HUMANITARIANISM AT STAKE

James Orbinski's "An Imperfect Offering" Reviewed

Since 1945 the art of warfare has changed dramatically: of the 80 wars fought after World War 2 only 28 were traditional battles between regular armies of two or more nations. There has been a steep increase in civil wars and guerrilla war tactics in the second half of the 20 century and the majority of all these wars took place in developing countries (65 out of 80). James Orbinski, a Canadian physician and former general director of Médecine Sans Frontiers (MSF), takes us in his autobiographical page-turner to the frontlines of these battlefields where total anarchy is the only rule and where not only his own life was in jeopardy regularly but the act of humanitarianism as well.

We meet the protagonist when he is 27 years old, fresh out of medical school and heading for Rwanda to do research on paediatric AIDS. Before that he had told us already about his childhood, his Irish background and the first encounter with humankind’s cruelty when he links the tattooed number on the arm of the Jewish cobbler down the street to the images shown on a program on TV about the holocaust. He is then 13 years old and very upset.

In Rwanda he eagerly commences his research about the relationship between craniofacial dysmorphy and HIV infection during pregnancy. Oblivious to the country’s horrible colonial past where German and Belgium doctors and anthropologists draw racial conclusions based on facial features, the young graduate measures meticulously the characteristics of the faces of Rwandan HIV infected children, looking for differences.

A few years later in Somalia, on his first mission for MSF, Orbinski swiftly loses his naivety: for the first time he is confronted with the destructive effects of violence and anarchy. He is exposed continuously to people in sheer agony and at the same time gets involved in world politics when George Bush senior decides to dispatch troops to provide security for famine-relief operations, like the one Orbinski is working for.

When back in Canada he feels a stranger in his own country, and when he is offered the posting of head of mission in Rwanda in 1994, he has no shred of doubt. It is there and then that the devastating effects of the genocide and the endless frustration from the idle of the West and the Security Council presented to him is multiplied beyond description and it makes his work the more admirable yet incredibly daunting. His innocence is lost, just as is so many other’s.

After a final mission in war-torn Goma in the Democratic Republic of Congo, he retreats from the actual medical frontline when he is elected general director of MSF. He becomes a frequent flyer and commutes between failed states, Geneva, Brussels and the UN headquarters in New York, where he occasionally addresses the Security Council. Orbinski is a widely recognized good public speaker, solid words spoken with a soft voice, and the written sentences in his book add to his determination to improve the situation for the world’s less privileged.

Orbinski does not mince words. His first fight was against the prices of anti-retroviral treatment (ART), deliberately maintained high by the pharmaceutical industry, and it was a good one from the beginning. In that fight world politics, national interests, pharmaceutical companies, NGO’s, the UN, judges, journalists and patients all came together and with clever diplomacy, science, international trade laws and persistence from a carefully chosen coalition, Goliath was eventually defeated by David but the battle is far from over.

The latest threat to humanitarianism comes – again – from the West. In the last decade invading coalition forces have been initiating humanitarian actions as well to win “hearts and minds”. As a result the clear distinction between aggression and aid has become blurry. Where in Africa MSF was still able to work in the midst of rival armies, bullets where seldom aimed at them. But in Iraq and Afghanistan MSF had to suspend its operations after intentional attacks and kidnapping of its employees.

Orbinski’s life story is impressive and adventurous, but what begins as an exciting boys’ book soon evolves into dramatic non-fiction. He gives us details we would rather not hear but we cannot look away: his style is too accessible for that, his story too gripping. Yet after all the tragedies and massacres witnessed, he is still able to hold on to his optimism and the epilogue exhales hope: no one can do everything, but everyone can do something.