"Humanitarian Challenges of Today" - Keynote address by Mrs. Sadako Ogata, United Nations High Commissioner for Refugees, at the 8th International Congress on Infectious Diseases, Boston, 15 May 1998

Ladies and Gentlemen,

It is a pleasure and an honour to have been invited here by the International Society for Infectious Diseases. You are an important audience - you have a key role in today's society. The very subject you are discussing proves it. Let me, however, diverge from the main focus of this Congress. I would like to speak to you about problems not immediately related to health and disease. I shall rather take advantage of the opportunity to be with you, to talk about our work as a humanitarian organization, and also about the challenges we are facing.

I believe that the very nature of your work will help you understand what we do. Doctors and nurses have always been associated with humanitarian work. The outstanding and courageous contributions of the medical profession to humanitarian endeavours need not be recalled. But allow me to go further, and make some analogies between your work and ours. Doctors save lives and cure diseases. We do, too. We are often called upon to save the lives of the people we care for - refugees. One could say that we have to treat one of the most serious symptoms of unhealthy societies - the forced displacement of innocent civilians. Doctors heal wounds. The wounds we are often called upon to heal are those of divided communities, especially when refugees return home. Finally, and most importantly, you try to prevent diseases. Through various means, we also try to prevent new movements of refugees and other displaced populations. In certain regions, for example the countries of the former Soviet Union, prevention of human displacement has indeed become a key activity of my Office.

Our work started almost fifty years ago, in December 1950, when the General Assembly of the United Nations approved a resolution to set up the Office of the High Commissioner for Refugees (UNHCR). It was then a very small organization. Its initial staffing provisions included only 23 persons and its budget for 1951 was less than five million dollars. In its first few years, UNHCR dealt mostly with refugees from Eastern Europe, who were fleeing communist rule - individual cases were its main concern, and much of its work was of a legal nature. Forty-seven years later, the organization has grown enormously. It employs over five thousand people. Its annual budget, since 1992, has exceeded one billion US dollars. Twenty years ago, my Office dealt with 2.5 million refugees. Today, we care not only for 12.5 million refugees, but also for more than 10 million people of other categories - persons displaced within their own country, returnees, and others.

To give you some examples of the scope of our work, approximately 20 to 30% of the population of Afghanistan - 3 million people - live in exile in neighbouring countries. Although the war in former Yugoslavia ended in 1995, about 30% of the people of Bosnia and Herzegovina continue to live away from their homes. During a period of four years, at the end of a bloody civil war, over half a million people were massacred in a genocide in Rwanda, and over two million people fled the country; a massive repatriation followed: one quarter of its entire current population has recently returned from exile.

All these - Afghan refugees, Bosnian displaced persons, Rwandan returnees - as well as many others, are "people of concern" to my Office. There are 23 million of them - almost the size of the population of Canada, or South Africa. In addition to legal work on individual cases, the Office now deals with massive flows of displaced people. Sometimes, huge logistical means must be mobilized to bring assistance to refugees or returnees - many of you will remember the airlift which kept the city of Sarajevo alive for three years during the war in Bosnia, and which lasted longer than the famous Berlin airlift of 50 years ago; in 1994, again in cooperation with military forces, we ran the air bridge operation which brought emergency assistance to a cholera-stricken population of one million Rwandans in the Zairean city of Goma.

The size and scope of UNHCR's activities have therefore increased substantially since 1950. But its core mandate - to ensure the protection of people who flee because they are threatened by persecution, discrimination or violence - has not changed. Of these people, refugees - that is, those who flee across international borders - are obviously the main target group of the Office. Our concern for them translates into concrete action, such as ensuring that they are granted safe asylum, that they are not returned involuntarily to their country, and - whenever necessary - that they are provided with basic material assistance. "Protection" is not merely a legal concept: it can also be physical protection, ensuring that people are not harassed, tortured, imprisoned, or even killed.

Moreover, UNHCR is called upon with increasing frequency to protect and assist people who flee their homes for reasons which are similar to those which cause refugee movements - except that they do not cross frontiers, and are therefore known as internally displaced persons. This occurs very often when States collapse or implode because of internal conflicts, as in the former Yugoslavia after 1991. When the internally displaced do not benefit any longer from the protection of their own State, they find themselves in a situation similar to that of refugees. Indeed, they are often potential refugees - hence our concern and involvement, whenever we are requested to intervene.

For many years, during the Cold War, refugees crossed borders that were as much ideological as they were political. The large groups of refugees from Ethiopia, Viet Nam or Afghanistan were all fleeing communist regimes. Refugee problems originated directly from extremely polarized international relations: solutions to these problems were, as a consequence, very difficult to pursue and achieve. The end of the Cold War suddenly made it possible for many "frozen" refugee situations to be unblocked. Since the early Nineties, therefore, although we have continued to focus on protecting people who flee, and on meeting their basic material needs, we have increasingly attempted to seek and pursue solutions to refugee situations.

I can assure you that having worked with refugees for almost 50 years, UNHCR has learned one important lesson: refugees, usually, want to return home. Last year, for example, in Ukraine, I visited a group of Tatar women who had been expelled from their area of origin and deported to other regions under the Stalinist regime when they were young girls. Forty years elapsed, but these women were determined to return home, and as soon as conditions permitted, they requested help to be repatriated. Those whom I met had recently returned, with our help. I was profoundly struck by their strong determination to start a new life in their original homes - in an area which was even poorer than the one they had been deported to. Belonging to one place is a feeling which has deep roots in peoples' hearts and minds. Voluntary repatriation is therefore our preferred solution to the problem of human displacement.

When repatriation may expose refugees to persecution or death, however, different solutions must be pursued. The most common are the integration of refugees in their host country, or their resettlement to another one. Economic problems and ethnic conflicts have made local integration a more difficult option. On the other hand, Western countries, the most frequent resettlement destinations, admit only a small number of refugees every year - hence the limited potential for resettlement, which we try to reserve for very vulnerable people, for example unaccompanied minors, single mothers and their children, rape victims, or other "protection" cases.

Searching for solutions is therefore a constant activity of UNHCR worldwide. My Office has been sometimes accused of artificially prolonging refugee situations. This is a very unfair statement. The emphasis we put on solutions shows that we are striving to achieve precisely the opposite. We ask States to respect the principle of asylum. We think no refugee should be forcibly returned to his or her own country. We also think, however, that nobody deserves to be a refugee for longer than necessary and useful to protect his or her own life.

Let me now share with you some reflections about the nature of our work, and about the problems confronting us - I shall insist in particular on the concepts of "safety" and "prevention", which, as I said earlier, are surely familiar to people dealing with health and disease.

Humanitarian work, as we think of it today, has its origin in a simple, but powerful idea - saving the lives of innocent civilians threatened by persecution or violence. Conflicts in earlier days were as deadly and destructive as they are now, but their patterns were simpler - and the same can be said of international relations, especially during the Cold War period. Assisting victims was generally considered a neutral, humanitarian, respected act.

Today, both war and peace have changed. There may be only one superpower left in the world, but internal conflicts have multiplied. These conflicts are often extremely violent, and tend to target civilian populations as much as they involve armed groups. Distinctions between fighters and victims have become difficult to make. Entire ethnic groups are targeted and - as in the former Yugoslavia - "cleansed". To starve people has become a tool of war. And humanitarian workers are often perceived as taking sides.

The most blatant example of this situation occurred in the eastern region of what was then Zaire, and is now the Democratic Republic of Congo. There, over one million Rwandans took refuge in July 1994. Among them were refugees fleeing the civil war in their country - innocent women and children - but also the perpetrators of one of the most terrible acts of this century, the massacre of hundreds of thousands of Rwandans of Tutsi ethnic origin, and of those who opposed this genocide. UNHCR and other humanitarian agencies were put in an impossible situation: either help the refugees, and by so doing, inevitably assist the criminals; or withdraw, and by so doing, let the innocent die.

We appealed in vain for military support to separate the two groups. And finally, we decided that we had no right to abandon the refugees, and we stayed on to provide protection and assistance. This decision - perhaps the only one which as a humanitarian agency we could take in the absence of any political or military intervention - haunted us for over two years. Undoubtedly, the lives of many refugees were saved - and this alone, I believe, justified our presence. But refugees and criminals continued to live together. Not only did the latter benefit from the assistance given to the former - they also re-organized themselves and launched terrorist attacks against the new Government of Rwanda. Their activities largely contributed to igniting the civil war in Zaire, in which all camps were destroyed. Many of their inhabitants fled. We helped save more lives through a rescue operation involving an airlift and several land evacuation routes. Thousands of refugees, however, died in the forest.

Let me give you two more examples. In the former Yugoslavia, if we rescued people threatened by ethnic cleansing by moving them to safer areas, we were called accomplices to this criminal practice; if we did not, we were called accomplices to murder. Many believe that the US-led United Nations intervention in Somalia did indeed save thousands of people from death by starvation, but failed to contain inter-communal fighting, fuelled the war between factions, and thereby prolonged the conflict which had caused famine in the first place.

I believe that the moral value of saving people's lives is still recognized. In a world which offers few opportunities for courageous acts, helping victims of humanitarian tragedies is perceived as one. And indeed, in many situations, people in danger are still successfully rescued through humanitarian operations. As the examples that I have mentioned indicate, however, the circumstances and especially the consequences of humanitarian intervention have become much more complex. The crises in former Yugoslavia and Central Africa have shown that the line between those who suffer and those who inflict the suffering are not always clear. Situations therefore occur in which civilians are threatened, but the international community, and even its humanitarian agencies, hesitate to intervene. With increasing, worrying frequency, they are aware that the unintended consequences of their intervention may unwittingly prolong the crisis, and inflict additional suffering on the innocent.

I do not have quick prescriptions on how to tackle these dilemmas. The main reason for this, is that solutions to humanitarian problems such as forced displacement or famine are never exclusively humanitarian. Other actors must be involved. Governments must assume their responsibilities. You, as active members of society, have some responsibilities. In this respect, I would like to propose a few ideas which you can perhaps reflect upon.

First, we must look for ways to re-establish a consensus on the value and necessity of "safety" for those who are persecuted, or threatened by violence. We must, somehow, recreate respect for the international means, channels and instruments through which those who suffer from violence and persecution can be brought to safety. In order to achieve this, a sense of international responsibility for the security of people in need of protection, must be restored. As regards refugees and other victims of forced displacement, the international community has developed, over the years, a variety of tools and instruments to ensure their safety and protection.

The most important means of ensuring the safety of refugees is of course granting them secure asylum: in this respect, not only must we seek a reaffirmation of the irrevocable nature of the principle of refugee asylum, by all States; but we must also help States uphold this principle - especially those whose resources are limited - and provide them with the necessary means to bear an additional burden. Another means to ensure safety is to resettle to a third country those who are in danger, as I mentioned earlier. In this case, procedures have to become more rapid and flexible. People whose lives are threatened cannot wait for weeks in an unsafe place in order for bureaucracy to follow its course, as often happens. And finally, in situations of internal conflict, it may be necessary to intervene directly in the country where threatened people find themselves - across the conflict lines. This may require the use of force; and obviously, this is the most difficult type of intervention, given the political and financial hurdles that such a measure must overcome before it is decided and implemented.

Second, as I have already said, it is essential to understand that without political and diplomatic support, it will be impossible for humanitarian agencies alone to resolve the problems they face today. It will be impossible for them not to be confronted by the kind of intractable dilemmas I have given some examples of. They will not be able to avoid becoming the pawn of unscrupulous warring parties. Without the intervention of political actors, attempting to protect threatened people will become a courageous but fruitless act. Worse, the rescue of some may imperil the safety of others.

Talking of political support, a comparison between two situations is useful. Although the international community did little to stop war and ethnic cleansing in the former Yugoslavia until 1995, the horrors of Srebrenica - and also, one should say, the proximity of the war to the West - finally prompted the strong international reaction which culminated in the Dayton Peace Accords. Through this agreement, a complex network of institutions was mobilized to ensure the respect and implementation of peace. These institutions are not only humanitarian, but also political, economic and military.

This combination is crucial. By comparison, little has been achieved in the other area in which humanitarian actors have been confronted with the worst moral and operational dilemmas - the Great Lakes region of Central Africa. Some situations - for example the displacement of hundreds of thousands of Rwandans - have been resolved through violent means, and in the absence of any significant international input, except for humanitarian assistance. Most significantly, and despite the media images of horrors which certainly matched those of Srebrenica, the international community failed to intervene militarily at each crucial stage of the Rwandan tragedy. To date, reconstruction and development aid remain very limited. Should another humanitarian crisis occur, agencies such as ours would again be left alone facing the same dilemmas of having to save people's lives across complicated conflict lines. We would be damned if we rescued the innocent, and damned if we did not.

Third, while striving to guarantee access to safety for all victims, and requesting political support so that humanitarian interventions can be both effective and impartial, we also need to examine ways to actually prevent situations in which long-term solutions cannot be sought, and we must limit our response to the immediate, dramatic imperative of saving lives. Talking to medical people, an easy metaphor comes to mind: focusing only on life-saving activities is like curing a symptom without really treating its causes, nor preventing a disease from reappearing again. Although, as a humanitarian agency, we do want to relieve the immediate symptom, we also wish to contribute to a larger, longer term effort to treat the disease.

Preventing refugee movements is of course a complex exercise. Think of the flashpoints, today, in which tension and instability may cause fresh or renewed human displacement: for example the Balkans, the Great Lakes region of Africa, the former Soviet Union, and even South East Asia. Analysing situations and predicting refugee flows may be easy. Practical measures to prevent such flows are politically much more delicate, and usually discarded as interference in internal state matters.

One way of preventing forced human displacement is however feasible, and can be effective. In the crucial phase which immediately follows the return of refugees or displaced people to their homes and communities, humanitarian agencies can help create the conditions to make repatriation sustainable, and therefore contribute to the prevention of further refugee movements. They can achieve this result by meeting the immediate needs of returnees and of their communities, to avoid creating frictions and imbalances. But in planning and implementing reintegration programmes, they can also focus more specifically on activities aimed at helping divided communities live together again; invest resources in people and groups who have the highest stake in a cohesive society - women, for example; and promote reconciliation through the reintegration of those who return, and thus contribute to healing the wounds which prompted people to flee.

My three points - to refocus on the value and necessity of bringing safety to those in need; to promote solutions to humanitarian problems through more comprehensive international interventions; and to prevent the recurrence of displacement through reintegration and reconciliation of divided communities - are meant to indicate which directions we should take if we want to go beyond the dilemmas often blocking humanitarian work. All, obviously, depend on the willingness of governments to take political initiatives and to allocate resources. The current environment, in developed countries, is not very favourable. Public funds are decreasing. Unemployment continues to be high in most countries. Immigration - often mixed and confused with refugee flows - is seen as a threat. An inward-looking, often very politicized trend prevails.

This trend is very worrying. It affects the policies and practice of asylum and resettlement of refugees in developed countries. On the international scene, it does not encourage donors to provide resources and show commitment to resolve refugee and other humanitarian problems.

I have appealed to governments, and I will continue to do so, on behalf of those who flee violence and persecution. But this is not enough. We are fully aware that to respond to inward-looking government policies it is necessary to address and counter inward-looking public attitudes. A constructive approach to refugee problems - internally and internationally - is also the responsibility of civil society.

For this reason, I would like add a few words addressed to you - doctors and other members of the medical profession. Not only your key role in modern societies, but also your vocation - as people dedicated to saving and improving lives - entrust you with the moral duty to fight against the exclusion and marginalization of the weakest members of society. To counter negative attitudes threatening refugees and asylum. To resist the easy appeal of xenophobia. To depoliticize refugee issues and promote a message of acceptance and tolerance. To realize - and convince governments to realize - that problems of displacement in far away regions have a very wide impact on peace and stability everywhere. That resources allocated to address these issues are not substracted to you and your fellow citizens, but contribute to resolve problems which are of concern to all.

Refugees are not a threat. This country, the United States, was built by millions of immigrants and refugees - and immigrants and refugees continue to make a substantial contribution to its progress and prosperity. I started my speech by talking about some analogies between your work and ours. In concluding, let me highlight in particular one common characteristic, which may be the most important - humanitarians, like doctors, are people who work with and for other people. I have tried to explain to you what we do, and what dilemmas we face. Now we need help. From states. From civil society. From you.

Thank you.