Dr. James Orbinski served as head of mission for Doctors Without Borders during the Rwandan Genocide. What he saw there transformed him.
Orbinski’s new book, An Imperfect Offering: Humanitarian Action in the Twenty-First Century, to be published April 22 by Doubleday Canada, traces the journey of a humanitarian doctor who has served in some of the world’s most dangerous conflict zones. Orbinski, 47, was international president of Médecins Sans Frontières (Doctors Without Borders/MSF) from 1998 to 2001, and he accepted the Nobel Peace Prize on the organization’s behalf in 1999.
Over the past quarter-century, he has worked in places such as Somalia during the famine and civil war; in the refugee camps in Jalalabad, Afghanistan; and at the Kosovo Macedonia border during the NATO bombings in 1999. His book explores every facet of his work, from the deeply personal to the broadly political: How does a man persevere – and, furthermore, create meaning and invoke change – after witnessing the most violent, sadistic acts human beings can inflict on one another? What is the role of the humanitarian in the post–Cold War era, in which traditional rules of war have been swapped for anything-goes ethical nihilism? How could MSF confront politics and public apathy during crises so it had the space and resources to heal patients?
The notion of imperfection permeates many of Orbinski’s answers. “The book’s title is inspired by the poem and song Anthem, by Leonard Cohen, and there’s a beautiful line where he says, ‘Forget your perfect offering. There is a crack in everything,'”says Orbinski. “When I read that poem, it struck me that that’s the essence of my experience over the last 20 years as a physician, as a putative humanitarian, as a person who has tried in various ways to influence the political processes that determine who gets what, when. It’s very much an imperfect process with equally imperfect outcomes, but it doesn’t obviate the absolute necessity of trying. You achieve something, and sometimes just enough to go on.”
It was the Rwandan Genocide that he has called both “my undoing” and “the most transformative moment in my life.” During the 100-day period from April to July 1994, one million men, women and children – including 85 per cent of all Tutsis in Rwanda – were murdered by Hutu extremists. By early April, only MSF, the Red Cross, the UN peacekeeping force headed by Roméo Dallaire, and two UN humanitarian members remained in Kigali. Orbinski split his time among the King Faycal Hospital, the UN compound, the Red Cross Hospital and a stadium filled with 12,000 people seeking refuge. When he arrived at the Faycal Hospital, 6,000 people occupied every recess of the building, from the stairwells to the closets. Orbinski and other MSF members worked 16- to 18-hour days while outside, killing squads continued to slaughter men, women and children. The MSF team treated waves of victims with machete wounds, gunshot wounds and shrapnel injuries. They cared for people who had chest injuries from being buried alive; women and girls who had been raped; and those maimed by grenades and land mines. They established an orphanage in Faycal Hospital for children whose parents had been killed. And still, more and more victims arrived.
In his book, Orbinski writes that he “felt beaten by the waves of suffering, of killing, of screams, of silent stares, of terror, and waves of not just political indifference but malfeasance.” He had acted and spoken, while an entire world stood by without helping. He remained while the violence eddied more constrictively around the hospitals – until he was one of the last doctors left in Kigali. He made a choice. His choice was to stay and save what lives he could, to relieve what suffering he could – it was that simple, and that hard. He did not leave until the genocide ended.
In a companion documentary, Triage, Orbinski returns to Africa to clear his mind and complete his book. Taking a journey to Rwanda, Congo and Somalia, he revisits the past, and engages with the present. Orbinski’s steady heartbeat propels the film forward, taking the viewer to a place beyond rage and despair, where bonds of solidarity are forged, and human spirits somehow remain unbroken.
“There are moments in a particular story [in An Imperfect Offering] where I knew that my fear overwhelmed everything else, and there are other moments where the implications of not acting or speaking overwhelmed my fear.” Later, he adds, “What I’ve experienced is that I can’t know the future. I can’t know if anything that I do will change what happens tomorrow. I can’t know with certainty, but what I do know is if I do nothing, nothing will change.”
Excerpted from University of Toronto Magazine