Interview with James Orbinski

Orbinski
I joined in 1990 after having worked in Africa as a researcher on pediatric AIDS.  In that experience, I was really confronted with the power of politics and the impact of politics on people’s access to healthcare in the developing world. And at that very young age I naively believed that I would just be a good doctor and I wanted to somehow avoid the messy business of politics and just focus on delivering good medical care, and when necessary, speaking out on behalf of what I know, and MSF was the organization that somehow encapsulated that for me at the time. So, a group of friends and I started a chapter here in Canada.

Natalie
Countries are connected through economic and political struggles. How has globalization facilitated an environment where Canadians would be able to help other countries that are suffering?

Orbinski
I have a very different view. I don’t have such a purist view of the world and what you call globalization. Globalization is not new. Human beings have been interacting with each other and with different communities. City-states, nation-states, for as long as human beings have existed have traded across communities, and across political constituencies. People have fought; disease has spread for as long as we know. So the idea of globalization as a kind of a new phenomenon is an idea that I basically reject. There is a phenomenon that has taken place, since the end of the Cold War, and it’s a rapid acceleration in the speed and the scope of that interaction that has been part of human history and that has been driven by a very particular political agenda, the agenda of neoliberalism. It has had a very particular affect on the inclusion and exclusion of people in different parts of the world, both within the west and outside of the west.  One of the other major forces that emerged with the end of the Cold War, again, not as a new force, but in a new accelerated form, was transnational civil society networks. They emerged with a new power, and a new capacity to communicate with each other, and to see, physically, proximately, each other as human beings. And that has meant a radically different and invigorated sense of what civil society organizations have engaged in, and the values that they pursued.

Alex
Would you say this has, helped the mission of MSF, or has it hampered it in some ways?

Orbinski
MSF’s sense of itself is something that is a reflection of the political context it is in. And as that context has changed as I have described so too, has the, the practical operational intent of the organization. But in principle, it’s commitment to the dignity of all people, and to rendering or bringing to bear medical assistance to people who need it in situations of war, or social crisis, or famine, or epidemic, or exclusion. That hasn’t fundamentally changed.

Alex
With international agreements such as the TRIPS agreement, and all those patent laws, how has that affected the ability of MSF to, for example, move supplies in between regions, keep their vaccines and all their supplies stocked? Has it been an impediment, with all these new legislations?

Orbinski
There’s always been legislation, international structures, legal, logistical and operational structures that govern action in that space. And there’s always been national law, whether it’s in Malawi or France or Canada that you have to accord to or comply with. When you talk specifically about the TRIPS agreement that is a product of this post Cold War neoliberal hegemony. That’s what it came out of, and that has had an enormous impact on the ability of organizations like MSF to purchase low-cost generic medications for use in their projects. It means that that the majority of new medicines will be patented, and it also means that therefore, at a much higher cost. Also, that R&D for medicines, vaccines, diagnostics, will be driven by a purely marketized conception of those products and so it has implications. Serious implications.

Alex
When MSF goes into different countries, do you work with the permission of the government?

Orbinski
Well, in the main, yes. And in the main, MSF works under international humanitarian law, which, in situations of war, particularly international humanitarian law, mandates very clearly the right of people to receive humanitarian assistance, and the duties of state and belligerence to allow access of independent impartial humanitarian organizations. So that’s essentially the legal framework that you operate under in war. We should work with government, and get permission. But if it is not possible, then, you have to make a decision. What are you going to do? Are you going to cross a border illegally? In the past, MSF has made the decision that yes; it is going to cross a border illegally in some situations.

Natalie
Have you ever been in a situation where you were just not welcomed to help? How did you respond to that? Did you just leave or remain in the country?

Orbinski
Yes. Well, in North Korea MSF was trying to provide humanitarian assistance to millions of people who were starving. And the government refused to acknowledge that those people were starving. MSF was allowed to only work in 3 or 4 provinces, hosting 1100 clinics, 60 feeding centers; a huge operation. But we knew that in the other provinces, there were millions of people starving and the government refused to let us work there. What they wanted us to do was to provide pharmaceuticals to the government, and that’s not what a humanitarian organization is about. It’s not about responding to a request for a particular product by a government that can be seen as in some sort of generalistic way as a good, you know, a medicine. A humanitarian organization at least as far as I understand it, and as far as MSF certainly understood it then, is one that responds to the most vulnerable people in the most direct way. And if you know that there are a million people starving, that’s what you should focus on, not on building pharmaceutical plants. They essentially refused to allow us, and the few other organizations that were there, access to those territories, and they essentially forced us out of the country. We denounced the situation publicly and their unwillingness to allow humanitarian assistance to get to the people who needed it. We refused, publicly, to be complicit with a regime that was starving its own people. So that’s how you react.

Natalie
Do you believe in the global village as a plausible concept? Will advancing technology and more modernized needs allow for international advancement? Or will third world countries be essentially omitted from participating?

Orbinski
You know, if you take that from a technological perspective, I think that actually we have an emerging technological apartheid, that defines an ‘us’ and ‘them’, even more starkly then in the past. You ask me do I believe in the global village. In a certain way I do believe in utopia. What I believe in, is engaging, working, struggling, and experimenting with others to find ways and means that respect our basic human dignity. That’s what I believe in.