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非洲：无国界医生在行动
2011年01月22日11:40 来源：人民网-国际频道 李安山
2010年9月29—10月1日，本人应邀出席无国界医生（MSF，Medecins Sans Frontieres）瑞士分部在日内瓦召开的小型国际研讨会，主题是“各方对医疗人道行动的理解”。出席者分别来自无国界医生这一国际非政府组织( INGO, International Non-governmental Organization)散布于世界的19个分部、联合国相关部门、国际红十字会以及一些教学科研单位。通过参加这次会议，本人对无国界医生的活动有了一个初步的了解。
无国界医生的成立
可以说，无国界医生这一国际非政府组织的诞生与非洲直接相关。1967年5月，尼日利亚发生内乱。以奥朱古为首的伊博族军人集团宣布东部地区脱离联邦中央政府独立，成立“比夫拉共和国”。7月，尼日利亚中央政府出兵征讨，一场持续两年多的战争爆发。1968—1970年间，一群法国医生参加法国红十字会在比夫拉的救援工作。尼日利亚内战于1970年结束，约有50—100万人死亡。面对这一残酷的现实，红十字会要求成员保持沉默。几位年轻的法国医生忍无可忍，决定成立一个新的独立于政治或信仰之外的组织，以为受害者提供直接的医疗援助为己任，无国界医生在巴黎应运而生。
无国界医生为何要另立门户呢？首先，红十字会历来都在征得当地政府许可后才在该地工作。其次，保密规定的约束也使无国界医生的创始者认为不合时宜。其三，红十字会的职责是保护而非医疗，而无国界医生的创始者认为受害者需要更直接的以医疗援助为主的人道主义救援。无国界医生的宪章明确规定：“无国界医生是一个国际的非政府组织，其成员主要为医生和其他医务人员，也欢迎有助于组织完成自身使命的其他专业人员参与。全体成员同意遵循以下准则：无国界医生不分种族、宗教、信仰和政治立场，为身处困境的人们以及天灾人祸和武装冲突的受害者提供援助。无国界医生遵循国际医疗守则，坚持人道援助的权利，恪守中立和不偏不倚的立场，并要求在其行动中不受任何阻挠。全体成员严格遵循其职业规范，并且完全独立于任何政治、经济和宗教势力之外。作为志愿者，全体成员深谙执行组织的使命所面临的风险和困难，并且不会要求组织向其本人或受益人作出超乎该组织所能提供的赔偿。”
为何要举行此次研讨会？
无国界医生自1971年成立以来，一直独立于任何政治、经济和宗教势力，秉承完全中立、不偏不倚和独立的指导原则，致力为战争、自然灾害以及疫症受害者提供紧急医疗救助，也为一些医疗设施不足的地区提供基本医疗服务，并协助当地人民重建医疗系统。1999年，无国界医生这一国际非政府组织获诺贝尔和平奖，获奖理由是“他们专业地、有效率地帮助那些遭受苦难的人，代表那伸出来的援助之手，进入一切冲突和混乱之中。”
组织成立近40年来，由于国际局势的复杂多变，战乱横生，对人道主义救援的需求增加，加上该组织特有的专业技术和职业精神，无国界医生发展很快，目前已在全球超过70个国家进行过救援行动。仅在2009年一年内，它共为全球超过750万名病人提供了治疗，并接受了近30万人/次入院治疗。然而，近年来，“一些组织和政府利用‘人道’这个标签来包装某些特定的政治议题”（无国界医生香港办事处主席范宁医生语）。这些组织和政府打着人道主义救援的招牌来实现自己的政治目的。例如，2001年，美军飞机在阿富汗就一边投掷炸弹，一边投放人道主义救援物质。这些年来，美国仍以人道援助作为宣传其软实力的一个重要手段。这种人道救援与军事行动的致命混淆，一方面使无国界医生这种致力于救死扶伤的纯人道主义组织被人误解，导致交战各方和受援者对救援人员产生怀疑；另一方面，救援人员日益成为各方袭击的目标，其处境因此受到威胁，无国界医生的志愿人员在阿富汗等战乱地区就曾多次遭受不测。2004年，无国界医生的5名员工在阿富汗惨遭杀害；2009年，包括无国界医生的法国和荷兰分部在内的13个国际救援组织被苏丹政府驱逐出境；4名无国界医生员工在达尔富尔被绑架（数日后获释）。一个希望独立于政治之外的国际救援组织却日益处于政治斗争的漩涡之中。如何看待国际人道主义救援行动？怎样面对目前的危机？无国界医生组织何去何从？这些问题成为此次会议的焦点。
无国界医生在非洲的行动
让我们来看看无国界医生2009年在全球救援活动的一组数字：无国界医生共进行了7509512次门诊，其中292347人/次入院治疗；治疗了1110495宗疟疾确诊个案；为7932403人接种脑膜炎疫苗并医治77901名脑膜炎病人；为1419427人接种麻疹疫苗并医治28261名麻疹病人。无国界医生还接收了严重营养不良的儿童入院，为性暴力的受害者进行治疗，为孕妇和产妇服务，为结核病以及一些热带病患者进行治疗，为暴力事件受害者进行外科手术，等等。到2009年为止，无国界医生还为190254名艾滋病病毒感染者进行登记并护理，给予162728名病人抗艾滋病第一线药物治疗及1781名病人抗艾滋病病毒第二线药物治疗。
这些救援和治疗行动绝大部分发生在非洲。在苏丹，无国界医生于2009年开展了数次紧急救援行动，为超过43万人提供了医疗服务。刚果民主共和国长期处于战乱，民不聊生。无国界医生在该国设立了医院和流动诊所，为当地人民提供免疫和治疗服务。2009年，他们共进行了53万宗诊疗，为65万名儿童注射麻疹疫苗，并在南、北基伍省为5600名被强暴者提供护理。索马里自1991年以来长期处于战乱状态。2006年年底，虽然索过渡政府在埃塞俄比亚军队帮助下击败反政府武装，控制了索马里主要地区，但反政府武装并未中断其在摩加迪沙等地的袭击。由于安全形势恶化，针对联合国工作人员及援助机构人员的袭击事件频频发生，多数国际援助机构已因此撤离索马里。然而，无国界医生从1991年起即持续为索马里人民提供人道援助，历经战乱，仍然坚持。2009年，无国界医生以内罗毕为基地，为索马里人提供医疗照顾。1300名索马里当地员工在百余名内罗毕员工的支持下，进行了约65万宗诊疗。病人中23.8万名为5岁以下儿童，4.9万名孕妇得到产前保健，2.6万名在无国界医生的医院或诊所得到收治。外科人员进行了近3000台手术，其中900宗因暴力所致。此外，无国界医生还诊治了200多名患“黑热病”的病人、2600多名疟疾病人和1300多名结核病人，并为22.4万名儿童注射了疫苗。
以无国界医生的香港分部和瑞士分部为例。2009年，由香港无国界医生分部派出志愿者114人/次分赴全球40个国家参与救援项目，其中包括18个非洲国家：乍得、刚果民主共和国、埃及、埃塞俄比亚、几内亚、肯尼亚、利比里亚、莫桑比克、尼日尔、尼日利亚、塞拉利昂、索马里、南非、苏丹、斯威士兰、乌干达、赞比亚和津巴布韦。2009年，香港分部在世界各地的救援工作共拨款1.2亿港元，其中非洲国家占48%。在拨款救援的50个国家和地区中，非洲国家有23个。香港民众也尽力支持无国界医生的崇高事业，2009年公众捐款（不包括赞助）达1.7亿港元。为了与中国的学术部门进行沟通，从而使国内的民众更加熟悉无国界医生这一国际救援组织，香港分部的代表还在2009年12月到中国社会科学院西亚非洲所举办专题讲座，并与该所研究人员进行交流。
无国界医生瑞士分部的主要活动范围在非洲。它是由80个国家的员工组成。以2009年为例，它派出620名国际人员，并聘用了2730名当地员工，共花费140万瑞士法郎的救援款，为20个国家提供了医疗救援服务，其中12个为非洲国家。瑞士分部负责人表示，减低病人的痛苦程度、降低死亡率，以及提供治疗和关键食品是他们救援的主要目标。无国界医生从2002年即开始在索马里进行救援行动。2009年，为帮助索马里难民，无国界医生瑞士分部在肯尼亚东北部难民营开展医疗服务，这是该分部2009年取得的重要成绩之一。他（她）们中的524名当地员工和7名国际员工为当地的妇女、儿童和战争及病痛受害者提供救治，人数达24万。无国界医生从1996年开始在苏丹进行救援，目前共有24名国际员工与258名当地员工。他们深入南部苏丹为当地民众治疗。2009年，南部苏丹爆发脑膜炎疫情，无国界医生及时进行治疗和防疫。
无国界医生自1988年起开始在中国工作，救援范围涉及自然灾害以及艾滋病防治项目等工作。然而，中国人对无国界医生了解不多，除香港人外，国人中参加无国界医生志愿工作的医疗工作者微乎其微，北京大学人民医院的屠铮医生是其中之一。近年来，中国政府日益重视与非政府组织的合作。我们相信，在中非合作论坛的框架下，中国政府与无国界医生这一国际非政府组织在非洲的合作将大有作为。
【本文主要数据来源于MSF International Activity Report 2009; Activity Report 2009, MSF Switzerland, Medecins sans frontieres/Arzte ohne grenzen; MSF Activity Report 活动报告 2009，Medecins sans frontieres/无国界医生（香港）】
（作者系北京大学非洲研究中心主任、教授、博士生导师）
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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Africa: MSF in action
At 11:40 on January 22, 2011 Source: People's Network - International Mountain Ang Lee
29-10 September 2010 On 1 May, I was invited to attend the Medecins Sans Frontieres (MSF, Medecins Sans Frontieres), held in Geneva, Switzerland, a small segment of international seminars on the theme "parties to the understanding of the medical humanitarian action." Participants were from the MSF international NGOs (INGO, International Non-governmental Organization) spread in the world 19 divisions, the relevant United Nations departments, the International Red Cross and some teaching and research units. By participating in this meeting, I am the activities of MSF has made a preliminary understanding.
MSF set up
It can be said MSF international non-governmental organizations that Africa is directly related to the birth. May 1967, civil unrest in Nigeria. Headed by Austrian Chocolate Ibo tribe in eastern junta declared independence from the federal central government established the "Republic of Biafra." July, the central government of Nigeria to send troops crusade, a war broke out over two years. 1968-1970, a group of French doctors to participate in the French Red Cross relief work in Biafra. Nigerian civil war ended in 1970, some 50-100 million people died. Faced with this harsh reality, the Red Cross asked members to remain silent. Several young French doctors intolerable, decided to set up a new independent political or belief outside the organization, that provide direct medical assistance to victims of mission, MSF in Paris came into being.
MSF why separate portal it? First of all, the Red Cross has always permitted only after the approval of the local government in the work. Second, the confidentiality constraints also the founder of Doctors Without Borders that the out of date. Third, the Red Cross is responsible for protection rather than medical care, the founder of Doctors without Borders that the victims need medical assistance more directly to the main humanitarian relief. MSF Charter clearly stipulates: "MSF is an international non-governmental organization whose members are mainly doctors and other medical personnel are also welcome help to organize and complete their mission, other professionals involved. All members agree to abide by the following Criteria: MSF, regardless of race, religion, beliefs and political stance, the people in distress and victims of natural disasters and armed conflict to provide assistance. MSF international medical codes to follow, adhere to the right of humanitarian aid, abide by the neutral and impartiality, and called in its actions without any obstruction. all members strictly follow their professional standards and is completely independent of any political, economic and religious forces outside. As a volunteer, all members of the organization familiar with the implementation of The mission of the risks and difficulties, and does not require organizations to make their own or the beneficiary than the compensation offered by the organization. "
Why this seminar to be held?
MSF has set up since 1971, has been independent of any political, economic and religious forces, adhering to the neutral, impartial and independent of the guiding principles, is committed to war, natural disasters and emergency medical assistance to victims of the disease, but also for a number of areas with inadequate medical facilities to provide basic medical services and help local people rebuild health care system. In 1999, MSF international non-governmental organizations that received the Nobel Peace Prize winners because "they are professionally and efficiently to help the suffering people, on behalf of that helping hand stretched out into all the conflicts and confusion into. "
Organizations established for nearly 40 years, due to the complex and changeable international situation, the war will occur, the increased demand for humanitarian relief, combined with the unique expertise of the organization and professionalism, MSF has developed rapidly, now more than 70 in the world countries carried out rescue operations. Only in the year 2009, which total more than 7.5 million patients worldwide for treatment, and received nearly 30 million people / times hospitalized. However, in recent years, "some organizations, and government use of 'humanitarian', the label to package certain political issues" (Medecins Sans Frontieres Hong Kong Office Main Xi Fanning medical language). These organizations and the government signs the name of humanitarian relief to achieve their own political purposes. For example, in 2001, U.S. aircraft dropped bombs in Afghanistan to one side while running humanitarian relief material. Over the years, the United States still promote their humanitarian aid as an important means of soft power. Humanitarian relief and military operations that the deadly confusion, on the one hand this MSF is committed to the pure life-saving humanitarian organizations have been misunderstood, leading to the warring parties and recipients of aid workers doubt; the other hand, the rescue all personnel are increasingly becoming targets of attacks, their situation so threatened, MSF volunteers and other war-torn areas of Afghanistan had suffered several unexpected. In 2004, the five MSF workers were killed in Afghanistan; 2009, including MSF's Dutch branch, including France and 13 international aid organizations were the Sudanese government expelled; four MSF workers in Darfur Darfur has been kidnapped (released a few days later). Independent of the political than a hope of international aid organizations is increasingly in the whirlpool of political struggle. How to treat international humanitarian relief operations? How the current crisis? MSF go from here? These issues became the focus of the meeting.
MSF's operations in Africa
Let's look at 2009, MSF activities in the global rescue a group of figures: MSF conducted a total of 7,509,512 times patient, including 292,347 person / times hospitalized; treated 1,110,495 confirmed cases of malaria; to 7,932,403 persons vaccinated meningeal inflammation and heal the 77,901 meningitis vaccine patients; as 1,419,427 people were vaccinated against measles and 28,261 measles patients heal. MSF also received the severely malnourished children admitted to hospital for treatment of victims of sexual violence, for pregnant women and maternity services, as well as some tropical diseases, tuberculosis patients were treated, for the victims of violence, surgery, and so on. To 2009, MSF also 190,254 people living with HIV were registered and care given to 162,728 first-line drugs against AIDS patient treatment and 1781 patients second-line anti-HIV drugs.
Most of these rescue operations and treatment in Africa. In Sudan, MSF carried out in 2009, several emergency relief operations for more than 43 million people with medical services. A long period of Democratic Republic of the Congo war, times of hardship. MSF set up a hospital in the country and mobile clinics to provide immunization for local people and therapeutic services. In 2009, they conducted a total of 530,000 treatment, injection of 65 million children against measles, and in North and South Kivu were raped for the 5600 to provide care. Somalia since 1991, a long period of war status. The end of 2006, although the transitional government claim the help of Ethiopian troops defeated the rebels control major areas of Somalia, but the rebels did not interrupt their attacks in Mogadishu and other places. Deterioration of the security situation for United Nations staff and aid agency personnel attacks occur frequently, most international aid agencies in Somalia have been so withdrawn. However, MSF is continuing since 1991, providing humanitarian assistance for the Somali people, after the war, still persist. In 2009, MSF in Nairobi as a base for Somalia to provide medical care. 1300 Somali staff in over a hundred local support staff in Nairobi, conducted approximately 650,000 clinic. Patients, 238,000 children under the age of 5, 49 000 pregnant women receive antenatal care, 26,000 in the MSF be admitted to the hospital or clinic. Surgical staff of nearly 3,000 procedures, including 900 caused by the violence. In addition, MSF has more than 200 patient diagnosis and treatment of "kala azar" patients, more than 2,600 malaria, tuberculosis patients and more than 1,300 people and 22.4 million children vaccinated.
To MSF Hong Kong office and the Swiss branch as an example. In 2009, MSF Hong Kong Division sent 114 volunteers / time teams to participate in global relief projects in 40 countries, including 18 African countries: Chad, Democratic Republic of Congo, Egypt, Ethiopia, Guinea, Kenya, Liberia, Mozambique, Niger, Nigeria, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Uganda, Zambia and Zimbabwe. In 2009, the Hong Kong branch of the relief efforts around the world a total funding of 1.2 billion Hong Kong dollars, of which 48% of African countries. Grant relief in 50 countries and regions in 23 African countries. Hong Kong people also try to support the noble cause of MSF in 2009, public donations (not including sponsorship) of 1.7 million. China's academic departments in order to communicate, so that people become more familiar with domestic MSF of the international relief organizations, representatives of the Hong Kong branch is still in December 2009 to the Chinese Academy of seminars organized by West Africa, and with the the researchers to communicate.
MSF Switzerland Division's activities largely in Africa. It is composed of staff from 80 countries. Instance, in 2009, it sent 620 international staff and 2,730 local staff employed, total cost of 140 million Swiss francs of aid money, for the 20 countries provided medical assistance service, including 12 African countries. Swiss branch official said, to reduce the suffering of the patients, lowering mortality, and treatment and critical food is the main objective of their aid. Since 2002, MSF began relief operations in Somalia. In 2009, to help Somali refugees, MSF Switzerland Division refugee camps in northeastern Kenya, medical services, which is the segment in 2009 one of the important achievements. He (she) had in 524 local employees and 7 international staff for the local women, children and victims of war and pain treatment, the number of 24 million. MSF in Sudan since 1996 to rescue, there are 24 international staff and 258 local staff. They in-depth treatment of the local population in southern Sudan. In 2009, an outbreak of meningitis epidemic in southern Sudan, MSF timely treatment and prevention.
Since 1988, MSF began working in China covering natural disasters, relief and AIDS prevention programs and so on. However, the Chinese people know little about the MSF, with the exception of Hong Kong people, the people in volunteering to participate in the work of MSF health workers is minimal, Zheng Tu, Peking University People's Hospital, doctors are one of them. In recent years, increasing emphasis on government and non-governmental organizations. We believe that in the framework of China-Africa Cooperation Forum, the Chinese Government and MSF the international non-governmental organizations in Africa cooperation will accomplish much.
【In this paper, data from the MSF International Activity Report 2009; Activity Report 2009, MSF Switzerland, Medecins sans frontieres / Arzte ohne grenzen; MSF Activity Report Activity Report 2009, Medecins sans frontieres / Doctors Without Borders (Hong Kong)】
(The author is Director of the Centre of African Studies, Department of Peking University, Professor)
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