All About Alumni / Autumn 2001
Aggressive Humanitarianism

Grads provide medical services in some of the world’s most violent regions with Doctors Without Borders


Dr. James Paupst (BA 1958 St. Michael’s, MD 1962) has come in contact with many doctors and nurses from Médecins sans frontières (Doctors Without Borders); two who are U of T alumni told him about their experiences:

In 1992, Dr. Paul Spiegel (MD 1991), then 26, was working on the border between Kenya and Sudan. He was the only doctor there when Sudanese death squads drove more than 25,000 refugees into Kenya, half of them children without parents. The children began to trade their food rations for Coca-Cola, cigarettes and sweets. Some months later, some minors came into the hospital limping and complaining of joint pain, says Spiegel. Some had loud heart murmurs, and their lungs were full of fluid. “I diagnosed scurvy and beriberi – two diseases I never thought I would ever see in my lifetime,” he says. “I treated them with a cocktail of vitamin C and B1, and they improved almost instantly.”

This experience led Spiegel to specialize in the medicine of catastrophe, and he is now one of the world’s experts on displaced persons and refugee camps. An epidemiologist, Spiegel works at the Centers for Disease Control and Prevention in Atlanta. His study of mortality rates in wartorn Kosovo appeared in the British medical journal The Lancet. The study indicates that Kosovar Albanian men over the age of 50 may have been a particular target of the Yugoslavian military. “We documented war-related trauma that indicates that the Yugoslavian army had a definite plan of ethnic cleansing,” he says. 

According to Spiegel, 90 per cent of modern war casualties are civilian, and older men are more than three times as likely to die of war-related trauma as men of fighting age. In The Lancet article, he and his colleague, Dr. Peter Salama, stress: “Serbian forces may have targeted older men, who are traditionally the heads of households, to weaken the social and cultural integrity of Kosovar Albanian society and to encourage abandonment by the family of their land…. The targeting of older men represents a new facet of ‘ethnic cleansing.'”

Dr. James Orbinski (MA 1998), who completed his term as president of the international council of Médicins sans frontières in January, accepted the Nobel Peace Prize on behalf of the organization in 1999. Orbinski was in Rwanda in 1994, when members of the majority Hutus were conducting their campaign of genocide against the minority Tutsis. “We were in an area divided into opposing war zones,” he says, “and learned that there were Tutsi children in an orphanage. I wanted to bring these children to our hospital,” he says. Orbinski remembers the commander saying, “They are insects and they will be treated like insects.” By the next day, many of the children had been slaughtered. “This is how people commit atrocity,” Orbinski says. “The first step is to dehumanize the victim.”

Orbinski and his colleagues in Doctors Without Borders are exemplars of aggressive humanitarianism.


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