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Case Studies from Ethical Challenges in Humanitarian Medicine

In a move toward transparency, Médecins Sans Frontières (MSF) has released primary documents from some of its most difficult ethical dilemmas.

Médecins Sans Frontières, known as Doctors Without Borders in the United States, is an international humanitarian-aid organization. Laurence Binet, director of studies internal historian for MSF, spoke Wednesday about MSF’s recently released Speaking Out Case Studies.

The archives document challenging decisions the organization made during humanitarian crises. Some examples:

-- When a MSF staff member was taken hostage during the Chechnyan conflict in the 1990s, the organization had to decide whether going public would assist efforts to free him or put his life at risk.

-- During the war in Kosovo, the organization was challenged by human rights violations against Kosovar Albanians by Serb forces. Publically opposing the violations might have limited their ability to gain access to the Albanians and help them. Likewise when NATO started a bombing campaign to stop the Serbian forces, MSF was challenged to take a stand on a military action that was intended to stop a humanitarian crisis but which also caused civilian casualties.

“Doctors Without Borders is creating a body of knowledge that is unique in the world with groups that are trying to grapple with human rights and humanitarian aid issues,” said Robin Kirk, faculty co-chair of the Duke Human Rights Center at the Franklin Humanities Institute. “Really difficult and sometimes wrenching decisions have to be made about how and where to be provide basic assistance in so many parts of the world.”

Binet has spent more than 20 years combing through archival data, but the data was only made accessible to the public in 2013. Since then, Binet has written and published 10 studies regarding a variety of conflicts around the world, most of which occurred during the 1980’s and 90’s. The studies are available for free on MSF’s Speaking Out website.

The case studies, which were originally intended to educate members of MSF, focus on crises where mass crimes were committed, such as the genocide in Rwanda and Zaire, Somalia in the early 1990s, the war in Chechnya during the early days of Russian leader Vladimir Putin and others. Binet said all case studies are published a minimum of five years after MSF has left that specific area. 

“We need a common document about speaking out,” Binet said. “So we decided it would be a reflection, because it isn’t about guidelines when you speak out. You don’t follow a guideline, you have to sit down and reflect on the dilemma.”

MSF began internally reviewing crises in the 1990’s after facing several situations in which the organization had to speak out against human rights violations, Binet said. The project remained private for several years as Binet organized and reviewed data.

“We couldn’t all of a sudden display these interviews publicly,” Binet said. “We didn’t want [MSF members’] trauma making headlines.”

Now that the information has become public, Binet said researchers can petition to study MSF’s archives.

Binet’s current projects include writing a history of MSF’s various associations and serieses on the Yugoslav Wars, which spanned from 1991 to 1999. She is also beginning to collect data for a future case study on the current Ebola crisis.

“At least during the [Ebola] crisis, people don’t put their emails or documents in the garbage,” Binet said. “They keep them and we’re going to be organizing them so that in five years or whenever we start working on that, we will have the documents organized.”