still in the midst of an HIV explosion. And so far, some 28 million

people have died of the disease worldwide over the last 25 years. And around the world, 33 to 40 million men, women, and children are living with HIV AIDS. And every year, upwards of 2.5 million more become infected with HIV AIDS, and about 2.5 million die every year of the disease. And in the United States, 56,000 Americans will become infected with HIV. And AIDS is the number one killer of African American women between the ages of 25 to 34. Now, until recently, the vast majority of people living with HIV in the developing world largely had no hope of access to treatment because the pharmaceutical industry, mostly Western governments, and the World Trade Organization, have all repaciously pursued patent protection for life-saving pharmaceuticals,

even in the face of pandemics like HIV. Now, how do you have hope in the face of an epidemic like AIDS? How do you see possibility when charity and pity are just simply not good enough? Well, at that clinic in South Africa, in a public act of civil disobedience, MSF was about to begin treatment by publicly and illegally importing AIDS drugs into the country. In 1999, as President of MSF, I had the privilege of launching our access to essential medicines campaign. And it was a campaign that challenged a failing politics. And we mobilized a coalition of citizen groups from around the world. And we publicly shamed pharmaceutical companies and governments that supported the privilege of profit over people's right to exist. We also took very pragmatic actions. We pooled our enormous purchasing power, and the purchasing power of MSF

is quite significant. It's about a billion. The budget this year is somewhere around a billion US dollars. And we pooled our purchasing power with other organizations, understood the generic market internationally. And we pooled our purchasing power to buy generic versions of AIDS drugs. And we also, in doing that, we brought down the price of treatment for HIV AIDS down from 15,000 US dollars a year for patented versions of anti-retrovirals to less than $140 for generic versions of exactly the same medications and of an exact and comparable quality. We did this while also lobbying the WTO at Doha. We pushed and we could jolt and we shamed the pharmaceutical industry. We did the same with the WTO, with the World Health Organization,

and with many UN bodies and with many national governments. The coalition of civil society organizations also challenged 39 multinational pharmaceutical companies in South Africa in 2001 who sought to block the South African government's legal right in international trade law to import generic medications. We also pushed for the creation of what is now the global fund for AIDS, TB, and malaria. And we also pushed for what has been a commission led by the WTO on R&D research and development, innovation, public health, and the impact of intellectual property on public health outcomes and access to healthcare technologies. All of these have had imperfect outcomes, even the now 4 million people who were on anti-retrovirals in the developing world. That is a significant fraction, but a fraction of the number of people who still have yet

to gain access to treatment, but their numbers are growing and their far greater, 4 million is far greater than the 40,000 of the 28 million who in 1999 needed access to treatment. Now, none of the outcomes that the campaign has achieved have been perfect. But like the drugs for neglected diseases initiative, not for profit pharmaceutical company, I told you about, which is also an outcome of the campaign. An outcome by the way which has 17 compounds under development, which has released two new fixed dose combination anti-malarials in the last two years, which will release a new treatment for African sleeping sickness this year, and which is a coalition of essentially public sector research institutions in Malaysia, India, Brazil, 15 African research centers, the Pasteur Institute, MSF, and a couple of private institutions in Europe.

That organization, that initiative, the DNDI, is not in itself a solution to the issue of the lack of R&D for neglected diseases, but at least it is a demonstrable alternative that shows that it is possible to actually achieve a good and viable outcome to address a need that is profound and overwhelming for over a billion people in the developing world. None of these outcomes are perfect, but they do demonstrate that however imperfectly that change, that just change, in fact, is possible. And most importantly, for people who are going to die a terrible death, they now have at least a hope in hell that they can live with HIV and with other neglected diseases in the developing world. Now, I want to turn very quickly to the issue of climate change. And I want to do that by looking at what is now a contemporary genocide.

It is, in fact, climate change that drives competition for access to water and access to arable land in Darfur. And Darfur, as you well understand, a well-known, is a place where war crimes, where crimes against humanity and where, in the very least, a slow-motion genocide is actively taking place. Now, the consequences of climate change will certainly worsen in the coming 10 to 15 years, as, for example, the number of cars increases from today's 700 million to more than 3 billion by 2050. And that's according to an IMF for International Monetary Fund Projection. A decade from now, crop yields in some parts of Africa are expected to drop by 50 percent. And water stress could affect as many as 250 million Africans.

And the same, with obviously different numbers, is evident already in some areas of South America and in Central Asia. And globally, not only will the number and the severity of droughts and floods and hurricanes increase, but as climate change worsens, and there is no question. And I'm almost embarrassed to have to say or to have to address the question of the question about climate change. In the United States, it seems to be the only country in the world except my own Canada, where the question about the question is still the question. Everywhere else in the world, it is absolutely clear that climate change is real, that climate change is happening now, that climate change is worsening, and that it is even the projections of the International Panel on Climate Change, the 2007 projections, which were stark and shocking in their own right,

that these grossly underestimated the reality of climate change, and that in fact, climate change is accelerating at a rate far greater than what the 2007 International Panel on Climate Change concluded. Not only, as I said a moment ago, will the number and the severity of droughts and floods and hurricanes increase, but as it worsens, wars over water and arable land will also worsen. And a June 2009 report by researchers at Columbia University, and I know it's arrival to Harvard University, but slightly more conservative, a report released by researchers at Columbia warned that we could see the largest migration in human history, upwards of 700 million climate change migrants within the next 20 years. Now, I just want to close by noting that the local and the global challenges that I've touched

on, they're formidable. There's no question. And I'm often asked, how do you have hope? How do you have optimism in the face of what you know? Well, I answer very simply by saying that hope is not the same thing as optimism. And while I'm sometimes optimistic, I always try to be hopeful. Optimism is the expectation based on the evidence at hand, that there's a reasonable chance of a good outcome. And hope, on the other hand, is the certainty that a given action is right, that it makes sense, regardless of how the situation might turn out. Now, this distinction between hope and optimism, it's actually not mine, I wish it were, but it's not. It's Vaclav Hovels, who, as many of you know, was a playwright, is a playwright and political dissenter, and he tirelessly opposed the communist regime in Czechoslovakia.

And he became the first president of a newly democratic state when the communist regime fell. And Hubble didn't write or didn't make this distinction, or offer these words as a victorious reflection. But he wrote them in a letter to his wife from prison. And his was a grim solitary confinement, where there was no reason at all to be optimistic about his own future or that of his country. But he remained certain, he remained hopeful, that his dissidence against the regime was the right thing to do. Now, hope is not an idle feeling. It's very much a powerful force that fuels the courage for change. Now, I just want to reflect very, very quickly on the United States. When Martin Luther King was assassinated in 1968, 125 cities across this country erupted in a firestorm of rage and bloodshed. It was absolutely inconceivable back then that a mere 40

years later, that a black man would be elected by a majority of Americans. Now, Obama does not represent African Americans, in my view. But rather, he represents the power of an engaged citizenship in a contest of ideas and choice. And every major advance in social or political thinking, if not also in scientific thinking, has come about because somebody dared to imagine and someone dared to believe that the impossible is possible. The most innovative and politically transformative ideas in Western culture, ideas in the defense of greater equity and justice, these ideas of the last 200 years have not only emerged in but have been driven by active citizenship engaged in an active and vibrant civil society. The abolition of the slave trade,

the emergence of labor rights, the emergence of children's rights and women's rights, the civil rights movement for African Americans, reform of the post-World War II and post-cold war, rules of war, the very emergence of the environmental movement and now the global health movement. Each of these are examples of transformative political ideas that are rooted in notions of equity. And each and every one of them began as a lost cause. And however imperfectly have achieved practical outcomes that surpass those of the prior world. I'm just going to close now by asking a very simple question. How does one see possibility? Well, as I said earlier, it does not lie in naive utopian dreams, but it lies in what we do. As human beings, we are capable of doing great and good things, but wanting or being good is just simply not good enough. To return to Hannah Arendt, her central preoccupation was the

revaluation of politics and of political action. And she was deeply concerned about our responsibility for politics and our duty to be citizens and deeply concerned about looking after the world and taking our responsibility in it and facing the world as it is. She saw as hubris as she put it, the notion that everything is possible. She was concerned with gratuitous activism. She was concerned also with limits. And for her politics is not a field for the action of deterministic forces, but political action is something that happens among plural actors who respect each other. And political action for her is a practical activity, not a matter of executing theoretical blueprints, but something to be practiced with courage, with skill, and sometimes with

restraint. And for her rent, human beings have demonstrated their capacity to do the thoroughly unexpected. And if answers can be found anywhere at all, they will be found in the political capacity of human beings. In speaking, in listening, we can create the possibilities of political process and institutions that can minimize the risk of disaster, that can minimize the risk of political crime, and that can minimize the risk of catastrophe. That, in essence, is the broad theme of my book and imperfect offering. I explore, again, through stories, through narrative, the personal and the political world that I have lived in over the last 20 years. And I do hope that at least some of you will pick up a copy and read it.

And I'm very happy now to take any questions that you may have. Thank you very much. Well, I think it's absolutely clear that the human population is growing at a rate that is simply unsustainable. Our bio and eco imprint is at a level now where we threaten to literally wipe ourselves out by virtue of the magnitude of our proliferation. Our population 100,000 years ago, there were 10,000 bipedal hominids, us, 10,000 of us. Now 100,000 years later, we are 6.8 billion. By 2050, the number is projected to be around 9 billion, and some even suggest that that may actually be an underestimate by approximately a billion. There is just simply

no question that we have got to address the issue of population. But the question, the substantive question is how? That's really the key issue. And what I would say is that the evidence shows very clearly that the most effective means of reducing population is actually women's education and women's empowerment. That's it. It all comes down to women and to their place and position in society. When women are educated, when women are empowered, they are freed from the constraints that impose on them and pinge on them and create the necessity of having many children. There are very good studies that have been done in India that show this definitively, virtually every other, in my view, virtually every other approach is really just tinkering at the margins. The key issue in terms of population control is women's empowerment and women's education.

I don't think there's any question about the evidence. Sir, and we can see, by the way, you see changes within a generation, which is unbelievable in terms of demographics. Within one generation, you'll see a massive drop in birth rates. One thing that I didn't say that I should have said is that I speak for myself tonight. I don't speak for MSF. So I should be very, very clear about that. MSF, unfortunately, had to pull out of Iraq shortly after the onset of the invasion. As it did in Afghanistan, shortly after the U.S., NATO-led bombing in Afghanistan. And the reason for that was because humanitarian actors were seen as part of the invading force. And that came about because Colin Powell and the Pentagon and the White House actively

pursued a publicly-stated policy of bringing the NGOs non-government organizations into their military and political strategy. And Colin Powell actually said, quote, non-government or humanitarian organizations are part of our combat team. They are a force multiplier. And so what that meant was that suddenly aid workers who are not soldiers and who are not saints, by the way, were effectively wearing a bullseye. And without any of the protections that typically accrued to military actors. And so the consequence was that we saw, for example, the bombing of the Red Cross headquarters in Iraq that was not an accident. That was real-time theater, the theater of war that sent a very clear message to the world about how humanitarian

assistance will be seen. We also saw the bombing of the UN headquarters, which again was fantastic theater, in terms of sending a message to the world about how United Nations agencies, humanitarian and otherwise, would be seen in Iraq. We also saw in Afghanistan when the bombing campaign started. We saw a world food program offices being fire bombed. We saw humanitarian organization offices all over the Muslim world being attacked, being fire bombed, people being attacked, and so on. And that was the direct consequence of the policies of the White House under George Bush. And so what that has meant for humanitarian actors in Iraq and in Afghanistan, and also in Somalia, by the way, where there's active U.S. military activity in pursuit

of terrorist cells within Somalia. It's meant that this nature of humanitarian space has been fundamentally altered by a disrespect of basic humanitarian principles by major belligerents who are at war, the United States, NATO, and others. That's not to take blame away from, for example, the Taliban and Afghanistan. They have engaged in equally profiteous and equally sinister manipulations of humanitarian action. So sinister, in fact, that they assassinated five MSF aid workers in the summer of 2004. And when those five aid workers were assassinated, they left the Taliban stated publicly that they were assassinated because they work for the Americans. And other aid workers will also be killed. Now, under those circumstances, MSF had no choice but to leave. And if I had been the President at that time, I would have made exactly the same

decision. There is absolutely no question where there is no respect for humanitarian principles in practice, particularly by the belligerents in a conflict. You simply cannot put young volunteers from Nebraska, from Toronto, or from Paris, who just want to help. You cannot put them in a situation where they are wearing effectively a bullseye. So to get to your question about children, I think I certainly don't, again, I don't speak for MSF, so I wouldn't be able to speak to any kind of partnership. But I'm always very leery about programs that specifically target children. Because in a certain way, it's not that I don't think children are worthy of care. I have three children of my own. It's not anything against children, believe me. But it is that

when you specifically target a child, what you do is you, in a certain sense, sanitize the broader landscape of need, which is, I think it's fairly obvious, that it's not just children who suffer and more. And you cleanse the palette of questions that actually are part of the process of ensuring that humanitarian assistance is provided to people in situations of need. And so by focusing on the cute kid on the specific needs of the most vulnerable, you actually remove from the diets or from the space for public debate. You remove the needs of others. And you also remove the necessary and constant reflection of citizens about what their governments are doing as they wage war. And I'm not, believe me, I am not in principle

anti-war. I think I abhor war. Believe me, I abhor it. I mean, I've seen enough of it. But I am not naive enough to believe that war is always avoidable. It is not always avoidable. Sometimes you must go to war. But when you go to war, there are rules to war. And humanitarian law is the framework under which, is the legal framework that, that belligerence and warfare must follow. And if, though, if a belligerent in warfare does not provide for the material and humanitarian needs of civilians that, or allow for the provision of those needs, or allow for unfettered independent access by independent organizations, they are breaking the rules of war. And it is we as citizens that hold our governments to account around these very basic principles. And when a belligerent in warfare engages in the kind of a military

conduct that leaves hundreds, if not thousands, of so-called victims who are collateral damage, this is simply unacceptable. One of the great challenges now in Afghanistan and now Iraq is the response of civilian peoples to collateral damage. It's actually now, it's a backlash. It's now a huge military issue because of the way in which drones and other technologies have been used to wage war. There have been massive civilian casualties as a consequence. Massive innocent civilian casualties. And people's response to that is perfectly predictable. I mean, I would be really pissed off if my house was bombed and my wife was killed and my children were killed and so on. And it was a mistake. I mean, I would be very upset about that. I think everybody here would be too. And so the adherence to the rules of war is a responsibility

of the belligerents who wage war. But it's also a responsibility of the citizens of those governments to insist that those rules of war be followed. And so I know I've gone beyond you at the scope of your question, but it's a good access point to some very important issues. Well, there's a whole series of issues that you raised there. I won't address all them. I'll just choose to. In the first instance, certainly Bill Clinton has expressed publicly his regret about the failure of the United States to act definitively in Rwanda. He's apologized and he's claimed that he didn't know. Well, he didn't know. The military intelligence reports that he received every single day, the presidential intelligence briefing included detailed accounts of genocide. In fact, used the word genocide in in 1994. So he knew that's just to be really clear about that. And I'm very and to be fair to President Clinton, I'm glad that he is courageous enough

as a man, as a human, I don't mean as a man, but as a human being is what I mean. He's courageous enough as a human being to publicly state that he made it that he was wrong. But I think it would be even more courageous of him if he were to say that he did know what he did know. That's just an aside. In Bosnia, in the form of Yugoslavia, the big issue was obviously stopping the genocide. But the problem in how the NATO bombing campaign was waged, the problem was that they defined it in a humanitarian, in humanitarian terms. When the NATO bombing campaign started, it meant that humanitarian organizations, because this was a humanitarian bombing campaign, and if you just think about that, I mean, just think about that for a minute. It's a complete oxymoron. It's a complete oxymoron. Humanitarianism by definition honors life, by definition respects life,

by definition seeks to relieve suffering. By definition is non-discriminatory. In other words, it focuses on those on on need and those in greatest need get the greatest service period. Bombing to achieve a humanitarian outcome is just ludicrous. Now, that's not to say that in some circumstances, again, going to war is not necessary, or using force to achieve a good stopping genocide is not sometimes necessary. I absolutely think it is necessary under some circumstances. But the political justifications for stopping the genocide should have been in the first instance to stop genocide. It should have been a genocide intervention, which is what I would call it, a genocide intervention. The other is that there were very legitimate state security rationales for stopping Milosevic. The security of southern Europe was very much at risk.

The entire Balkan region was at tenure box and is very much less so today, but still quite there's a lot of tension. And there were refugee flows, there were threats of hundreds of thousands of millions of refugees moving across borders through Europe. So there were very legitimate state security interests at play, and I'm not minimizing those. I'm absolutely front and center, and it's the responsibility of states to ensure state security. So I don't have any difficulty with that. In Darfur, the political reality today is that because of the tension and the state of war that has been humiliated by President Obama in the last few months, but that actually normatively essentially has existed under the guise of the war on terror, the state of war between Islam and the West. The fact of the matter is that it is politically and militarily and practically infeasible to imagine a Western-led military intervention into Darfur.

The practical reality as well is that that kind of intervention, any kind of military intervention into a region like Darfur requires massive logistical airlift capacity. The only armies in the world that have that capacity are Western armies. So the other practical reality is that it is not a small force of 12,000 men. Darfur is a vast region, and it's not just Darfur, it's also Chad, and then there are bordering regions of Sudan. It's a vast territory, and it would require, I don't even know what the numbers are, but it's held a lot more than 12,000 people on the ground are soldiers, arms soldiers on the ground to actually contain and control the forces that play in the Darfur region. The African Union has troops on the ground, in fact, and they have thousands of troops. I don't know what the number is, I think it's somewhere around 17,000 troops. But the big issue, in terms of their effectiveness, is logistical airlift capacity

and airlift deployment capacity. That's the issue. Now those resources could be provided by Western militaries without military engagement, without boots on the ground, thereby minimizing the political fallout of Western troops on the ground in the region. And I think those things should be explored actively. The logistics and politics of a specific situation aside morally. I'm not hearing any objection to the use of... No, look, you know, and again, I just be very clear. I agree. Yeah, look, I don't speak for MSF. MSF has a different position today. In 1994, we as an organization called for UN military intervention in Rwanda to stop the genocide. And I personally believe that there is a place for an enforcement capacity, an internationally legitimately sanctioned enforcement capacity,

not a coalition of the willing, not one country that wants to, in theory, do good, like emancipate the women above Afghanistan, which is now, which was, to some extent, is the rationale of the NATO-led forces and the American forces in Afghanistan, and which obviously is a profidious or a spin on the political and military objectives in the region. I mean, let's really be honest here. It is a spin. It's got to be. It is a spin. There's no quite... There's too much at stake. Oil, gas, China, India. There's a nuclear containment of a very legitimate nuclear threat. These are very real state security issues. And we as citizens should be demanding that the debate be in those terms, not in the terms of some sort of fancy and heartwarming humanitarian flag. But in principle, I don't disagree that there should... That a legitimately sanctioned

enforcement capacity at the UN level should be available on issues like genocide, on issues like crimes against humanity and war crimes. So I do not have any difficulty with that. The question is how and the question is the politics of that. In fact, the original UN charter actually included this. I believe it's Article 55. This is part of the original UN charter. They actually outlined a command structure and so on that would govern a standing UN force. And for all kinds of political reasons, that has not yet happened. So it's not the ends that I agree with the ends, but the question is the means, how do you do it in a legitimately political manner? And we'll just... I think we're done, are we? Yeah, we're done. Okay. Thank you.