His world without borders

Jean-Christophe Rufin wears many hats, but he is most famous for being one of the earliest members of Médecins Sans Frontières (Doctors Without Borders). Now a writer, the 66-year-old Frenchman talks about his role in the global aid organisation’s early years and how his career has spanned the fields of medicine, politics and literature

(Feb 11): In 1967, when the Biafran War broke out in Nigeria, France was one of the few major nations supportive of the newly independent Biafra region. A number of French doctors volunteered with the Red Cross to provide assistance in a blockade established by the Nigerian military. They, in addition to Biafran health workers and hospitals, were subjected to attacks by the army and even witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticised the Nigerian government and the Red Cross for their seemingly complicit behaviour and concluded that a new aid organisation was needed that would ignore political and religious boundaries and prioritise the welfare of victims.

One of the doctors was Bernard Kouchner, who along with some others founded Groupe d’Intervention Médicale et Chirurgicale en Urgence (Emergency Medical and Surgical Intervention Group). At the same time, Raymond Borel, the editor of French medical journal TONUS, had started a group called Secours Médical Français (French Medical Relief) in response to the 1970 Bhola cyclone, which killed at least 625,000 people in what was then East Pakistan. In the days preceding Christmas of 1971, the two teams merged to form Médecins Sans Frontières (MSF) — a global humanitarian organisation focused on medical care and anchored on the three core principles of independence, impartiality and neutrality.

Jean-Christophe Rufin was a young doctor in France when MSF (which in English is called Doctors Without Borders) was founded, and signed on as one of its earliest members. The grandson of a physician who was interred in German concentration camps during World War II, Rufin was deeply inspired by MSF’s ideals and spent many years with it before pursuing other things — he was president of Action Against Hunger and French ambassador to Senegal, and is the second-youngest of the members (informally referred to as les immortels, or the immortals) of the prestigious Académie française.

His knowledge of global politics and instinctive feel for medicine have dovetailed quite nicely, as his first book, Le piège humanitaire (The Humanitarian Trap), is on the political stakes of humanitarian action. Adding to his political credentials, Rufin was commissioned by the then French Interior Minister Dominique de Villepin to write an in-depth report on the upsurge of anti-Semitism in France, which is so oft-referenced that it is known as the Rufin report.

These days, Rufin is no longer actively practising medicine or politics. Instead, he spends his time at home, in the French Alps, writing — he is a critically acclaimed novelist with several bestselling fiction and non-fiction books to his name. He was in Malaysia last year to attend the George Town Literary Festival and I caught up with him in Kuala Lumpur in the days preceding his trip to Penang. A statuesque man with a gentle smile, he speaks in a careful, considered way that teems with tender, grandfatherly affection. He is a wonderful conversationalist, opinionated, yet not obnoxiously so, and the hour we had together proves to be grossly inadequate for me to fully enjoy his unique perspective on the world.

Rufin is well prepared for my visit and has as many questions for me as I do for him, and his most interesting career that spans medicine, literature and language. “Ah but my full-time job now is writing,” he laughs. “I love skiing and hiking as well, but writing is my life now.”

That being said, even he has to agree that his early days as a doctor were indeed very interesting, as was his position of MSF’s vice-president. Our chat begins on that note — the obvious inspiration for his opting to do medicine and the impression that his grandfather had had on his chosen career.

“You know, in many ways, medicine wasn’t just a profession for me; it was my way of forming a relationship with the world,” he explains. “When I studied medicine, it had of course changed very much from what it was during my grandfather’s time. So, maybe that was why I looked so hard for a means to practise that was more traditional… I was less interested in the scientific part of the job, and more in the humanities aspect. The direct contact with the patients and their diseases — that was key.”

The earliest seeds of his inclination towards humanitarian work arose when he was sent to Tunisia as part of his then compulsory military service. “I arrived there with my own ideas as a young medical student, thinking my job was to work on treating disease for human beings, which was the same all over the world. But when I arrived there, I realised things were the other way around — diseases were the same, it was the people suffering who were different. I started to get more interested in the human aspect of medicine, but this didn’t mean I wasn’t interested in technical aspects — just that it wasn’t my main concern.”

Fuelled by passion
He was not alone. Many other young doctors like him were eager to do something more than treat patients in clinics all day. The timing of MSF’s establishment is a crucial part of understanding why it, and other humanitarian organisations of its kind, was so well received — Europe was emerging from an ugly, beleaguered past and ready to become a global source of comfort. Rufin explains this point beautifully.

“For centuries, Europe was the place where there were wars, famines and epidemics. It was only late in the 20th century that Europe started to be at peace, rich and protected, and started to become generous. Before that, after two wars, we were only receiving aid, but after the 1960s, we could start to give as well. Most people involved in associations like MSF had been political activists and, at the end of the Cold War, felt deceived by their own political ideals. So, humanitarian action was like ground zero, or level zero, of what they could do without political involvement. The Cold War did not permit institutions dependent on public funds — like Red Cross — to provide aid. There was a possibility to be useful at the time and so a very small organisation became very large because they were responding to what was then a new world situation.”

In Kier, South Sudan, MSF nurse and midwife Furaha Bazikanya examines a young pregnant woman in one of the two consultation spaces at a mobile clinic in the village

Throughout the 1970s, MSF was kept extremely busy. In 1972, it arrived in Nicaragua, which was hit by an earthquake, and then two years later, in Honduras to help those displaced by Hurricane Fifi. From 1975, after South Vietnam had fallen to North Vietnam, MSF’s refugee camps in Thailand supported Cambodians escaping the Khmer Rouge. Starting from 1976, MSF spent nine years assisting surgeries in the hospitals of various cities during the Lebanese Civil War, and established a reputation for its neutrality and willingness to work under fire while helping Christian and Muslim soldiers alike.

“There was a kind of exhaustion at the end of the century, which was when MSF was founded,” Rufin says. “It was the idea to say, ‘We can cure without trying to create new problems.’ There was a surge to find a common ground without getting overly political about everything.”

In its early days, the fuel that powered MSF was often nothing more than the passion of its members. Funding was hard to come by, and its membership (then, as it is now) was purely voluntary.

“It was nothing — it was a group of friends operating out of an office smaller than this room. We were discovering what we were doing as we did it,” Rufin recalls. “There was no example of such an organisation before — yes, there was Red Cross and the United Nations, but it wasn’t quite the same. We were totally self-funded and private, and the only strength we had was that of public opinion.”

Apart from funding, another issue MSF faced was a lack of insider information — doctors and aid workers who arrived in war-torn regions had often very little knowledge about the communities they were to help, or how to wade through the complicated politics that governed the conflict. Good intentions were simply not enough, so Rufin set out to create a bank of knowledge to support MSF’s medical personnel.

“It became my concern, personally — I was the one who started to think about these technical issues. Technical not in terms of medicine, but in terms of what the dangers of each situation were, what propositions we should and should not resist. I started to try to create a kind of know-how for this new practice, and my earliest books were on this — trying to summarise our experiences in the different fields and build our knowledge of what we were doing. It’s about going to a place and not going against cultural norms or making terrible mistakes. Every situation is different, although some things may be the same,” he says.

Moving on
In the late 1970s, MSF underwent a change in leadership that also reflected the growing differences of opinions within the ranks. While Kouchner believed that documenting and broadcasting the suffering in a particular country was the most effective way to solve a problem, incoming president Claude Malhuret felt that MSF should avoid criticism of the governments of countries in which they were working. Debates raged over the future of the organisation, and those who disagreed with the new leadership opted to leave MSF.

“These associations were very personal in the sense that the people who are involved were invested personally — it’s something in which you believe with all your being. In this sort of circumstance, people tend to disagree and quarrel. Plus, we are French, and maybe that doesn’t help,” Rufin laughs. His oldest child had been born by this time, and he was splitting his time between his own private practice and his voluntary work with MSF — it was time to do something else.

And so he did, which includes the time he spent as a diplomat and his groundbreaking work with the Rufin report. Although he wrote it in 2003, he believes that his once-unheard-of observations of the rise of anti-Semitism in France continue to hold water today.

“When there was anti-Semitic activity, we were always accusing the extreme right, who, of course, could be responsible,” he shares. “But there was another anti-Semitic sentiment that was growing at the time, which comes from young, second-generation immigrants. They are instrumentalised by the extreme left, and you cannot combat anti-Semitism by looking only at the extreme right. Most of the action now is done by the young people from the suburbs of Paris, and they come from North Africa — they have nothing to do with the extreme right! When I said this at the time, it was a very touchy matter. And I think this is truer today than ever. If we keep looking at the far right, we are ignoring the sentiment that comes from the other side.”

Protected by the “relative” safety afforded to us by virtue of being in the French ambassador’s residence, we briefly talk about how this rule could very well apply just as well in Malaysia. Have we all been looking the wrong way in tackling systemic racism? Worth a think, we say.

Although he has been courted multiple times to stage a return to politics, Rufin has refused, stating that this part of his life is over and he no longer wishes to be a part of it. He rarely even discusses the contents of the report anymore, refusing to be defined by it. “You can spend your life on this topic; I don’t want that. It’s not my whole life — just relevant to a part of my life,” he states. Fair enough.

‘Doctor who writes’
These days, his passion for the written word keeps him most occupied. Rufin’s past as a doctor actively colours his present in a most unique way, I discover. “When I started to write novels — which is more than 20 years ago — my problem was that, as a physician, writing fiction was difficult. When you take the Hippocratic Oath, you swear that you will see everything, know everything, but you can never talk about it. So, when you start writing, you look at things in your memory and you start to think how you can use them without breaking your oath. Speaking and writing about the present is a huge problem for someone with this background, so my first novel was based on the past. I changed contexts and time periods so I could be open and honest, but without breaking my oath.”

I ask whether he would ever return to practising medicine one day, and he admits that he misses it, although a return to MSF is highly unlikely. He has, however, watched the organisation grow with much pride, although he admits that it has not quite evolved fast enough for the change of tides its birthplace of Europe has been experiencing of late.

“Europe was for a long time consumed directly by war and, for 50 years, there was a kind of blessed period in which the continent has been at peace and able to help the rest of the world. Organisations like MSF were very relevant at this point. Since 2010, terrorism has come back to Europe; refugees have started to come back to Europe — the problems are no more far away, but right next door,” he says thoughtfully.

“These organisations have been created to act in remote countries, and yet today, the issues are in our own homes. For that, they have not adapted very well. They are important in their fields, of course, but their time has passed in a way.

“Public opinion is less interested in something happening far away. When you advertise about sending funds to the Rohingyas, people will go down to the street and see refugees right in front of them. So, what’s more important is in their own communities, their own lives. I think we are facing a humanitarian crisis at this moment.”

It sounds like MSF could still use perspectives like his. He laughs, shaking his head. “I still list my profession as doctor; I think you can have different experiences in your life, but you can be trained professionally in only one thing. I don’t know if at my age I can train to be a pilot or a racing car driver, and then actually go and race cars... What you train to be when you are 20 is who you will always be. I’m a doctor with different experiences, even as a diplomat. Now, I am a doctor who writes books, but who knows what will happen after this?”

Rufin sets a great example of someone who has never let his professional training get in the way of his life’s calling — what you do with your existence on earth is limited only by your own beliefs, so it feels like the lesson here is to be open to opportunities when they come knocking and have faith in the decisions you make along the way.

Anandhi Gopinath is an assistant editor of the Options desk at The Edge Malaysia