The authors of Humanitarian Negotiations Revealed: The MSF Experience recount their experiences with Doctors Without Borders/Médecins Sans Frontières (MSF). In particular they focus on some of the practical and frequently difficult experience of having to work with unfriendly governments or warring factions. While Doctors Without Borders is committed to providing medical assistance to all individuals civilian and combatant alike, they must be wary of being used for political purposes.
The following excerpt is from the chapter, “Afghanistan: Regaining Leverage,” by Xavier Crombe (with Michiel Hofman) describing MSF’s return to the country. In this passage Crombe describes MSF’s dealings with opposition groups, including the Taliban:
Full compliance with MSF’s “no weapon” policy was to be the starting point for the medical programmes. They were launched officially in Kabul in October, but remained effectively on hold in Lashkar Gah until January 2010. The teams were on the wards, but had to wait for drug supplies to arrive as their transport by truck from Kabul to Helmand depended on obtaining permission from the Islamic Emirates of Afghanistan (IEA), the most influential armed opposition group, also known as “Quetta Shura”. This was in essence a sovereignty issue, as most districts in the southern provinces, and consequently road traffic, were under effective control of this group.
Since MSF’s return to Afghanistan, there had been several setbacks in engaging the Taliban leadership. Getting approval for the Kabul project had been relatively straightforward as MSF’s initial opposition contacts judged the selected hospital located in a Pashtun area to be easily accessible by their constituency, and planned surgical activities opened up the prospect of treatment for their wounded combatants. But the scant interest and commitment they had shown from the outset regarding MSF’s intended projects in the southern provinces, including Helmand, known to be the heartland of the IEA, had cast doubts over the breadth of their connections.
Hence, in the spring of 2009, MSF set about establishing different contacts with the opposition, this time relying on its own network of former Afghan staff and, by the summer, had been able to initiate communication with known IEA members. Right from their first discussions, these new interlocutors made clear to MSF that its earlier contacts were not legitimate representatives of their group. Their connections lay instead with the Haqqani Network, whose influence extended over Kabul and Afghanistan’s southeast, as well as the Waziristan region in Pakistan. The IEA was rooted in the south but was also influential in the rising insurgencies in the west and north. The two groups were partner organisations, but they had distinct constituencies and interests. From then on, the two channels should be engaged separately for negotiation, depending on the area at stake.
While MSF had been successful in expanding its network, time had nonetheless been lost in identifying the right contacts to secure guarantees in Helmand. Moreover, soon after a first and promising encounter, the organisation was informed that the IEA council had rejected its two projects, on the grounds that working in MOPH facilities displayed unacceptable support for the Karzai government, derisively referred to as the “Labour Department” of the American forces. This decision effectively prohibited the safe transport of drugs by road from Kabul to Helmand.
It took six more months to resolve the issue. MSF defended its operational choice as a necessary first step to import drugs and insisted that, with its teams already on the ground and drugs waiting in Kabul, it was too late to cut the project short. Assessments for future projects, MSF argued, would consider areas suggested by the IEA. The agency also stressed it had received assurances from foreign and Afghan forces that they would not interfere in the hospitals. On the part of the IEA, security considerations were inseparable from issues of legitimacy and the authorisation for the transport of drugs MSF was asking for was used as a bargaining chip to extract further guarantees and concessions from the organisation. Airing their distrust of the MOPH doctors in Lashkar Gah and of US respect for the Geneva Conventions, the opposition demanded that MSF give a commitment in writing stating that it had control over the hospital staff and provide an official MoU with the US military to prove their compliance with humanitarian law. MSF was careful not to commit itself regarding the behaviour of the international forces, stressing instead its ability to hold them to account through the media.
In January 2010, the IEA eventually gave permission for the drugs to be transported to Helmand. Wishing to be recognised as an able and legitimate government in the regions where they were gradually gaining control, the opposition leadership was seemingly more interested in medical aid as a tool to win “hearts and minds” than as an actual asset for their combatants. When MSF asked if the IEA had suggestions for future projects, one representative answered: “The biggest needs are with civilians, especially maternity care; we can take care of our fighters”.