Afghanistan without doctors

This article first appeared in The Wall St Journal on August 12

MSF responded with the opinion piece: The real reasons MSF left Afghanistan

Doctors without Borders, known for its intrepid presence in the world's worst trouble spots, has pulled out of Afghanistan. This is a blow to the Afghans, whose needs in this area are enormous. But more fundamentally, the decision was made for the wrong reasons, on a premise about humanitarian aid that no longer holds up to political reality. Afghanistan needs NGOs such as Doctors without Borders. The country was poor and underdeveloped to begin with; now, after 25 years of war, civil war and Taliban rule, its health situation is desperate. The devastated Afghan nation has no capacity to deliver its own health care. What they need -- doctors, nurses, clinics, roads to create access to rural populations -- will take years to build up. In the meantime, they need outside help. Doctors Without Borders, whose grit and expertise enable them to work in the most difficult and peripheral situations, and whose 24 years of experience in Afghanistan made them one of the most valuable organizations there, will be sorely missed.

The group cited two reasons for shutting down its operations. First, it was distressed by the murder of five staff members, who were killed in northwestern Afghanistan in June. This was indeed a terrible thing. Ordinarily, though, such an occurrence would lead to a suspension of operations in the relevant district and a reevaluation of the program, not to a complete pullout. That decision, as the organization admits, was motivated by a second and deeper issue pertaining to how the group defines itself and its work, and how it sees the rules of conflict. As they explained in their press conference, Doctors Without Borders take issue with the coalition's approach in Afghanistan. They bitterly resent the policy of using military units to also perform humanitarian and development tasks. In particular, they object to Provincial Reconstruction Teams, whose mixed assignment of security and economic development is anathema to them. Humanitarian aid, they believe, must be kept strictly separate from anything military. If aid workers can claim to be unarmed, neutral individuals with a purely humanitarian motivation, then the parties to the conflict will respect their status. But when military groups start building village clinics and offering medical help, this jeopardizes the special status of aid workers, thus undermining their safety.

In their press conference, Doctors Without Borders complained that the "U.S. backed coalition consistently sought to use humanitarian aid to build support for its military and political ambitions." I admire this organization and its strong ethics, but it has missed a paradigm change in global conflict. It's a different world out there, and unless they want to get out of the aid business altogether, they'll have to come to terms with it. Leaving Afghanistan is no solution. It postpones their dilemma but does not resolve it. The new generation of terrorists does not spare unarmed humanitarians. They do not leave clinics, schools and other benign civilian projects untouched: They destroy them especially, because they want civilians to suffer and reconstruction to fail. Fear and backwardness are a kingdom they can rule; healthy, secure and prosperous populations have no use for them. This means that humanitarian aid workers are not neutral in the eyes of the terrorists; rather, because they work to make things better, they represent a threat. The principle championed by Doctors Without Borders -- that civilian professionals providing medical help to the suffering will be granted safe passage -- is now part of our nostalgic past.

Altogether, 30 aid workers have been killed in Afghanistan during the past two years. All of them were unarmed, all of them were working on civilian projects. The absence of weapons and soldiers did not protect them; it just made them easier to kill. Whoever supports progress, stability and the well-being of civil society is the enemy. In this deeply regrettable new situation, security, development and aid are parts of an inseparable whole, and until stability is achieved, humanitarians will have to operate under the cover of arms -- or not at all. An objective assessment of the facts would lead organizations like Doctors Without Borders to demand more military presence, not less; closer cooperation with the military, not a separation of spheres. Alternatively, they will have to withdraw not just from Afghanistan, but from most of the conflicts of the 21st century.

Ms. Benard, a scholar with The RAND Corporation, recently returned from a three-week assessment of Afghanistan's reconstruction effort. Her husband is the U.S. ambassador to Afghanistan.