Skip navigation

Respect and Distance – Médecins sans Frontières and the Military

The framework of humanitarian assistance: the humanitarian principles

Humanitarian organizations need to keep a distance from armed forces in order to be able to work; at the same time they have to expect respect to be shown for their principles and way of working. Too often this expectation proves to be a tough challenge. Why? This is what shall be explained in the following pages, in this case from the particular perspective of Médecins Sans Frontières (MSF). Although MSF is only one of thousands of aid organisation, it is the one which international armed forces will most likely come across if and when they intervene in foreign lands. 

MSF is a private international humanitarian association providing medical assistance to populations in distress. Like many humanitarian organizations, MSF assists those in need irrespective of their race, religion, creed or political convictions. Independent international nongovernmental organizations (NGOs) like MSF are different from UN organizations which are always politically dependent and also differ from the International Committee of the Red Cross (ICRC) which has an official mandate to operate in situations of conflict and a special responsibility to protect people affected by conflict.

While there is no legally binding definition of humanitarian aid, four principles are commonly understood to form the essential framework for humanitarian action: Humanity (which is more of a fundamental value than a principle), impartiality, independence, and neutrality. These are based on the Geneva conventions and the Code of Conduct of the Red Cross and Red Crescent Movement. 

Humanity means that individuals are treated humanely and with respect for their human dignity in all circumstances. In that sense, humanity forms the basis of humanitarian aid; it justifies its use and importance because every person, being human, is entitled to life-saving assistance. Impartiality translates this shared humanity into practical work: Aid must be given solely on the basis of need, and as such should not allow for any adverse discrimination based on nationality, ethnicity, gender, sexual orientation, religion or affiliation to any particular political group. Impartiality also means that to the extent possible, the most vulnerable should be supported first. Aid that does not aim to be impartial cannot be considered humanitarian. Independence means that aid should not be constrained or influenced by military, political, ideological or economic interest; this principle is vital for any humanitarian organization striving to implement impartial aid programs. And finally, neutrality means that humanitarian organizations are not to take sides in situations of conflict and that aid should not be used to favor one side or support political or economic goals.

Evidently the reality of humanitarian aid is much more messy and complex even when aid organizations strive to live and work according to those principles.

Blurring the lines: the instrumentalization of humanitarian aid 

Beginning with the end of the Cold War and the collapse of the Soviet Union, international armed forces and humanitarian organizations have increasingly found themselves working alongside each other in cases of armed conflict: North Iraq at present and Somalia, Bosnia, Kosovo and Afghanistan in the early 1990s are cases in point, to name just a few. Many of these military interventions (so-called humanitarian interventions) have been justified, at least partly, by governments as having ‘humanitarian goals’: Supporting the affected populations or protecting the work of humanitarian organizations in the conflict areas. After 9/11, this process took a new turn, as governments started using humanitarian aid as one of several tools to counter terrorism and/or stabilize fragile situations, through a comprehensive approach that ties security to aid and development in the context of international crisis management.. The matter is far more complex than what can be illustrated in a single article or lecture – most of today’s armed conflicts involve a range of state and nonstate actors, all of whom use and misuse aid and tend, for a variety of reasons, to restrict humanitarian access to populations in need.

The extent to which aid has become an integrated component of Western countries’ foreign and security policies has increased so much over the past two decades that Antonio Donini, a well-known expert and researcher on humanitarian aid, wrote in his book “The Golden Fleece” in 2013 that “humanitarianism has become part of global governance, if not of government”. For many humanitarian organizations, and certainly for MSF, this represents a critical breach of humanitarian principles – one that endangers the ability of humanitarian actors to provide help to vulnerable populations. 

The very real consequence of this is a growing distrust towards humanitarian organizations by local authorities or communities in numerous conflict areas. This may stop humanitarian access to populations in need. In Pakistan, for example, MSF and other organizations have been struggling to gain access and acceptance while armed groups — state and nonstate — have used a number of reasons to deny aid organizations access to locals. In 2011, when the U.S. government was said to have employed a fake vaccination program in the search for Osama bin Laden, the damage was almost immediate – and it will be long-lasting. Another example is the deployment of German government forces in northern Iraq to assist with the training of Iraqi security guards in 2015.4 By integrating a so-called humanitarian response into a broad military-political approach, the German government purposely blurs the lines between humanitarian action and a political or military response that threatens humanitarian organisations’ access to the area.

At the same time, access to people in need may be reduced when they avoid seeking assistance, because they have to fear retribution from one of the warring parties. MSF’s field experience in the conflict-torn province of North-Kivu in the Democratic Republic of Congo illustrates this : “In October 2009, hundreds of women and children who had gathered for a vaccination campaign [...] came under fire in seven separate villages during attacks by the Congolese Army against the Forces Démocratiques de Libération du Rwanda (FDLR). These attacks occurred just after the medical teams had received security guarantees from all parties involved in the conflict to carry out the campaign in these areas, which were otherwise inaccessible to the national ministry of health. This use of medical aid as bait for military purposes shattered the trust of patients in health services, causing only more suffering for people already confronted with violence and displacement.”(This account is taken from an MSF report.)

Increased insecurity for humanitarian workers are another direct consequence of the lack of trust. Indeed, when assistance is seen as part of a political or military agenda, aid workers may be at risk of becoming a target themselves. While there is no formal evidence to tie the integration of humanitarian aid into Western security policy to the increased violence faced by aid workers, most experts nevertheless agree that the rise in safety risks for humanitarian staff is also a consequence of the policies described above. Certainly Afghanistan proved to be a very dangerous place for relief agencies to operate in, because the integrated approach made it extremely hard – for the local population and the parties involved in the conflict alike – to differentiate between independent aid workers and members of the Provincial Reconstruction Teams (PRTs). At the same time, some aid agencies were also complicit in this confusion, as many of them accepted funding from Western states that were party to the conflict or sought military protection for their staff, which is incompatible with humanitarian principles, particularly the principle of independence. Recent studies, for example by Tufts University, have also shown that the underlying approach to staff safety is not effective.

Even today, Afghanistan remains quantitatively the most dangerous place in the world to engage in relief work: According to the Aid Worker Security Report 2014, the number of attacks on aid workers increased by 45 percent in 2013 compared to the previous year. This is in part due to military involvement in activities traditionally implemented by aid agencies and the resulting blurred boundaries between both groups. The consequences for the perception of the neutrality and independence of aid in the country have been dramatic, as MSF has repeatedly shown, including in the 2014 report Between Rhetoric and Reality: The Struggle to Access Healthcare in Afghanistan.

Tentative regulations for coexistence 

Due to the massive increase in so-called integrated missions, the need to clarify the roles of humanitarian and political actors grew. This is why a number of rules and regulations have been introduced since the 1990s. These include, for example, Good Humanitarian Donorship (2003), the European Consensus on Humanitarian Aid (2007) and the Oslo Guidelines (2007). 

These documents reiterate that humanitarian aid aims to preserve human life and alleviate suffering in situations of crisis. They also stipulate that aid must be needs-based and should not be used as an instrument towards political or military ends. The European Consensus on Humanitarian Aid adopted by the EU and its member states, for instance, states that “respect for independence means the autonomy of humanitarian objectives from political, economic, military or other objectives, and serves to ensure that the sole purpose of humanitarian aid remains to relieve and prevent the suffering of victims of humanitarian crises”.

In a similar way, the 2009 Lisbon Treaty reflects the tensions between a commitment to humanitarian principles and comprehensive approaches to foreign policy and action. It states that “the Union’s operations in the field of humanitarian aid shall be conducted within the framework of the principles and objectives of the external action of the Union.”2 This effectively institutionalizes the Union’s comprehensive approach to international crisis management. Significantly, the principle of independence of humanitarian aid is explicitly avoided in the treaty. This negation or contradiction of humanitarian principles has been criticized by many humanitarian agencies as potentially further reinforcing the politicization of aid.

As we have seen, aid increasingly became subsumed under overall strategies to fight the “war on terror”. As such, it came to be used as a reward for political good behavior or to deprive those groups who are politically unwelcome and/or considered terrorists (such as UNSCR 1373) of aid. Thus, a number of UN resolutions and laws (e.g. UNSCR 1373, UNSCR 1390) were passed at the time that criminalize any transfer of resources, including humanitarian aid, when these are intended for groups or individuals who are labelled as terrorist.3 These laws have been adopted at UN and EU level and became national law in some member states. They make it a criminal offence when aid organizations negotiate with groups that are considered terrorists or offer support to the populations living under the control of such groups. Thus, despite all efforts, humanitarian organizations like MSF keep facing major obstacles when working alongside international armed forces. Therefore it should be clear why MSF refuses to cooperate with military groups and strives to work as independently as possible from military interventions.

Don’t we all just want the same?

Do we even have to bother discussing the humanitarian principles and their implementation, and legitimacy on this extremely theoretical basis? Doesn’t it all come down to MSF also wanting security and stability in armed conflicts and to promote peace, democracy, and human rights? In other words, don’t we all want the same thing? 

These are questions MSF is frequently faced with. The fact is, however, that while stability, security, democracy, and human rights may be desirable and praiseworthy, they are not the responsibility of humanitarian organizations. Their role is not to support any particular ideology or world view; it is merely to save lives and alleviate suffering. For MSF, it is important to insist on this distinction.

Of course, humanitarian action does not happen in a vacuum. Aid workers operate in a political context, often finding themselves knee-deep in local and international political debates. It could be said that there can, in fact, never be a truly neutral position to any conflict – certainly not in the perception of the local population or any number of involved armed groups. Humanitarian aid, too, always has a function and a motivation; however, one that is more in the eye of the beholder to judge than in our own eyes. Indeed, while MSF strives to remain as neutral as possible, sometimes, in exceptional circumstances, we raise our voice and take a political stance. Staying impartial, independent and neutral in today’s complex armed conflicts is often a difficult balancing act. It is not our intention, in these arguments, to place humanitarianism above politics or deny that MSF itself sometimes has to make difficult compromises to try to help those people who are suffering the most in today’s world.5 But recognizing the complexities and challenges of humanitarianism in action does not legitimize the increased misuse of humanitarian aid evident in Western politics since the beginning of the 1990s. 

The stakes are high: Today, there are millions of people affected by armed conflicts and crises that aid workers cannot reach. While there is more humanitarian aid today than ever before and the sector has immensely professionalized, aid is very unevenly distributed, and, all too often, not needs-based.6 This is in large part a result of the instrumentalization, criminalization and abuse of aid resulting from the politics discussed above. 

For MSF, certain fundamentals are indispensable for a coexistence with political and military actors: 

The humanitarian principles remain the key framework for defining aid. Some claim the principles have lost relevance or that they never had much meaning on the ground. But despite the challenges involved and the compromises that have to be made sometimes, for MSF, as well as for many other humanitarians and for many concerned politicians, the humanitarian principles remain a valuable tool for defining and delineating what humanitarian aid should do and how it should do it. Therefore, more knowledge of and respect for these principles is needed. 

We also know this: Accepted, credible programs are our best safeguard against distrust. We aim to provide the best possible medical care we can. Helping local communities is usually the best way to ensure these communities trust us and our claim that we have no other aim but to help them. Our financial management is important for this reason. MSF relies mostly on private funds and, in cases of armed conflict, does not accept money from states involved in the conflict concerned. In certain prominent cases of armed conflict, like Syria, Afghanistan or northern Mali, we do not accept funds from any government. Altogether, MSF’s work is 90 percent privately funded. 

We talk with everyone (who talks with us). Providing healthcare to communities in volatile conflict areas requires MSF to demonstrate its independence and impartiality every day in a painstaking daily effort to communicate with all the actors involved in a conflict. We monitor the perception of us (well – we try). How a humanitarian organization is perceived locally influences its capacity to work and the safety of its staff. How a humanitarian organization is perceived internationally impacts on its capacity to wield political influence. This is a complex affair – many internal and external factors, often hardly understood, contribute to our counterpart’s perception of our work.

We keep a distance from all political actors, especially the military. We almost never accept armed protection and we do not comment on political or military strategy in difficult cases of armed conflict. Therefore we are not official members of any UN coordination bodies and clusters. The UN is a political organization of its member states as well as being in charge of coordinating humanitarian assistance. As we have shown, this can become very problematic in conflict areas, when the UN plays both a humanitarian and a highly political role. 

MSF will continue to call on governments to respect the independence and autonomy of humanitarian aid actors. European states, including Germany, must ensure an independent space for humanitarian aid and must also make sure that it can be clearly distinguished from other crisis management tools. In particular, states should stop labelling their political/military interventions as “humanitarian”, or describing humanitarian aid as part of a wider political and security strategy. 

“Es ist unsere humanitäre Verantwortung und unser sicherheitspolitisches Interesse, den Leidenden zu helfen und ISIS einzudämmen. Die Unterstützungsleistung  der Bundesregierung tragen zur Linderung der unmittelbaren humanitären Notlage und zur Stabilisierung der Lage im Norden des Iraks bei.“ (Seite 6). Further: „Die deutschen Unterstützungsleistungen sind eingebettet in einen breiten politischen Ansatz, der von der großen Mehrheit der Staatengemeinschaft getragen wird und auf politischer, militärischer und rechtsstaatlicher Ebene wirkt.“ (Seite 7) and „Die militärischen Unterstützungsmaßnahmen zugunsten der irakischen Streitkräfte bleiben eingebettet in einen ganzheitlichen politischen Ansatz und werden in Ergänzung der weiterlaufenden Entwicklungszusammenarbeit, Wirtschafthilfe sowie der fortgesetzten humanitären Hilfe umgesetzt. Abhängig von der weiteren Entwicklung und Umfang der Ressort-Engagements wird dieser Ansatz weiter zu entwickeln sein.“ Motion of the German Federal Government „Ausbildungsunterstützung der Sicherheitskräfte der Regierung der Region Kurdistan-Irak und der irakischen Streitkräfte“ (Drucksache 18/3561).

This article is based on the lecture and publication “Humanitarian action and Western military intervention – a view from Médecins Sans Frontières Germany“ by Ulrike von Pilar, Corinna Ditscheid, and Alfhild Böhringer – Médecins Sans Frontières / Ärzte ohne Grenzen, Berlin

1 Ibid. Chapter 3, Article 188 J, Paragraph 1.

2 Mackintosh, K. & Duplat, P. (2013): Study of the Impact of Donor Counterterrorism Measures on Principled Humanitarian Action, p. 18 ff.

3 In the 2011 book “Humanitarian Negotiations Revealed: The MSF Experience”, MSF openly explores the kind of compromises the organization has had to make, their limits, and the challenges to neutrality.

4 Healy, S. & Tiller, S. (2014): Where is everyone? A review of the humanitarian aid system’s response to displacement emergencies in conflict contexts in South Sudan, eastern Democratic Republic of Congo and Jordan 2012–2013, Médecins sans Frontières.



Ulrike von Pilar is currently heading the team for humanitarian issues for MSF in Berlin. She is a mathematician with a doctorate in biomathematics from the University of Tübingen (Germany). In 1991 she started working with Médecins Sans Frontières (MSF) in Brussels, cofounded the German division (Ärzte ohne Grenzen) of MSF in 1993 and became MSF’s founding president in Germany. From 1997 to 2005 she served as executive director of MSF in Germany. For the past few years, she has been the principal  advisor for the Berlin Humanitarian Congress. From June 2009 until April 2012 she served on the board of MSF UK and of MSF East Africa. She has published a number of articles on humanitarian issues and in 2011 a book about the 40-year history of MSF.



Birthe Redepenning holds a Masters Degree in Non Profit Management and Public Governance. She completed her Bachelors Degree in International Cultural and Business Studies. From November 2011 from March 2014, she has worked at Médecins Sans Frontières (MSF) in the donation department. Since then, she has been working as assistant of the executive director, also supporting the Advocacy-team in the Berlin office.