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An Imperfect Offering: Humanitarian Action in the Twenty-first Century
As Albert Camus wrote, the doctor’s role is as a witness–to witness authentically the reality of humanity, and to speak out against the horrors of political inaction. . . . The only crime equaling inhumanity is the crime of indifference, silence, and forgetting.—James Orbinski
In 1988, James Orbinski, then a medical student in his twenties, embarked on a year-long research trip to Rwanda, a trip that would change who he would be as a doctor and as a man. Investigating the conditions of pediatric AIDS in Rwanda, James confronted widespread pain and suffering, much of it preventable, much of it occasioned by political and economic corruption. Fuelled by the injustice of what he had seen in Rwanda, Orbinski helped establish the Canadian chapter of Médecins Sans Frontières (Doctors Without Borders/MSF). As a member of MSF he travelled to Peru during a cholera epidemic, to Somalia during the famine and civil war, and to Jalalabad, Afghanistan.
In April 1994, James answered a call from the MSF Amsterdam office. Rwandan government soldiers and armed militias of extremist Hutus had begun systematically to murder Tutsis. While other foreigners were evacuated from Rwanda, Orbinski agreed to serve as Chef de Mission for MSF in Kigali. As Rwanda descended into a hell of civil war and genocide, he and his team worked tirelessly, tending to thousands upon thousands of casualties. In fourteen weeks 800,000 men, women and children were exterminated. Half a million people were injured, and millions were displaced. The Rwandan genocide was Orbinski’s undoing. Confronted by indescribable cruelty, he struggled to regain his footing as a doctor, a humanitarian and a man. In the end he chose not to retreat from the world, but resumed his work with MSF, and was the organization’s president when it was awarded the Nobel Peace Prize in 1999.
An Imperfect Offering is a deeply personal, deeply political book. With unstinting candor, Orbinski explores the nature of humanitarian action in the twenty-first century, and asserts the fundamental imperative of seeing as human those whose political systems have most brutally failed. He insists that in responding to the suffering of others, we must never lose sight of the dignity of those being helped or deny them the right to act as agents in their own lives. He takes readers on a journey to some of the darkest places of our history but finds there unimaginable acts of courage and empathy. Here he is doctor as witness, recording voices that must be heard around the world; calling on others to meet their responsibility.
Ummera, ummera–sha is a Rwandan saying that loosely translated means ‘Courage, courage, my friend–find your courage and let it live.’ It was said to me by a patient at our hospital in Kigali. She was slightly older than middle aged and had been attacked with machetes, her entire body rationally and systematically mutilated. Her face had been so carefully disfigured that a pattern was obvious in the slashes. I could do little more for her at that moment than stop the bleeding with a few sutures. We were completely overwhelmed. She knew and I knew that there were so many others. She said to me in the clearest voice I have ever heard, “Allez, allez. Ummera, ummera-sha”–‘Go, go. Courage, courage, my friend–find your courage and let it live.’—From An Imperfect Offering
In 1988, James Orbinski, then a medical student in his twenties, embarked on a year-long research trip to Rwanda, a trip that would change who he would be as a doctor and as a man. Investigating the conditions of pediatric AIDS in Rwanda, James confronted widespread pain and suffering, much of it preventable, much of it occasioned by political and economic corruption. Fuelled by the injustice of what he had seen in Rwanda, Orbinski helped establish the Canadian chapter of Médecins Sans Frontières (Doctors Without Borders/MSF). As a member of MSF he travelled to Peru during a cholera epidemic, to Somalia during the famine and civil war, and to Jalalabad, Afghanistan.
In April 1994, James answered a call from the MSF Amsterdam office. Rwandan government soldiers and armed militias of extremist Hutus had begun systematically to murder Tutsis. While other foreigners were evacuated from Rwanda, Orbinski agreed to serve as Chef de Mission for MSF in Kigali. As Rwanda descended into a hell of civil war and genocide, he and his team worked tirelessly, tending to thousands upon thousands of casualties. In fourteen weeks 800,000 men, women and children were exterminated. Half a million people were injured, and millions were displaced. The Rwandan genocide was Orbinski’s undoing. Confronted by indescribable cruelty, he struggled to regain his footing as a doctor, a humanitarian and a man. In the end he chose not to retreat from the world, but resumed his work with MSF, and was the organization’s president when it was awarded the Nobel Peace Prize in 1999.
An Imperfect Offering is a deeply personal, deeply political book. With unstinting candor, Orbinski explores the nature of humanitarian action in the twenty-first century, and asserts the fundamental imperative of seeing as human those whose political systems have most brutally failed. He insists that in responding to the suffering of others, we must never lose sight of the dignity of those being helped or deny them the right to act as agents in their own lives. He takes readers on a journey to some of the darkest places of our history but finds there unimaginable acts of courage and empathy. Here he is doctor as witness, recording voices that must be heard around the world; calling on others to meet their responsibility.
Ummera, ummera–sha is a Rwandan saying that loosely translated means ‘Courage, courage, my friend–find your courage and let it live.’ It was said to me by a patient at our hospital in Kigali. She was slightly older than middle aged and had been attacked with machetes, her entire body rationally and systematically mutilated. Her face had been so carefully disfigured that a pattern was obvious in the slashes. I could do little more for her at that moment than stop the bleeding with a few sutures. We were completely overwhelmed. She knew and I knew that there were so many others. She said to me in the clearest voice I have ever heard, “Allez, allez. Ummera, ummera-sha”–‘Go, go. Courage, courage, my friend–find your courage and let it live.’—From An Imperfect Offering
448 pages, Hardcover
First published April 4, 2008
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February 8, 2012
She was slightly older than middle aged. She had been raped. Semen mixed with blood clung to her thighs. She had been attacked with machetes, her entire body systematically mutilated. Her ears had been cut off. Her face had been so carefully disfigured that a pattern was obvious in the slashes. Both Achilles tendons had been cut. Both breasts had been sliced off. Her attackers didn't want to kill her; they wanted her to bleed to death. They knew just how much to cut to make her bleed slowly. She lay on the road, a 1 taped to her forehead, and now we were just looking at each other.
"Je m'excuse, je m'excuse," I said, apologizing for the pain my pinching forceps gave her. She blinked once, slowly to let a wave of pain pass. She held my forearm. I felt a wave of nausea as I looked again at the pattern someone had cut in her face. I turned from her and vomited for the first and only time during the genocide.
She waited as I spit out what was left of the bile in my mouth. Then she touched my forearm again. I looked into her brown eyes. "Ummera." I wasn't sure if she was saying it to herself, but then she continued. "Ummera-sha." Sha, I thought, it means my friend. She was speaking to me. "Ummera, ummera-sha." she repeated. I tied off the bleeding arteries where her breasts had been. The nurses were calling again, "Docteur, le pro chain, le pro chain! Vite, Docteur!"
The woman was one among many, among hundreds. She knew there were so many more. Again she reached to touch my forearm. She didn't hold it this time. She nodded, looking at me. "Allez... allez... Ummera, ummera-sha," she said in a slow whisper. "Go, go. Courage, courage, my friend." It was the clearest voice I had ever heard.
I finished this book feeling repulsed yet oddly comforted. The sheer weight of human suffering is palpable, and the corresponding list of depravity goes on to include everything from genocide, to pharmaceutical greed, to the exploitation of famine relief. In stark contrast stands James Orbinski, a man I have subsequently developed a great deal of respect for. In some of humanity’s darkest moments he remains vigilant, dedicated, and compassionate in his work. He doesn’t differentiate between the large and the small fights, and from opposing big pharma to putting his own life in danger to save a single person Orbinski is a guiding light in a world of darkness. While many parts of this book were deeply disturbing, reading it all from the perspective of such an exceptional human being lent a silver lining of hope.
Where I live, we simply do not grasp what occurs in other parts of the world. We read about it, we may watch it on television; we may even meet someone who has experienced it, but that is never a substitute for being there. Many of Orbinski’s words describe scenes of unimaginable horror. The largest portion of the book is devoted to his role in the midst of the Rwandan genocide, an event that affected him profoundly. Yet rarely does he address the personal impact of his experiences. There are many scenes that I found difficult to finish, including one that forced me to put the book down for the rest of the day (the one I have quoted above). How Orbinski managed not only to survive but to be a positive force in the midst of such suffering and chaos I will never know.
As advocate and for a time president of Medicins sans Frontieres, Orbinski’s work has taken him all over the world. Other chapters are devoted to Afghanistan, Somalia, Zaire and Kosovo (among others). He developed MSF’s Access to Essential Medicines campaign, and established Dignitas International in Malawi to combat its rampant HIV/AIDS epidemic. The latter topic deeply resonated with me, having travelled to Malawi three years ago. As a tiny, landlocked country with one of the highest HIV/AIDS infection rates in the world, it rarely receives much press. The exceptionally high death rate means countless orphaned children and broken families, an out of control intellectual/workforce drain, and little to no healthcare support. It's not uncommon to meet someone there who has lost their entire family.
The most compelling part of this book stems not from its darkest passages, but from the voice of its author. If one man can face such daunting challenges with so much care and perseverance, perhaps there is hope for us after all.
"Je m'excuse, je m'excuse," I said, apologizing for the pain my pinching forceps gave her. She blinked once, slowly to let a wave of pain pass. She held my forearm. I felt a wave of nausea as I looked again at the pattern someone had cut in her face. I turned from her and vomited for the first and only time during the genocide.
She waited as I spit out what was left of the bile in my mouth. Then she touched my forearm again. I looked into her brown eyes. "Ummera." I wasn't sure if she was saying it to herself, but then she continued. "Ummera-sha." Sha, I thought, it means my friend. She was speaking to me. "Ummera, ummera-sha." she repeated. I tied off the bleeding arteries where her breasts had been. The nurses were calling again, "Docteur, le pro chain, le pro chain! Vite, Docteur!"
The woman was one among many, among hundreds. She knew there were so many more. Again she reached to touch my forearm. She didn't hold it this time. She nodded, looking at me. "Allez... allez... Ummera, ummera-sha," she said in a slow whisper. "Go, go. Courage, courage, my friend." It was the clearest voice I had ever heard.
I finished this book feeling repulsed yet oddly comforted. The sheer weight of human suffering is palpable, and the corresponding list of depravity goes on to include everything from genocide, to pharmaceutical greed, to the exploitation of famine relief. In stark contrast stands James Orbinski, a man I have subsequently developed a great deal of respect for. In some of humanity’s darkest moments he remains vigilant, dedicated, and compassionate in his work. He doesn’t differentiate between the large and the small fights, and from opposing big pharma to putting his own life in danger to save a single person Orbinski is a guiding light in a world of darkness. While many parts of this book were deeply disturbing, reading it all from the perspective of such an exceptional human being lent a silver lining of hope.
Where I live, we simply do not grasp what occurs in other parts of the world. We read about it, we may watch it on television; we may even meet someone who has experienced it, but that is never a substitute for being there. Many of Orbinski’s words describe scenes of unimaginable horror. The largest portion of the book is devoted to his role in the midst of the Rwandan genocide, an event that affected him profoundly. Yet rarely does he address the personal impact of his experiences. There are many scenes that I found difficult to finish, including one that forced me to put the book down for the rest of the day (the one I have quoted above). How Orbinski managed not only to survive but to be a positive force in the midst of such suffering and chaos I will never know.
As advocate and for a time president of Medicins sans Frontieres, Orbinski’s work has taken him all over the world. Other chapters are devoted to Afghanistan, Somalia, Zaire and Kosovo (among others). He developed MSF’s Access to Essential Medicines campaign, and established Dignitas International in Malawi to combat its rampant HIV/AIDS epidemic. The latter topic deeply resonated with me, having travelled to Malawi three years ago. As a tiny, landlocked country with one of the highest HIV/AIDS infection rates in the world, it rarely receives much press. The exceptionally high death rate means countless orphaned children and broken families, an out of control intellectual/workforce drain, and little to no healthcare support. It's not uncommon to meet someone there who has lost their entire family.
The most compelling part of this book stems not from its darkest passages, but from the voice of its author. If one man can face such daunting challenges with so much care and perseverance, perhaps there is hope for us after all.
May 18, 2010
a while ago, I saw the film 'Triage' and there leaned a bit about Dr. James Orbinski and his work. it was incredibly moving and i was absolutely fascinated - with his work and with what a great story teller he is. The film covered his return to Somalia and Rwanda where he had worked for MSF (Doctors without Borders) and his (then) current endeavor of writing a book about his experiences and viewpoint. i do highly recommend the film. the book itself is a more thorough look at his life, motivation, and time spent working for MSF and beyond. it's difficult to say 'this is a good book' in a conventional sense - as the subject matter is at times frustrating, horrific, and emotional. yet it is the best book i've read in some time. but again, I find Orbinski is an incredible story teller - focusing in on such small but important moments in the midst of detailing the political situations. it is amazing to me that someone can see the worst of humanity and still have hope, still fight. and that, to me, was the question i had reading this book.
Quote:
Stories, we all have stories. Nature does not tell stories, we do. We find ourselves in them, make ourselves in them, choose ourselves in them. If we are the stories we tell ourselves, we had better choose them well.... I ask again and again, "How am I to be, how are we to be in relation to the suffering of others?"... It is about a way of seeing that requires humility, so that one can recognize the sameness of self in the other. It is about the mutuality that can exist between us, if we choose.
Quote:
Stories, we all have stories. Nature does not tell stories, we do. We find ourselves in them, make ourselves in them, choose ourselves in them. If we are the stories we tell ourselves, we had better choose them well.... I ask again and again, "How am I to be, how are we to be in relation to the suffering of others?"... It is about a way of seeing that requires humility, so that one can recognize the sameness of self in the other. It is about the mutuality that can exist between us, if we choose.
February 21, 2011
An open, honest, beautifully disturbing account of humanitarian work. James Orbinski is an inspiration. He does what most of us would be afraid to even attempt. If you have an interest in human rights and want to hear the truth, read this book.
I read the introduction as a preview on Amazon. Next thing I knew I had to own this book! His thoughts were compelling and insightful from the first line, making you think about the politics our world is caught up in and how humantarianism fits in to the global discussion. He does not accept the easy answers but searches for the raw uneasy stories that lie beneath.
And let me tell you, some of his stories will turn your stomach. Some of the images I was left with will never leave me...I can't imagine seeing it first hand. The chapter on the Rwandan genocide was the hardest to get through. Yet, I never wanted to stop. I rather know the truth than hide from it. This is our world and no matter how hard you try that is one truth you should not hide from. Orbinski decided, once coming back from Rwanda, that he rather know the truth about the world then be blinded by propaganda and pretty pictures. If more of us would make this choice our world would have the chance to be a better place.
I also really appreciated the chapters on Somalia, the DRC, Afghanistan, and the Afghan/Iraq invasion. I was educated on issues I was not aware of. For brief moments, as I read its pages, this book opened my eyes. Some people live this everyday...they live it. I was captivated by the destruction and violence, the idea that this brutality resulted from human hands. But I was also captivated by the perseverance, hope, and kindness that human beings possess. In these chapters, I caught a glimpse of what these countries have, and are facing, daily. It made me want to know more. This book gave me the desire to seek out answers.
One thing I truly loved about Orbinski's writing was that he did not let his successes get in the way of his story telling. Often, when reading political pieces I get frustrated by the egos that are involved. I never felt this with Orbinski. He has reason to be proud of himself, yet he reamins level headed with his humility intact. I found that he placed facts and stories in front of me without forcing me to choose his ideals and beliefs. I really appreciated and respected that.
Finally, I want to say that I am grateful to Mr.Orbinski for striving to make our world a place he wants to raise his children, for being open to sharing his experiences, for remaining hopeful in the face of so much hate, and for educating me on the issues that matter.
I read the introduction as a preview on Amazon. Next thing I knew I had to own this book! His thoughts were compelling and insightful from the first line, making you think about the politics our world is caught up in and how humantarianism fits in to the global discussion. He does not accept the easy answers but searches for the raw uneasy stories that lie beneath.
And let me tell you, some of his stories will turn your stomach. Some of the images I was left with will never leave me...I can't imagine seeing it first hand. The chapter on the Rwandan genocide was the hardest to get through. Yet, I never wanted to stop. I rather know the truth than hide from it. This is our world and no matter how hard you try that is one truth you should not hide from. Orbinski decided, once coming back from Rwanda, that he rather know the truth about the world then be blinded by propaganda and pretty pictures. If more of us would make this choice our world would have the chance to be a better place.
I also really appreciated the chapters on Somalia, the DRC, Afghanistan, and the Afghan/Iraq invasion. I was educated on issues I was not aware of. For brief moments, as I read its pages, this book opened my eyes. Some people live this everyday...they live it. I was captivated by the destruction and violence, the idea that this brutality resulted from human hands. But I was also captivated by the perseverance, hope, and kindness that human beings possess. In these chapters, I caught a glimpse of what these countries have, and are facing, daily. It made me want to know more. This book gave me the desire to seek out answers.
One thing I truly loved about Orbinski's writing was that he did not let his successes get in the way of his story telling. Often, when reading political pieces I get frustrated by the egos that are involved. I never felt this with Orbinski. He has reason to be proud of himself, yet he reamins level headed with his humility intact. I found that he placed facts and stories in front of me without forcing me to choose his ideals and beliefs. I really appreciated and respected that.
Finally, I want to say that I am grateful to Mr.Orbinski for striving to make our world a place he wants to raise his children, for being open to sharing his experiences, for remaining hopeful in the face of so much hate, and for educating me on the issues that matter.
Read
July 30, 2011Being an MSFer myself, I can relate to many of the stories James Orbinski talks about in his book. This book is about the passion that we all have for the work we do on the field, and the genuine interest in humanity. And there is one picture in the book where James took it in Masisi - DRCongo, that has Jean PP as a young driver next to James. Jean PP is still working today with MSF in North Kivu!! He hardly recognized himself in the picture though...
April 11, 2011
An Imperfect Offering is one of those rare books that not only breaks your heart but puts it back together again and at the same time, inspires you. Dr. James Orbinski has experienced the horrors of war, famine and genocide. Despite that, he writes about the ordinary people he's either treated or worked with and the compassion and courage they each display. Dr. James Orbinski is a true humanitarian in every sense of the word. This is a tender and beautifully written book that you will never forget.
August 21, 2019
The book is really cool.
November 20, 2011
This book was heartbreaking and intense, but important nonetheless. It's the memoir of a physician who worked in the field with MSF for many years and then went on to become the international president of the organization. "Dr. James" worked all over the globe...Somalia, Congo, Kosovo, North Korea, Russia, Central and South America, Zaire, and Rwanda during the Rwandan genocide in 1994. His stories and the details of these global conflicts, from the perspective of a humanitarian aid worker and physician, are shocking and gut-wrenching. In his accounts he not only addresses the horrors of human suffering worldwide, but also the politics during these events and how detrimental they sometimes were to the humanitarian effort. I was shocked to learn how little it would have taken for the UN or the United States to intervene in Rwanda and spare the lives of over 800,000 men, women and children (not to mention the many more who died in refugee camps of starvation or infectious disease). It wasn't until weeks, and hundreds of thousands of brutal killings later, that the UN finally acknowledged the situation as a genocide so that appropriate international intervention could even take place.
After working in the field, Dr. Orbinski went on to advocate for AIDS/HIV patients in Africa, going up against the pharmeceutical industry who feared that releasing their patent on antiretroviral drugs in order to allow for a generic, would disturb their profits. With the international clout of MSF he was successful in forcing the pharmaceutical company to release the patent, making possible the production of a generic, thereby lowering the annual cost of the ARV treatment from $15,000 per year to $200 per year per patient.
Reading this book, I feel grateful for the existence of people like Dr. Orbinski who sacrifice and risk so much to work in some of the most difficult situations a person can imagine, who have a profound compassion and concern for the health, well-being and survival of far less fortunate people, who are willing to stand up and speak out on their behalf, and who are able to do all of this while maintaining a certain humility and somehow, unbelievably, sanity.
After working in the field, Dr. Orbinski went on to advocate for AIDS/HIV patients in Africa, going up against the pharmeceutical industry who feared that releasing their patent on antiretroviral drugs in order to allow for a generic, would disturb their profits. With the international clout of MSF he was successful in forcing the pharmaceutical company to release the patent, making possible the production of a generic, thereby lowering the annual cost of the ARV treatment from $15,000 per year to $200 per year per patient.
Reading this book, I feel grateful for the existence of people like Dr. Orbinski who sacrifice and risk so much to work in some of the most difficult situations a person can imagine, who have a profound compassion and concern for the health, well-being and survival of far less fortunate people, who are willing to stand up and speak out on their behalf, and who are able to do all of this while maintaining a certain humility and somehow, unbelievably, sanity.
May 18, 2009
Orbinski's book is an easy read and is a great starting point for people who know little about the Rwandan genocide. I enjoyed his vivid, raw and at times lurid detail of the events that unfolded. I have a profound degree of respect for his selflessness and his relentless pursuit to help others and lobby for their plight. I especially enjoyed the last chapter on his advocacy work to allow cheap access to drugs in developing countries, his fight against the PHRAM lobby and his explanation of the politics behind ARVs and its relation to the pharmaceutical companies and western governments. It was succinct and concise, and his arguments for the ending of pharmaceutical monopolies on patented ARVs was clearly presented.
July 9, 2025
Orbinski's book tends to be as imperfect as the subject he seeks to cover. I do not blame Orbinski for this, because the imperfections of this book are understandable considering the immense levels of anger, frustration, and trauma he experienced during his time as a humanitarian. Certain aspects and frustrations of this book hit home to me, especially as someone who has seen governmental failure lead to incredible degrees of human suffering. But this emotional resonance cannot deny the incredible dryness with which he approaches some of his material. I found myself slogging through his early and late humanitarian experiences as he describes dry political debates around humanitarian law and American politics.
Orbinski does showcase sparks of emotion, especially in describing the horrors of the Rwandan genocide. However, I wish there were more literary moments that focused on his ability to find solace and peace amidst chaos and suffering. **There are a few moments when Orbinski describes his ethical and emotional turmoil with a Canadian priest. These are great set pieces that ask the reader to grapple with ethical dilemmas while also seeing Orbanski at his most human.**
Unfortunately, much of this book is drier than expected, and I feel like this is partially because Orbinski is not a natural writer and partially because he was still coming to terms with his own trauma as he described these experiences.
Overall, I found this book to be just enjoyable enough to finish, and it is definitely worth your time if you are thinking of entering the humanitarian space.
Orbinski does showcase sparks of emotion, especially in describing the horrors of the Rwandan genocide. However, I wish there were more literary moments that focused on his ability to find solace and peace amidst chaos and suffering. **There are a few moments when Orbinski describes his ethical and emotional turmoil with a Canadian priest. These are great set pieces that ask the reader to grapple with ethical dilemmas while also seeing Orbanski at his most human.**
Unfortunately, much of this book is drier than expected, and I feel like this is partially because Orbinski is not a natural writer and partially because he was still coming to terms with his own trauma as he described these experiences.
Overall, I found this book to be just enjoyable enough to finish, and it is definitely worth your time if you are thinking of entering the humanitarian space.
September 24, 2024
This book messed me UP - like I am not okay! Parts of this book made me feel physically ill which has never happened before but had to stick it out (and binge it) for med school book club. It was a frighteningly honest account of finding strength and not giving up on humanity even when faced with some of the darkest things that people are capable of. It feels wrong to rate an account like that so five stars.
February 5, 2025
Easily one of the most horrible yet beautiful books I’ve read. Had to physically turn away from the pages a number of times.
October 16, 2024
Incredibly moving and sickening at the same time. Orbinsky is no formally-trained author but his words carry a lot of passion and rage regarding what he's seen. He also has a career path I'm exploring as an NGO physician and he does a great job explaining the pros and cons of this kind of work.
August 10, 2018
I gave this worthy of 5 stars book a 4 star review because to me it was too harrowing at times, although that should not be changed by the author, but the subtitle "humanitarian action in the 21st century" didn't reveal the fact that it dealt so thoroughly with the Rwanda genocide and msf ( doctors without borders).
Orbinski is a good writer, and as a humanitarian must be almost legendary.
This book deserves to be read, and should be read.
Canada has not only its D'Allaire who saw Rwanda from our military perspective, but also our Obinski, a doctor who accomplished so more, mixing healing with an Amnesty International perspective, and that of a research scientist who fought for inexpensive new drugs for Africa. Imagine fighting big Pharma, inaction of the United Nations, for neutrality of NGOs in Kosovo, and for dignity to all.
You don't have to. Orbinski did it all, thus redeeming humanity and hope in the midst of mans inhumanity to man.
Orbinski is a good writer, and as a humanitarian must be almost legendary.
This book deserves to be read, and should be read.
Canada has not only its D'Allaire who saw Rwanda from our military perspective, but also our Obinski, a doctor who accomplished so more, mixing healing with an Amnesty International perspective, and that of a research scientist who fought for inexpensive new drugs for Africa. Imagine fighting big Pharma, inaction of the United Nations, for neutrality of NGOs in Kosovo, and for dignity to all.
You don't have to. Orbinski did it all, thus redeeming humanity and hope in the midst of mans inhumanity to man.
July 5, 2009
This book is written by a former president of Doctors without Borders. Each chapter chronicles his experiences and the Borders organization in various countries including Afghanistan, North Korea, Rwanda, Sudan, etc. Sometimes I got lost in all the names and politics of it all but I learned a lot. The theme that stood out to me is the relationship between humanitarianism and politics and how so many try to keep the two separate but this is near impossible. I especially enjoyed one of the last chapters on his work in trying to promote access for life saving drugs to developing countries. Except for a few exceptions, the author writes from a very objective standpoint- which is helpful so that the reader can make up their own mind- especially when it comes to the politics but I think I would have liked to know a little more about his own reactions and feelings on things.
March 30, 2016
This is one of the most powerful books I have ever read. It seemed that the entire book was a manifesto for preserving the power of humanitarianism: pure humanitarianism, free from political tangles or ulterior agendas. It was refreshing and poignant; timely and timeless. The book was very well-researched, which is one of the reasons it took me two months to read. The level of detail about political exchanges and turmoil was impressive and I learned a great deal. Reading this reminded me of humanitarian ideals that must be upheld and how easy it is to be ensnared by nationalism.
Would recommend this book to anyone interested in global health or international relations, especially those feeling burnt-out or compassion- fatigued.
Would recommend this book to anyone interested in global health or international relations, especially those feeling burnt-out or compassion- fatigued.
December 3, 2008
I think this was the most difficult book I have ever read. Everytime I opened it, I knew my heart would race and heart would sink. In fact, I had to stop reading it before going to bed, becase I wouldn't be able to fall asleep for too long.
This is the kind of book that slaps you across the face awareness. It is important to have this type of read, with events in Darfur and the DRC. It wakes you up, makes you alive, and reminds you of what is means to be human. Also interesting political and historical accounts of some of the major recent conflicts across the globe, not to mention knee deep (no forehead deep) human stories. It also makes me want to be a doctor. really bad.
This is the kind of book that slaps you across the face awareness. It is important to have this type of read, with events in Darfur and the DRC. It wakes you up, makes you alive, and reminds you of what is means to be human. Also interesting political and historical accounts of some of the major recent conflicts across the globe, not to mention knee deep (no forehead deep) human stories. It also makes me want to be a doctor. really bad.
July 29, 2018
This was half a story of a humanitarian doctor and half a history of Medecins Sans Frontieres. It reminded me of how recent a concept the citizen humanitarian is, and clarified some how very different international development (the work I do) is from humanitarian work. One of the more fascinating discussions in the book is how and when MSF will engage politically to manifest change when it is committed to political objectivity (hence the organization's name). Orbinski covers many of the major humanitarian conflicts of the last 3 decades, including Rwanda, Somalia, and Kosovo. I highly recommend for people working or interested in international development or humanitarian aid.
February 25, 2009
This book highlights past and present humanitarian concerns. It is written by the former president of Doctor's Without Borders. He had some interesting stories about his time during the Rwandan genocide and enusing conflict in Zaire. He also highlights the responsibility of the UN and governments to invest more research and money into diseases that primarily affect the developing world. He has traveled extensively and the information he provides tells of what really goes on behind the scenes in various wars and with big drug companies.
June 29, 2017
Orbinski captures the brutalist nature of humanity in such an honest and compelling way. Through humanitarian crises in Peru, Kosovo, Rwanda and North Korea, this book allows the reader to gain valuable insights into the barbarity of mankind, the follies of political intervention masked as humanitarian relief and the philosophies and guiding principles that define Orbinski and Doctors Without Borders, the institution he would later chair.
Heart-breaking, gripping and deeply personal.
Heart-breaking, gripping and deeply personal.
February 22, 2013
This book was riveting and informative. Orbinski has a real flair for telling stories. I watched a documentary about him through Netflix and immediately ordered the book, which I read quickly over the course of a week. I learned a lot about places like Somalia and Rwanda and even more about international politics, humanitarianism, and the intersection and tensions between the two. I've recommended this book to lots of other people because it's as entertaining as it is eye-opening.
January 30, 2016
The biography of James Orbinski, former head of MSF. It chronicles his career working as a humanitarian doctor in the developing world, especially in the Somali famine and civil war as well as the Rwandan Genocide. In his role as a doctor, he treated many of those suffering most. Powerful and moving, and surprising that he retains hope for the future, and the manner in which humanitarianism can regain its own space in conflict to alleviate those suffering most.
February 14, 2018
Great book. Dr Orbinski delicately describes genocides he worked through. If you're at all interested in the politics of health and/or genocide, I'd recommend this.
His experiences are hair-raising at times.
His experiences are hair-raising at times.
April 5, 2013
Excellent
April 1, 2023
“...each day I make a choice, against nihilism and towards justice.”
In An Imperfect Offering, Dr. James Orbinski, the past president of Doctors Without Borders
(Médecins Sans Frontières), writes an authentic account of humanitarian work and its politics. It begins with his first experiences working as a medical doctor through MSF, continues into his undoing following the Rwandan genocide, and then finishes in part three with a broader, institutional perspective, one that is tinged with hope on what we can learn and do to move towards a world we want to see.
Dr. Orbinski describes, in often scathing ways, the way high-income countries like the United States and France have and continue to support violence in low-income regions, the inefficient bureaucracy of institutions such as the United Nations, and the politics of humanitarian military aid. He emphasizes the need to keep humanitarian work apolitical as possible and to hold on to the values of universality, impartiality, and independence. However, in the 21st century, humanitarian work is deeply impacted by political machinations due to the “blurring of boundaries between humanitarian assistance and the political objectives of military intervention” and thus for humanitarian space to exist, “we had to be willing to confront political power.” Thus comes the MSF's mission to bear witness: they will not choose a side but refuse to stay silent in the face of atrocities. To support victims of injustice, we must refuse to remain complacent and must elevate their experiences and rally support. It isn’t enough to provide aid; one must ensure they are not keeping those who are oppressed from regaining their own power by indirectly allowing the oppressors to continue on with their violence under the safety of silence.
Good and evil are a choice, but following the stories of medical professionals working through war and genocide, it is clear that there are people around us who have a strong intrinsic pull towards doing good, who will speak against injustice and stay in seemingly hopeless situations “because it was possible to do something, even something small that helped. Once you’re there, there is no other choice.” Regardless of the terrible things some humans do, there will always be people who stand in the face of it and defy it with selfless kindness.
In a world that seems to choose nihilism day after day, accounts like Dr. Orbinski’s are vital to keeping hope alive, because it is hope that will bring change and justice to victims.
In An Imperfect Offering, Dr. James Orbinski, the past president of Doctors Without Borders
(Médecins Sans Frontières), writes an authentic account of humanitarian work and its politics. It begins with his first experiences working as a medical doctor through MSF, continues into his undoing following the Rwandan genocide, and then finishes in part three with a broader, institutional perspective, one that is tinged with hope on what we can learn and do to move towards a world we want to see.
Dr. Orbinski describes, in often scathing ways, the way high-income countries like the United States and France have and continue to support violence in low-income regions, the inefficient bureaucracy of institutions such as the United Nations, and the politics of humanitarian military aid. He emphasizes the need to keep humanitarian work apolitical as possible and to hold on to the values of universality, impartiality, and independence. However, in the 21st century, humanitarian work is deeply impacted by political machinations due to the “blurring of boundaries between humanitarian assistance and the political objectives of military intervention” and thus for humanitarian space to exist, “we had to be willing to confront political power.” Thus comes the MSF's mission to bear witness: they will not choose a side but refuse to stay silent in the face of atrocities. To support victims of injustice, we must refuse to remain complacent and must elevate their experiences and rally support. It isn’t enough to provide aid; one must ensure they are not keeping those who are oppressed from regaining their own power by indirectly allowing the oppressors to continue on with their violence under the safety of silence.
Good and evil are a choice, but following the stories of medical professionals working through war and genocide, it is clear that there are people around us who have a strong intrinsic pull towards doing good, who will speak against injustice and stay in seemingly hopeless situations “because it was possible to do something, even something small that helped. Once you’re there, there is no other choice.” Regardless of the terrible things some humans do, there will always be people who stand in the face of it and defy it with selfless kindness.
In a world that seems to choose nihilism day after day, accounts like Dr. Orbinski’s are vital to keeping hope alive, because it is hope that will bring change and justice to victims.
April 8, 2025
A book I picked up inspired by work I did with an organization focused on neglected tropical diseases and some short international aid trips. An Imperfect Offering details the integral role independent humanitarian aid plays in a world of growing governmental uncertainty.
James Orbinski details his time with Doctors Without Borders (MSF) spending time aiding war torn communities in Rwanda, Afghanistan, South Sudan, Zaire, North Korea, and Russia to name a few. He outlines the distinct role that humanitarian aid plays; in his own words “creating a space of normalcy in the most abnormal of situations”.
With the recent withdrawal of funding from governmental aid groups such as USAID and The Voice of America, Dr. Orbinski’s view of independent humanitarian action as uniquely important rings more clearly than ever.
Time and time again Dr. Orbinski defines the idea that separates governmental and independent aid; that
humanitarian action is not a political tool.
The work of MSF and other non-governmental organizations is more important than ever in the fight for dignity and the right to life for millions around the world. I think this book articulates this role incredibly well and is a great read for anyone interested in the workings of international humanitarian aid outside of the scope of government control.
Some notable quotes:
“In our choice to be with those who suffer, compassion leads not simply to pity but to solidarity.”
“Speaking is the first political act. It is the first act of liberty, and it always implicitly involves another. In speaking, one recognizes, ‘I am and I am not alone.’”
“There are means that cannot be excused. And I should like to be able to love my country and still love justice. I don’t want just any greatness for it, particularly a greatness born of blood and falsehood. I want to keep it alive by keeping justice alive.” - Albert Camus
James Orbinski details his time with Doctors Without Borders (MSF) spending time aiding war torn communities in Rwanda, Afghanistan, South Sudan, Zaire, North Korea, and Russia to name a few. He outlines the distinct role that humanitarian aid plays; in his own words “creating a space of normalcy in the most abnormal of situations”.
With the recent withdrawal of funding from governmental aid groups such as USAID and The Voice of America, Dr. Orbinski’s view of independent humanitarian action as uniquely important rings more clearly than ever.
Time and time again Dr. Orbinski defines the idea that separates governmental and independent aid; that
humanitarian action is not a political tool.
The work of MSF and other non-governmental organizations is more important than ever in the fight for dignity and the right to life for millions around the world. I think this book articulates this role incredibly well and is a great read for anyone interested in the workings of international humanitarian aid outside of the scope of government control.
Some notable quotes:
“In our choice to be with those who suffer, compassion leads not simply to pity but to solidarity.”
“Speaking is the first political act. It is the first act of liberty, and it always implicitly involves another. In speaking, one recognizes, ‘I am and I am not alone.’”
“There are means that cannot be excused. And I should like to be able to love my country and still love justice. I don’t want just any greatness for it, particularly a greatness born of blood and falsehood. I want to keep it alive by keeping justice alive.” - Albert Camus
July 2, 2020
A sobering, important read that I’d recommend to anyone
November 13, 2024
Great book because it touches on so many problems in the world but I found it at some points confusing. You definetly need to have a bit of background on humanitarian issues to truly grasp everything going on. It is denseeee but great nonetheless
August 16, 2010
sobering read. sad to think how screwed up the world is. mass genocides even in the new millennium... stirs one to action.
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Product Description
“As Albert Camus wrote, the doctor’s role is as a witness–to witness authentically the reality of humanity, and to speak out against the horrors of political inaction. . . . The only crime equaling inhumanity is the crime of indifference, silence, and forgetting.”
—James Orbinski
In 1988, James Orbinski, then a medical student in his twenties, embarked on a year-long research trip to Rwanda, a trip that would change who he would be as a doctor and as a man. Investigating the conditions of pediatric AIDS in Rwanda, James confronted widespread pain and suffering, much of it preventable, much of it occasioned by political and economic corruption. Fuelled by the injustice of what he had seen in Rwanda, Orbinski helped establish the Canadian chapter of Médecins Sans Frontières (Doctors Without Borders/MSF). As a member of MSF he travelled to Peru during a cholera epidemic, to Somalia during the famine and civil war, and to Jalalabad, Afghanistan.
In April 1994, James answered a call from the MSF Amsterdam office. Rwandan government soldiers and armed militias of extremist Hutus had begun systematically to murder Tutsis. While other foreigners were evacuated from Rwanda, Orbinski agreed to serve as Chef de Mission for MSF in Kigali. As Rwanda descended into a hell of civil war and genocide, he and his team worked tirelessly, tending to thousands upon thousands of casualties. In fourteen weeks 800,000 men, women and children were exterminated. Half a million people were injured, and millions were displaced. The Rwandan genocide was Orbinski’s undoing. Confronted by indescribable cruelty, he struggled to regain his footing as a doctor, a humanitarian and a man. In the end he chose not to retreat from the world, but resumed his work with MSF, and was the organization’s president when it was awarded the Nobel Peace Prize in 1999.
An Imperfect Offering is a deeply personal, deeply political book. With unstinting candor, Orbinski explores the nature of humanitarian action in the twenty-first century, and asserts the fundamental imperative of seeing as human those whose political systems have most brutally failed. He insists that in responding to the suffering of others, we must never lose sight of the dignity of those being helped or deny them the right to act as agents in their own lives. He takes readers on a journey to some of the darkest places of our history but finds there unimaginable acts of courage and empathy. Here he is doctor as witness, recording voices that must be heard around the world; calling on others to meet their responsibility.
“Ummera, ummera–sha” is a Rwandan saying that loosely translated means ‘Courage, courage, my friend–find your courage and let it live.’ It was said to me by a patient at our hospital in Kigali. She was slightly older than middle aged and had been attacked with machetes, her entire body rationally and systematically mutilated. Her face had been so carefully disfigured that a pattern was obvious in the slashes. I could do little more for her at that moment than stop the bleeding with a few sutures. We were completely overwhelmed. She knew and I knew that there were so many others. She said to me in the clearest voice I have ever heard, “Allez, allez. Ummera, ummera-sha”–‘Go, go. Courage, courage, my friend–find your courage and let it live.’
—From An Imperfect Offering
About the Author
Dr. James Orbinski is a past international President of Médecins sans Frontières (MSF). He is a Research Scientist and Associate Professor of Family and Community Medicine and Political Science at St. Michael’s Hospital and the University of Toronto. He is a founder of the Drugs for Neglected Diseases Initiative, a not-for-profit pharmaceutical research and development entity focused on the diseases of the South. He recently founded Dignitas, an organization focused on community based treatment, care and prevention of HIV in the developing world. Dr. Orbinski lectures internationally on humanitarianism and global health.
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Product Description
“As Albert Camus wrote, the doctor’s role is as a witness–to witness authentically the reality of humanity, and to speak out against the horrors of political inaction. . . . The only crime equaling inhumanity is the crime of indifference, silence, and forgetting.”
—James Orbinski
In 1988, James Orbinski, then a medical student in his twenties, embarked on a year-long research trip to Rwanda, a trip that would change who he would be as a doctor and as a man. Investigating the conditions of pediatric AIDS in Rwanda, James confronted widespread pain and suffering, much of it preventable, much of it occasioned by political and economic corruption. Fuelled by the injustice of what he had seen in Rwanda, Orbinski helped establish the Canadian chapter of Médecins Sans Frontières (Doctors Without Borders/MSF). As a member of MSF he travelled to Peru during a cholera epidemic, to Somalia during the famine and civil war, and to Jalalabad, Afghanistan.
In April 1994, James answered a call from the MSF Amsterdam office. Rwandan government soldiers and armed militias of extremist Hutus had begun systematically to murder Tutsis. While other foreigners were evacuated from Rwanda, Orbinski agreed to serve as Chef de Mission for MSF in Kigali. As Rwanda descended into a hell of civil war and genocide, he and his team worked tirelessly, tending to thousands upon thousands of casualties. In fourteen weeks 800,000 men, women and children were exterminated. Half a million people were injured, and millions were displaced. The Rwandan genocide was Orbinski’s undoing. Confronted by indescribable cruelty, he struggled to regain his footing as a doctor, a humanitarian and a man. In the end he chose not to retreat from the world, but resumed his work with MSF, and was the organization’s president when it was awarded the Nobel Peace Prize in 1999.
An Imperfect Offering is a deeply personal, deeply political book. With unstinting candor, Orbinski explores the nature of humanitarian action in the twenty-first century, and asserts the fundamental imperative of seeing as human those whose political systems have most brutally failed. He insists that in responding to the suffering of others, we must never lose sight of the dignity of those being helped or deny them the right to act as agents in their own lives. He takes readers on a journey to some of the darkest places of our history but finds there unimaginable acts of courage and empathy. Here he is doctor as witness, recording voices that must be heard around the world; calling on others to meet their responsibility.
“Ummera, ummera–sha” is a Rwandan saying that loosely translated means ‘Courage, courage, my friend–find your courage and let it live.’ It was said to me by a patient at our hospital in Kigali. She was slightly older than middle aged and had been attacked with machetes, her entire body rationally and systematically mutilated. Her face had been so carefully disfigured that a pattern was obvious in the slashes. I could do little more for her at that moment than stop the bleeding with a few sutures. We were completely overwhelmed. She knew and I knew that there were so many others. She said to me in the clearest voice I have ever heard, “Allez, allez. Ummera, ummera-sha”–‘Go, go. Courage, courage, my friend–find your courage and let it live.’
—From An Imperfect Offering
About the Author
Dr. James Orbinski is a past international President of Médecins sans Frontières (MSF). He is a Research Scientist and Associate Professor of Family and Community Medicine and Political Science at St. Michael’s Hospital and the University of Toronto. He is a founder of the Drugs for Neglected Diseases Initiative, a not-for-profit pharmaceutical research and development entity focused on the diseases of the South. He recently founded Dignitas, an organization focused on community based treatment, care and prevention of HIV in the developing world. Dr. Orbinski lectures internationally on humanitarianism and global health.
April 22, 2013
Written in a very accessible, almost conversational style, Orbinski's memoir is nonetheless both hard-hitting and thoroughly detailed.
Orbinski's goal is not merely to bear witness to both the best and worst that humanity can perpetuate on each other, although he does that effectively, but to bring attention to the fact that in recent years "humanitarianism" has become, in and of itself, less a matter of apolitical assistance and more a direct tool of political manipulation by those powers with enough money to provide it to those developing nations who need it.
Dr. Orbinski, with field experience around the world, experience as an administrator of an international organization and as a medical researcher, brings a unique perspective to the quandaries of providing assistance to human beings, regardless of the "side" of a conflict they are on, and while the inescapable conclusion he arrives at is that he must learn to manoeuvre in a political world in the attempt to be a humanitarian, he also reminds the readers that ultimately, wars are fought for people in power, and that ultimately the people who pay the cost are often sold out and sold short. There are usually no "good guys", regardless of what the media would have us believe, and no easy answers. There are only human beings - and when we engage in or permit human beings to be treated brutally, regardless of they may or may not have done to "deserve" such treatment, the cycle of violence, greed, terror, brutality, and atrocities is enabled and empowered to repeat itself again and again.
Warning - Orbinski pulls no punches and although he does not revel in ghoulish particulars he is not at all apologetic about detailing his experience; he states clearly his belief that part of his responsibility is to bear witness to what he has seen, and what he has seen are some of the most horrific eras and events our planet has witnessed in the last four decades. It can be hard reading, particularly if you have a vivid imagination. Consider whether you are prepared to deal with forthright and candid descriptions of people killing, maiming and brutalizing each other in vicious, bloody, merciless ways. Consider where you want to be reading this book if you think that your emotional reaction might be intense. There were times I had to put the book down and walk away from it because the images overwhelmed me, because I was sickened, literally, that we believe ourselves to be so evolved and intelligent and still we do such savage things to each other; at other times, I needed to put the book down because I was overwhelmed by the strength, the profound generosity of heart and spirit, and the tenacity of the people that Orbinski encountered and worked with.
It is a book that will make you think and will challenge your notions of what it means to be not only a humanitarian, but to be human.
Orbinski's goal is not merely to bear witness to both the best and worst that humanity can perpetuate on each other, although he does that effectively, but to bring attention to the fact that in recent years "humanitarianism" has become, in and of itself, less a matter of apolitical assistance and more a direct tool of political manipulation by those powers with enough money to provide it to those developing nations who need it.
Dr. Orbinski, with field experience around the world, experience as an administrator of an international organization and as a medical researcher, brings a unique perspective to the quandaries of providing assistance to human beings, regardless of the "side" of a conflict they are on, and while the inescapable conclusion he arrives at is that he must learn to manoeuvre in a political world in the attempt to be a humanitarian, he also reminds the readers that ultimately, wars are fought for people in power, and that ultimately the people who pay the cost are often sold out and sold short. There are usually no "good guys", regardless of what the media would have us believe, and no easy answers. There are only human beings - and when we engage in or permit human beings to be treated brutally, regardless of they may or may not have done to "deserve" such treatment, the cycle of violence, greed, terror, brutality, and atrocities is enabled and empowered to repeat itself again and again.
Warning - Orbinski pulls no punches and although he does not revel in ghoulish particulars he is not at all apologetic about detailing his experience; he states clearly his belief that part of his responsibility is to bear witness to what he has seen, and what he has seen are some of the most horrific eras and events our planet has witnessed in the last four decades. It can be hard reading, particularly if you have a vivid imagination. Consider whether you are prepared to deal with forthright and candid descriptions of people killing, maiming and brutalizing each other in vicious, bloody, merciless ways. Consider where you want to be reading this book if you think that your emotional reaction might be intense. There were times I had to put the book down and walk away from it because the images overwhelmed me, because I was sickened, literally, that we believe ourselves to be so evolved and intelligent and still we do such savage things to each other; at other times, I needed to put the book down because I was overwhelmed by the strength, the profound generosity of heart and spirit, and the tenacity of the people that Orbinski encountered and worked with.
It is a book that will make you think and will challenge your notions of what it means to be not only a humanitarian, but to be human.
March 5, 2016
I find it useful when reviewing these non-fiction books to look at what they set out to do and how their are built to achieve it, and this loosely follows Orbinski's life to be successively the autobiography of a doctor, the report of a witness to some of the very worst chapters of history, the portrayal of the internal workings of MSF during a very small range of years, and a broader reflection and call to action regarding the role of humanitarianism and its frayed relationship with politics.
With all that on its plate, it is unsurprisingly an uneven book. The first few chapters are peppered with portrayals of people, events and personal anecdotes. One concerns Bernard Kouchner, the polemic founding figure of the organisation, and is of particular interest to those interested in MSF itself: it is as damning as it can without veering on the insult. Still, not all stories are of the garden variety. I won't repeat them for shock value, but the bulk of the witnessing part regards Rwanda's genocide and later the refugees crisis and civil war in Zaire. His first missions in Rwanda, Afghanistan and Somalia are also covered.
The last few chapters tell of his work as president of MSF international's Council, and read like the end-of-year review of any similar organisation. He talks of conferences, politicians, and lobbies, many of whom he can't or won't name, and the campaigns for investigation and access to drugs for forgotten diseases, MSF's policy in Kosovo, Sudan and North Korea, the birth of Dignitas International, the legal battle between Big Pharma and South Africa regarding licensing and importing generics for TB and ARV drugs... there is an attempt at self-examination, but it is tenous at best; one feels that he's selling his bit like he's probably done previously in conferences. Still, why not?
A common thread for it all may be the need to understand what humanitarian campaings are and what they must be, specially after Kosovo and the post 2001 wars. It is a fact that the west hails itself as the bastion of human rights and uses that to deflect humanitarianism into war effort both to legitimise the wars it wages and as one more mean of warfare (we'll give food only to those who collaborate...)... But humanitarism needs to rely on politics and soldiers, both to create long-term solutions and to create working spaces for NGO. This debate is not dead and won't die anytime soon. Its hipocrisy is well documented. It's a sad business and a shame, and it has already had dire consequences. Time will tell where we go next.
With all that on its plate, it is unsurprisingly an uneven book. The first few chapters are peppered with portrayals of people, events and personal anecdotes. One concerns Bernard Kouchner, the polemic founding figure of the organisation, and is of particular interest to those interested in MSF itself: it is as damning as it can without veering on the insult. Still, not all stories are of the garden variety. I won't repeat them for shock value, but the bulk of the witnessing part regards Rwanda's genocide and later the refugees crisis and civil war in Zaire. His first missions in Rwanda, Afghanistan and Somalia are also covered.
The last few chapters tell of his work as president of MSF international's Council, and read like the end-of-year review of any similar organisation. He talks of conferences, politicians, and lobbies, many of whom he can't or won't name, and the campaigns for investigation and access to drugs for forgotten diseases, MSF's policy in Kosovo, Sudan and North Korea, the birth of Dignitas International, the legal battle between Big Pharma and South Africa regarding licensing and importing generics for TB and ARV drugs... there is an attempt at self-examination, but it is tenous at best; one feels that he's selling his bit like he's probably done previously in conferences. Still, why not?
A common thread for it all may be the need to understand what humanitarian campaings are and what they must be, specially after Kosovo and the post 2001 wars. It is a fact that the west hails itself as the bastion of human rights and uses that to deflect humanitarianism into war effort both to legitimise the wars it wages and as one more mean of warfare (we'll give food only to those who collaborate...)... But humanitarism needs to rely on politics and soldiers, both to create long-term solutions and to create working spaces for NGO. This debate is not dead and won't die anytime soon. Its hipocrisy is well documented. It's a sad business and a shame, and it has already had dire consequences. Time will tell where we go next.
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