Help for developing countries no easy matter

Medicins Sans Frontières has a reputation for brave and persistent activity aimed at relieving global human suffering. The group reports here on humanitarian aid efforts in 13 situations of conflict and violence — many in Africa, but also in the Middle East, Kosovo, Chechnya, East Timor and North Korea. Most of its 18 authors are French: some are health workers, the others are journalists, academics, lawyers or anthropologists with formidable credentials and extensive experience in international affairs.

Ninety per cent of conflicts in developing countries are internal, between factions or regional groupings within a country, and most continue longer than 5 years, causing complex humanitarian emergencies with cycles of war, civil strife, displacement, food shortages and significant mortality. There have been seven million casualties from these internal wars over the past 15 years, and 75% were civilians. Responses by the Western powers, whether of intervention or abstention, are often justified on the basis of high moral purpose, defending values of liberty, human rights and the rule of law, but can be devastating in their consequences. The relationship between bodies that seek to offer humanitarian aid and the prevailing powers in any situation is equally complex. Thoughtful analyses here show how aid efforts to succour the desperately damaged are always constrained, and sometimes completely negated, by sociopolitical realities, particularly those influencing the major powers.

“We must do something” is a common cry when reports are received of terrible cruelty, rape, forced recruitment of child soldiers, casual massacres and genocidal policies. But even the best-prepared and well-supported aid agencies face the risk of tragic failure when they confront unacceptable political imperatives and are forced to compromise their own values or clash openly with authorities. “Helping” resource-poor countries is no easy task; it needs informed and global debate, and here is an excellent start.

Ian Maddocks Emeritus Professor of Palliative Care Seacliff, SA