The 'Hardtalk' interview transcript

Hardtalk interview

The humanitarian aid organisation Médecins Sans Frontieres has accused leaders of the G8 summit in Evian of putting political and commercial interests ahead of promises to make essential drugs cheaper and more widely available to the world's poorest people. The President of MSF, just back from Baghdad, also holds America absolutely accountable for the tragic state of the Iraqi health system which he says is costing lives. He is my guest today.

HARDTALK: Morten Rostrup, welcome to Hard Talk. The G8 nations say they have come up with an action plan for cheap drugs to go to the world's poorest people. You have called it an inaction plan. Why?

Morten Rosprup: Well, if you look at the plan it is not very concrete at all. They will put some certain money into the aid and trying to do something but if you look at the whole process of the G8 - it started back in January in fact - and there was a kind on plan put up in which there were talked about use of generic drugs. It was talked about developing drugs in poor countries themselves and also technology transfer. And all of this has been taken away from the plan. And now they talk about giving money perhaps to pharmaceutical companies and let them do the job.

HARDTALK: OK, let's come to that because you talk about the drug companies. Glaxco Smith Kline has halved the prices of their anti-aids drugs, the anti-retroviral treatment - Now isn't that a good thing?

MR: Well it is good in the short term. It could be a good thing perhaps. but we need to think on a long term basis here and we need to find some sustainable solutions and the only thing we know works is generic competition for instance . You can go to Brazil and see what they are doing there. They are able to treat all the HIV/AIDS patients that need anti-retrovirals because they have the generic production there in place. So this is the long term solution and not donations just being given like that when they want to do it.

HARDTALK: But the G8 said that it was going to be fair efficient and sustainable. Exactly the things you have said should happen.

MR: But then they need to come up with a concrete plan how this is going to be sustainable. We have another issue as well and that is research and development because we do have a lot of neglected diseases. And because these people, the really poorest people, having these pretty rare tropical diseases, they cannot afford to buy the drugs.They have been abandoned by the research and development. And that is an issue we also have to raise and which the pharmaceutical companies have not paid any interest.

HARDTALK: You have also been very critical of the French position at the G8 summit in particular so they have not been perhaps as solid on this position as you think they could have been.

MR: Definitely. We were very disappointed because when the French were drafting this agenda, it seemed to be putting in exactly these elements into the G8 declaration. But then in May it seems that the US came and just threw everything away and changed the whole agenda in which now it seems that the interests of the pharmaceutical companies prevail over patients that are dying today in our missions.

HARDTALK: Why do you think that is?

MR: I think there is perhaps this general policy that tried to secure Western interests - economic interests - and that prevails. I think maybe also the change of political climate due to the Iraqi war may also make some countries not as pushy as they should have been.

HARDTALK: So France has had one confrontation with the America and does not want another?

MR: Well it could be interpreted like that. I am very surprised because France is also inviting a lot of countries from the Third World to come to the G8 and they really make the point. And then they end up with a total plan of inaction and it is not the way to go ahead.

HARDTALK: Don't you think it is possible though, that the end result will be that anti-aids drugs for example will be more widely available but not quite maybe on the basis that you would like to see them.

MR: Well, what we have seen, you know, and these are the mechanisms proposed from the pharmaceutical companies, is that they give a price reduction and if you go to Honduras today, for instance, we have a mission there where we have a programme treating HIV/AIDS patients. And we get drugs, generic drugs, for $300 a year. But the Government dealing with the pharmaceutical companies has to pay three times as much for the same drugs. We can treat three times as many patients - life saving treatment - more than the Government of Honduras because we are using generics. And this is what they propose. And it is not taking advantage of the resources present.

HARDTALK: Do you find the war in Iraq has changed the climate in which you operate in other ways as well?

MR: Well, I think what has changed is perhaps - and this is a political way the G8 may illustrate - another thing is, and i am very concerned that the whole focus on Iraq has been for a long time and still is, will lead to diversion of aid to Iraq and taken from other countries that really need this aid. As in many, many African countries. So I think that is really a danger coming up now.

HARDTALK: And what about MSF's role in Iraq? You were there in Baghdad at the start of the bombing. I want to talk about that in a minute but doesn't that indicate a criticism that is often made of your organisation that somehow MSF, they are swashbuckling, they are heroes but they are cowboys. They go to the most dangerous places and risks are being taken for risk's sake, for the adrenalin of being wherever the action is.

MR: Well that has been a criticism towards MSF

HARDTALK: Is it justified?

MR: No is not justified because we always consider the risk balanced towards what we can obtain by being present. But of course this is a huge dilemma for us. How much risk are we willing to take in order to save other people's lives and alleviate suffering. How much risk are we personally willing to take. It is very difficult. Sometimes we make those choices and we stay. We decided to stay in Baghdad because we knew it was a risky operation. But we knew that perhaps the impact of being there during the war and immediately after the war would pay off so to speak when it comes to the risk we were taking.

HARDTALK: What do you man 'pay off'? How do you judge if it has paid off?

MR: Well if we are able to really assist the civilian population and really carry out medical work. Then I think it is sometimes worth a kind of risk. But we are very very careful normally and it is not a typical MSF mission as has been portrayed.

HARDTALK: But some of your staff were taken prisoner.

MR: Yeah. Two people were taken. That's true.

HARDTALK: Is that a risk worth taking?

MR: Well, they were released after ten days. But of course I would have felt very badly now if they were killed. For sure.

HARDTALK: What happened exactly?

MR: What happened; they were taken by the Saddam Hussein security police and they were accused of being spies and they were detained in three different prisons for ten days. And then when Baghdad collapsed, the people in charge of the prisons did not know what to do. So luckily, because they lacked their superiors, they just opened up the jails and let all the prisoners free. And also our two colleagues.

HARDTALK: But you were there when the bombing was taking place. Did you get any official sanction for the work you were doing? Did you meet the health minister for example to discuss what you were going to do?

MR: Well we tried a lot before the war started to have an official meeting with the minister of health and to really work on a plan of action. And it was very difficult because the whole government was preparing for war. That was pretty obvious. What happened was the second night of the bombing by coincidence, we went to one of the hospitals because we wanted to see if we could be of any help since we had a surgical team in place - and then we ran into the minister of health himself and at that meeting we got a kind of agreement of how we could work further on in Baghdad during the war.

HARDTALK: But I just come back to the dangers of all of this because what Baghdad did not lack was doctors. There are lots of doctors. There was a very highly educated population in Baghdad and yet I am wondering what the motives were of MSF and go to Baghdad, which is a place which has an awful of medically trained staff.

MR: We did not have any clue on what was going to happen In Baghdad, We did not know how long war was going to be. We were not able to see what would happen immediately after the war, the coordination of humanitarian work and so on and we could perhaps see a situation in which many of the Iraqi colleagues would not be able to come to the hospitals at all. And we also could also foresee that there would be a lack of supplies, lack of equipment. So I think that safety was totally unpredictable. It was difficult for us to really define a role but still we found it was essential for us to be present in this conflict.

HARDTALK: But do you understand why other aid agencies tend to be critical of MSF? They admire much that you do but they tend to be critical that too many corners are cut; you expose yourselves to too much danger.

MR: I think this is, as I said, a kind of portrayal when you look at our missions around the world today. We do go off to some risky areas. And we have to do that. But we do have really very strict security rules. Of course we can go further than the UN system I believe is much more restricted. But its is very necessary today that some independent people, independent of the kind of pressure in these areas, and as I said it is a dilemma sometimes to find the right balance.

HARDTALK: How are the Americans doing in running post-war Iraq?

MR: I was very disappointed immediately after Baghdad fell because they had not planned any kind of emergency intervention. How to get the civil services running after Saddam Hussein regime fell and especially in the hospitals. They were looted, many of them, and they were totally disorganised for quite a long period. And the US should have forseen that and should have been able to do some immediate measures to have at least a few hospitals running in Baghdad.

HARDTALK: Yes, you said they were absolutely accountable the Americans and it is doubly frustrating when you listen to George Bush saying the hospitals are up and running. Today there is not one hospital that is fully functioning.

MR: Yes. This I said, two weeks after Baghdad fell, in an interview. And it was true at that point of time. And Bush in an interview, he really said that the hospitals were up and running. And I was there and I knew they were not. That was not the case. And we had to address this. The US as the occupying power they had the clear obligation to see to the basics.

HARDTALK: Let's talk about this. They have awarded a contract, $44 million worth, of service repairs to an American company to restore health services in Iraq. Do you welcome that?

MR: Well, of course I welcome everything that can restore services. My point is that this is moving too slowly. And they did not have a kind of immediate emergency plan just after the fall of the Saddam regime - and that was a mistake.

HARDTALK: I want to come back to something you said originally that too many resources are being diverted to Iraq. Is there or is there not a humanitarian crisis in Iraq?

MR: There are a lot of needs in Iraq. But how serious, how serious. It is changing by the day, so to speak, but compared to other contexts we are working, if you go to Congo or West Africa today, we don't see any mass displacement of people in Iraq. There are not any huge epidemics. There are no famines. It is not the humanitarian disaster in Iraq. It was not immediately after the war. But there are needs, specific needs, of course that should be met.

HARDTALK: I was in Kuwait in the early part of the war and there were all the aid agencies and they all seemed to be dressed up with nowhere to go. They were waiting for this huge crisis. And broadly speaking people had food. Broadly speaking, there were some medicines. It wasn't a catastrophe by any means. Do you think that the aid agencies are as guilty as all the nation's leaders in rushing to a country thinking there will be an impending crisis where perhaps the Democratic Republic of Congo goes unnoticed?

MR: Yes, I think it is a responsibility for aid agencies as well to try to be a bit more impartial in the way they are giving aid, for sure. I think it is very easy to jump into very heavily politicised conflicts, very media covered conflicts, in which also governments are pooling a lot of money in through aid agencies. It is very easy. I was in Kososvo in '99 and I saw the same pattern there. There were plenty of aid agencies in Kosovo. Not that much need. And it was a kind of humanitarian circus. And this we have to address. And that was also one of the points I made to try to get attention to other real humanitarian disasters.

HARDTALK: One of the really interesting things that has come at the end of the war with Iraq is the extent to which George Bush seems not to want to go down the line of supporting NGOs and voluntary organisations but wants to support companies that are there to make a profit and put them in to do the job whereas once it might have gone to aid agencies. What do you think of that development?

MR: I think this is pure politics. How to build up a country, how to reconstruct a country. And I think there are different ways of doing it. In MSF we are not part of that at all because as a humanitarian organisation we are giving immediate emergency relief. We are not into the development or more long term , so we are not part of this, in fact, the way you are talking about building up now.

HARDTALK: Yes, Derish Wolff, the Chairman of the global engineering company Louis Berger, said that non-profit groups, the NGOs, have their own agenda to be loving and caring and are very effective in relief work but it does not work for building institutions on a national scale. You seem to be ...

MR: Well, I am not in to that kind of politics. I do not know too much about nation building. I cannot give any certain recommendations; which kind of organisation should be used there. So it is difficult for me to really comment on what is best to build up a nation.

HARDTALK: What about the other argument that is put forward then? This is the wider criticism of the role of NGOs and aid agencies and that is that you go to these places and say you are independent but essentially you become the pawns, if you like, of the dictators, of the warlords, and that you are not that independent really after all.

MR: That depends on what you mean by independence. I think there are several issues here. One thing is that when we do intervene that we have a financial independence - we are not dependent on governments when we do our interventions. At the same time, we also always demand what we call a humanitarian space, the freedom to move around, the freedom to assess the needs, the freedom to give aid according to the needs and the freedom to monitor - and these conditions should be present before we can act. Then we have our independence. And we also act impartially. But sometimes it is difficult to get this.

HARDTALK: On your website you say in order to prevent compromise or manipulation of MSF relief activity MSF maintains neutrality and independence from individual governments. But working on the ground you have to make deals don't you?

MR: We have to relate to the powers in place, for sure. We have to negotiate, discuss with the guerrilla forces, armed factions, governments, whatsoever, to exactly get this humanitarian space to be able to act. And if you do not get it, then sometimes we feels we are manipulated we feel we are misused or abused by the people on the spot. Then even sometimes we say 'Enough is enough' and we leave.

HARDTALK: How often have you done that?

MR: Well, I cannot say exactly how many times but I can mention a few examples which illustrate it and I think North Korea was one of these examples in which we had been present for some years and then we found that we did not have the space to really give aid according to the needs. We could not see that the most vulnerable actually were receiving our aid and then we decided in this totalitarian regime we decided we could not be there because we were in fact supporting a regime that was causing the misery.

HARDTALK: But isn't that an inevitability of the work that you do that - fantastic though it is - that you are there to help. And no-one could take away from the courage of the people who go there representing MSF in these war-torn places of the world, or disease-ridden areas of the world but you are actually giving help to the regime by acting almost as their Red Cross hospital there.

MR: Yes, it is a problem. I totally agree on that and that is why we have to be very careful whatever we do in such very complex situations. And as I said sometimes,for instance when we were working in the refugee camps in Zaire and Tanzania we saw that the genociders from Rwanda 94 they were actually building up a kind of guerilla movement inside the camps and they were taking advantage of the aid in doing; also recruiting people and we had to leave. But it is very difficult because the needs are there and the people need actually medical aid. Then you say, 'OK , we are manipulated so we have to leave'.

HARDTALK: There is a very interesting book by David Reiff who is questioning the entire basis of humanitarianism, he calls it, and he asks three questions. He asks: "Are the aid agencies essentially medics for some warlords war efforts? Are you creating a culture of dependency. And are you being used politically. And to all of those questions he answers, 'Yes they are.'"

MR: Sometimes aid organisations may be like that. And it is a problem. And I think it is the way we act in the field that will decide to what extent. And we are very cautious about that, especially within MSF because we have seen how aid has been terribly manipulated. And I think in many, in most of the missions I have been visiting in the last year I feel that we are in fact able to go clear of some of these possible problems that David Reiff points to.

HARDTALK: Yes, he portrays 'aid workers as Scandinavians in Nelson Mandela t-shirts engaged in squishy and expendable social work'. Well, you have not got the Nelson Mandela t-shirt on but you are Scandinavian. Is that a cruel caricature of what you do?

MR: Yes, I think so. At least what I see myself and what I have been part of myself. But of course there are problems. I think we have to be pretty honest and transparent in what we are doing. And we have to be very self-critical. I think in MSF, within MSF, we are very, very self critical. We have a lot of debates and discussions. We criticise each other in the movement. Exactly in order to avoid being like you describe.

HARDTALK: How would you improve MSF? What are your weaknesses as an organisation at the movement?

MR: I think we need to keep the field focus. We need to keep the medical focus in the organisation. It is easy for a big well known organisation like MSF to develop into a kind of policy making body; being institutionalised and slowly but slowly perhaps losing contact with the field. So I think this is the most important for us. And then also increase the quality of the medical work.

HARDTALK: But then if you are going to make big sweeping statements on what comes out of the G8 summit, people are going to see you as a political organisation. That is not field focused.

MR: Well it is field focused to some extent because we said, what we say, to the G8 is based on the experience that we have on the field. It is based on the malaria patients I treated myself. These patients, they are dying. They are dying due to lack of drugs, effective drugs that could be given to them. And I am very frustrated. I get angry sometimes when what you see in the field, when you see a patient and then you look at what the G8 people are talking about. It seems that there are different worlds. And we have to try and fill out that gap, we have to wake them up. And this is part ..

HARDTALK: So it is policy focused and field focused?

MR: Yes. Because from the field we need to provoke political action. That is part of the work of MSF. We are not a charity only. We are not a service provider. We are not there just to give food or medicines. We are there to see what is going on and we are there to really call attention to the politicians to say, 'This is your responsibility. You have to do something. And you should do it'.

HARDTALK: I have seen one of your predecessors, Rony Brauman, talking about how he found himself proffering food shelter and medicines while he was confronted every day with mass murder rampant disease starvation and enormous refugee flows. And he said that made you feel there were real existential doubts about what you were doing. How do you avoid that?

MR: It is sometimes. .. You can feel a bit helpless or hopeless because you are dealing with problems of political failure and you are not able, really, to address the political failures. You point to them but the politicians, they don't do anything. Quite obviously sometimes they may even give aid as a sign of inaction because they really don't want to go into the political aspect of it so they just give aid through some organisation to keep the war going as in Sudan; the war has been going on for 20 years - and still going on. It is lack of political commitment to really do something. And, in the mean time, they give aid.

HARDTALK: Where are you most helpful? I ask this question to you as an individual perhaps as an organisation as well. Are you most useful with your stethoscope or are you most useful as a politician?

MR: I think the combination. Not as a politician. But as a humanitarian aid worker with both feet in the field and then talking (about) what we have experienced, point to some causes and challenge the politicians. That is where we are at out best.

HARDTALK: Morten Rostrup, thank you very much indeed.