State’s Repression toward INGO: The Dismissal of Médecins Sans Frontieres

The primary purpose of humanitarian-based INGOs is to provide and distribute assistance to those who could not get it. One of the INGOs engaged in this field and is quite successful in the international constellation is Medecins Sans Frontieres, often called Doctors without Borders. Humanitarian INGOs generally have a noble mission and have no mission to engage in the host country's political dynamics. However, the noble mission became a boomerang when MSF became one of the INGOs who worked to save the famine in Ethiopia. MSF has a noble mission, but the Ethiopian government has another mission that aggravates the condition of hunger in Ethiopia. As INGOs sought to be neutral, MSF decided to remain silent and take no steps relating to the political constellation of one of the world's poorest countries. Things got worse when MSF realized that one of their programs was being misused by the government to blackmail the guerrilla groups in the north. MSF could no longer remain silent and objected to any Ethiopian government policy related to them, resulting in the dismissal of all MSF members from Ethiopia at the end of 1986. This paper will explain the weak position of NGOs toward state, the main reason of the dismissal. The authors will be using the qualitative method by explaining the history about MSF and NGOs in the perspective of state which resulted the justification of the weak position of NGOs itself.


I. Introduction
Medecins Sans Frontieres (MSF) or often referred to as Doctors without Borders, is one of the INGOs with a humanitarian basis in their activities. This INGO was formed in 1971 with the noble aim of helping people in unreached areas who need help as soon as possible (MSF, n.d). It was a revolution in its time, after the Red Cross, as a movement with such a similar goal. Initially, MSF was a collection of international doctors on duty in two locations, Nigeria and Eastern Pakistan, and was frustrated by the difficulties in carrying out their duties. This condition has made MSF one of the successful humanitarianbased INGOs, and it has successfully sent nearly 2,500 volunteers to 80 countries since 1977. However, the journey taken by MSF is not as easy as imagined. Rejection, dismissal, and even direct problems with the bureaucracy of a country are some of the problems that MSF, and several other INGOs, often encounter when carrying out their missions. One of the most challenging problems MSF faced was in Ethiopia during the 1983-1985 famine. At that time, MSF faced the dilemma of not being directly involved in the political constellation and several illegal actions carried out by Ethiopia. However, this attitude put INGOs in a dilemma, to remain silent and carry out their mission or participate in protesting some issues that should be justified. This paper will explain how MSF as INGOs experienced a dilemma regarding the conditions that occurred in Ethiopia and ended in the dismissal of the INGOs. This paper wil seek the justification about how weak the NGOs toward state in the international world. In this paper, the readers can get to know about the MSF's stance which is different from Red Cross, the same humanitarian NGOs and the weak position of NGOs toward state. Although this case has been going on for quite some time, the author sees that this case is still relevant to be discussed today. This is because the conditions that occur in Ethiopia and MSF can occur anywhere, especially considering the increasingly rapid development of INGOs at this time. The dilemma experienced by the state will continue if the state is not able to accommodate the vision of INGOs which come to their country. Surely, this could lead to a collision of objectives between the state and the INGO which could lead to the dismissal of the INGO itself. The latter could be happened continuously because of the weak position of the NGO toward state which is undeniable.

II. Method
This article uses qualitative analysis in the discussion. The authors will analyze the qualitative data obtained and become supporting data in explaining the phenomena raised in this article. The research question in this article will be: is it necessary to dismiss the INGO from the state if their progamme doesn't suit the state interest? Starting from the question, the author will explain the history of the founding of MSF itself and see the true vision of this organization. Then the author will compare the organization's vision with Ethiopia's domestic conditions to see why MSF's response to the Ethiopian government is like that. Lastly, author will try to explain the dilemma from the state when the INGO who came for help is contrary to state's interest from the weak position of NGOs toward state.

a. Medecins Sans Frontieres and International Red Cross
The emergence of Medecins Sans Frontieres (MSF) is one form of "resistance" to the International Red Cross's leniency against local governments. Savelsberg (2015, 106-107) reveals that at the beginning of the 20th century, almost all humanitarian aid was managed by the International Red Cross, especially during the World War. The problem that emerged from the International Red Cross was that there were no medical units dispatched together with International Red Cross volunteers on the battlefield (Brauman & Tanguy 1998). There is a choice to ignore the condition of a country. Even when there is violence by the local regime so that it can carry out its mission without any obstacles, conditions like this are what the International Red Cross must pay dearly, witnessing many victims of violence by state officials against their people. In order to carry out its mission without encountering any difficulties, the International Red Cross decided to take a stand of silence.
Of course, there is a pretty painful price and must be paid by the International Red Cross for this silence. This condition was illustrated when in 1944, the International Red Cross paid a visit to the Nazi Concentration Camp (Davey 2011). The International Red Cross did not investigate the camp and disseminate it publicly for humanitarian purposes but preferred to remain silent and let the SS instrumentalize the International Red Cross for legitimate purposes (Savelsberg 2015, 107). This condition continues; the International Red Cross continues to assist people in need and see the government's atrocities against its people. The Civil War in Nigeria and the assignment of several doctors to the Biafra area by the French Red Cross in 1968-1970 was a turning point for the group of WIMAYA: Interdisciplinary Journal of International Affairs Vol.03/No.01, January-June 2022(e-ISSN: 2272 doctors to see the actual conditions occurring in the field (Brauman & Tanguy 1998).
There was much upheaval after the Biafra assignment, especially with the opinions of several doctors assigned to Biafra, later founders of MSF, who voiced the opinion that it was necessary to publicize the actual conditions on the battlefield. They are forced to understand that what happens on the battlefield is under the state's authority, and other actors should not interfere in these matters. It described the nature of the International Red Cross, which emphasizes that its task is to channel aid to countries that approve their assistance so that the International Red Cross automatically must comply with the rules of the country concerned (Brauman & Tanguy 1998). Indeed, this event was quite disappointing, considering that the International Red Cross volunteers assigned to Biafra at that time felt that Nigeria's condition had constituted genocide. The 50 doctors assigned to Biafra formed an association to raise public awareness of Biafra's problems. This is stated in the presentation from MSF regarding the founding of the organization:

"[Max] Recamier and [Bernard]
Kouchner [members of the French group of physicians in Biafra] believed the world needed to know about the events they were witnessing: civilians being murdered and starved by blockading forces. They openly criticized the Nigerian government and the Red Cross for their seemingly complicit behavior. In the following three years, other doctors began to speak up. These doctors, or "Biafrans," as they were known, began to lay the foundations for a new and questioning form of humanitarianism that would ignore political or religious boundaries and prioritize the welfare of those suffering." (Savelrsberg 2015, 107).
At the same time, the representative of the group of doctors assigned to the eastern part of Pakistan (now Bangladesh) conveyed his experience through the National TV channel. They stated that the conditions in Bangladesh are already in a dire state, and there should be a follow-up from the Bangladeshi government instead of just allowing more victims (Brauman & Tanguy 1998). Then, as if to get a breath of fresh air, a group of doctors in France and 3,000 nurses and volunteers declared themselves willing to sacrifice to help those who needed help and were in very isolated conditions. Although initially, MSF experienced many difficulties, especially regarding financing, in its journey, MSF proved that they were one of the INGOs that could develop, as evidenced by the achievement of the Nobel Peace Prize winner in 1977.
The beginning of the establishment was a tough time for MSF. From 1971 to 1976, MSF seemed to be a collection of doctors, nurses, and volunteers who only had enthusiasm, were independent and did not have adequate financial resources (Brauman & Tanguy 1998). This condition makes some parties doubt their capacity and even guarantees that there will be many interventions in the future. However, over time, the founders of MSF reaffirmed that symbols became very important in the early days of the establishment. Before, no INGO had done the same thing, sending doctors and other health volunteers to isolated places. The increasing conflict in the South creates more value for MSF because of the large number of refugee camps that have emerged due to these conflicts. Unlike UNHCR, which lacks doctors, MSF has a large stock of volunteer health workers ready to depart in all refugee camps in conflict areas (Brauman & Tanguy 1998). MSF is also helped by the volunteers' passion, considering that previously they were health

WIMAYA: Interdisciplinary Journal of International Affairs
Vol.03/No.01, January-June 2022 (e- ISSN: 2272-3760) workers who practiced in France and its surroundings. Many are then excited because they see medical phenomena in the South for real, which have only been seen through their books and studies. This attitude has encouraged MSF to be able to retain many doctors and continue to send many volunteers on an ongoing basis. Technically, MSF has very agile and practical steps to implement in remote areas. One of them is the availability of medical kits and logistics ready to dispatch. This condition is supported by MSF's readiness to carry out its mission structure, both in transportation and communication. The use of radio and HT and collaborating with local parties on transportation issues illustrates how MSF as an INGO in humanitarian matters is technically ready to save many lives in isolated areas. Furthermore, MSF is trying its best to continue to help many people and see how the political conditions are so as not to endanger their volunteers.

b. The Humanitarian Crisis in Ethiopia: An Emerging Dilemma
Several countries in the African region are experiencing bad conditions, one of which is Ethiopia. The Civil War that lasted for almost 20 years made the country a hell where many people were starving. Some say that the famine in Ethiopia is the effect of a prolonged drought (Haylemariam 2015). However, the famine in the period 1983 to 1985 resulted from the authoritarian government of Ethiopia. One of those who said that the cause of hunger in Ethiopia was the government itself, Nobel laureate Amartya Sen, revealed a close relationship between democracy and hunger (Haylemariam 2015). The famine in Ethiopia was the worst in history, where the death toll in the northern region reached 400,000 (Woldridge 2014). The term "Hell on Earth" is not an ordinary joke when you look at the condition of Ethiopia at that time. Hundreds of people die per week, and small children dig and gather at several points considered to produce food. Mothers carry their babies, run when vehicles pass and sell whatever they have to get food.
As an INGO based on humanitarian aid, MSF openly came to Ethiopia with a noble purpose. Conditions in a country that has become a symbol of famine and disaster in Africa moved the hearts of MSF officials to send their volunteers. MSF carries out its mission in Ethiopia in line with MSF's vision and mission, which is fundamentally different from the International Red Cross (Davey 2011). They distributed aid, opened health posts for the sick, and helped transport the aid. At first, everything went according to expectations. However, over time, MSF volunteers discovered the peculiarity of the system running in Ethiopia related to the assistance provided. Quoted directly from Scott (2002 in Bell & Carens 2004, 318), one of the representatives from the Belgium branch of MSF described the views of the volunteers assigned to Ethiopia, Eric Dachy, describing the conditions on the ground when they were on duty: "The Ethiopian famines of the early 1970s resulted from government policies of the Derg under Mengistu, which employed starvation as a means of control. Most of the NGOs working to alleviate this humanitarian crisis refrained from publicly challenging the government's human rights record, policies, cover-up of the cholera epidemic, and conduct of civil war in the northern part of the country based on the precept that they should avoid politics. Medicins sans frontieres (Doctors Without Borders) expressed opposition to the government in this case, and was expelled. Hence, it seems safe to assume that silence in the face of abuses was necessary if the starving were to be fed." This part explains the MSF's stance, unlike the International Red Cross, which decides to remain silent when there is a discrepancy in the government system WIMAYA: Interdisciplinary Journal of International Affairs Vol.03/No.01, January-June 2022(e-ISSN: 2272 regarding assistance to those in need. An INGO, especially a humanitarian or humanitarian-based INGO, must be neutral and impartial to anyone considering its position as an actor between states and global corporations. It is the price of neutrality that must be paid dearly. Many innocent victims must be sacrificed to protect certain parties' interests. Ethiopia under the Derg regime was proven to have committed many acts of violence, taken advantage of assistance from INGOs, and killed many innocent people. As quoted by Dachy, humanitarian INGOs must help those in need. Not as a government agent to carry out covert missions that harm the people. Some have seen that the Ethiopian government uses assistance from foreign INGOs to attract the attention of populations affected by famine and make them displaced people in the future (Bell & Carens 2014). The Derg regime at that time seemed to use the famine in Ethiopia to attract world attention and as one of their political agendas in fighting the opposition in the north. MSF is suspicious of the Ethiopian government's agenda of moving its population from the drier north to the more fertile South. In the first relocation operations, as one of the INGOs in the field, MSF also assisted. Over time, MSF saw much violence that occurred during the resettlement process. Worse, it seems as if there is no effort to bring together family members (Brauman & Tanguy 1998). The transfer process seemed as if they were moved without showing the people's health, many of whom eventually died on the way because there was no medical treatment for those who were sick.
In early 1985, MSF became increasingly aware that there was a political element in the agenda, and even MSF, as a humanitarian INGO, was involved in it. The hunger never shows results, even though there has been quite a lot of aid distributed from both the state and INGOs has also raised questions in the minds of MSF volunteers. The West blames Ethiopia's inability to deliver aid across the country and focuses solely on resolving their civil war (BBC 2000). This is what gives MSF volunteers an idea, have they been used all this time? Starting from that question, they realized that some of the assistance from MSF that should have been distributed according to the procedure was diverted to fulfill their interests. The New York Times (1985) stated that this displacement was one of the government's strategies to weaken the north, where rebel groups were in the region. Reports noted that at least 100,000 victims died because of the error of the volunteers (New York Times, 1985).
Unable to stand what the Ethiopian government was doing to those who should have received help, MSF made a statement. They cannot afford to be in the same corridor as the Ethiopian government, which is only defending their evil deeds (Bell & Carens 2004, 318 Humanitarian-based INGOs, such as the International Red Cross, do not touch the affairs of the state at all. Although many problems around him, the International Red Cross only focuses on helping those in need. It was this feeling that later confused MSF while in Ethiopia. How can they remain silent and do nothing when the aids they provide are supposed to help the community but are one of the causes of the loss of 100,000 lives. The problem of morality is one of the obstacles to implementing the humanitarian mission. Sometimes it is pretty complicated, especially when INGOs decide not to get involved with state affairs, such as not taking sides with any party when a conflict occurs in the host country. MSF's stance in announcing that they should be responsible for the deaths of 100,000 people is quite a bold move compared to other INGOs who have chosen to remain silent about the conditions of a country they are helping. What if the volunteer doctors become victims of the civil war? This condition continues to raise questions regarding the neutral condition in the host country. Does MSF report that by keeping silent about what is happening in Ethiopia, where is the humanity they hold dear? (May, 1986).

c. The Dismissal of INGO from the State: The Weak Position of NGOs toward State
The dilemma experienced by INGO is not something that will happen on purpose. On the contrary, INGOs emerge as actors who have a vision and mission, both of which are not owned by the state and global corporations. This can make INGOs also have a considerable influence in shaping a state policy and international view of a state condition. The problem of the dilemma lies in ethics, where when INGOs are expected not to "overstep" the state's authority to take action. However, this condition went against the conscience of INGO volunteers. They saw injustice on the ground, even violence that was not supposed to be. As if they were in the wrong position, INGOs would try to remain neutral by not interfering in state affairs.
The neutrality carried out by INGO is that the price is relatively high. One hundred thousand lives were lost in relocating people from North to South, where MSF was involved. As if not wanting to get more "protests", the Ethiopian government decided to "expel" MSF from Ethiopia on multiple charges. Was MSF made the wrong move? So dismissal is needed? To quote McDann & Johnstone (2005in Murdie 2014, 234) that: "World politics has undergone a radical and often-overlooked transformation in the last 15 years, resulting neither from the collapse of the Soviet Union nor the rising tide of fundamentalism, but from the unprecedented growth of nongovernmental organizations around the globe. NGOs or Civil Society Organizations (CSOs) have moved from backstage to center stage in world politics and are exerting their power and influence in every aspect of international relations and policy making. NGOs have been a positive force in domestic and international affairs, working to alleviate poverty, protect human rights, preserve the environment, and provide relief worldwide." The quote above reveals that INGOs (and Global Civil Society) have started to have great power in the international constellation. In addition, the number of INGOs in the constellation of international relations has never decreased. On the contrary, even from year to year, it has consistently increased significantly. In addition, the collapse of the Soviet Union and the end of the Cold War encouraged the development of actors other than the state, considering that during the Cold War, actors in international relations were only limited to the two superpowers. Of course, this should make the state pay more attention to INGOs. INGO targets that are very "humane" encourage them to gain popularity more easily among the public. The presence of INGOs, coupled with their reports, can also shape people's thoughts regarding "crimes" committed by the state. If the state takes careless steps toward the presence of INGOs, this can make the country lose its sovereignty and no longer get respect from its people. Worse, it can be seen as an evil party because it only sees its interests without considering the conditions of its community.
Nevertheless, some things should also be considered. Emerging as an "angel" in an individual security, INGOs are also part of several problems that arise, such as a form of plan that may not work correctly (Schuller 2007in Murdie 2014. The number of deaths that occurred after MSF arrived in Ethiopia was part of the "failure" of the mission from MSF itself, but at the same time, the source of the problem was not only the INGO concerned. MSF as an INGO claims that they are also responsible, showing that the actual position of INGOs is still relatively weak compared to the host country. Why then did MSF not take any action that could stop the government's activities in moving people from North to South? The author's answer is relatively short because MSF has no army or security forces that can "protect" the volunteers if they protest. MSF in Ethiopia should indeed be under the authority of the state, but again, the actions of Ethiopia itself are actions that should not be carried out. By utilizing assistance from MSF as a humanitarian-based INGO, the government's political agenda has harmed the values upheld by them. MSF sees that what the Ethiopian government is doing makes MSF appear as the "prime suspect" because it is directly responsible for the deaths of people who were transferred from North to South. Problems do exist in the relocation process, where MSF is one of the directly involved parties. MSF also feels that what is happening on the ground is a very dilemmatic condition. They must be under pressure to continue carrying out their activities regardless of the conditions on the ground caused by inappropriate state actions. However, should INGOs be dismissed from a country? In the author's opinion, this should not have happened. Expelling an INGO from a country that initially needs assistance will only give the international world the impression of "to cherish a viper in one's bosom" for the international community. Many of the responses related to the dismissal of MSF from Ethiopia, despite all the accusations given by the local government, were disappointed because of the harshness of the Derg regime at that time. Peter McPherson, head of the United States Agency for International Development, revealed that what happened in Ethiopia would be of particular concern due to a large number of casualties (May 1986). MSF's dismissal from Ethiopia also emphasized that the country dubbed "hell on the earth" does not have a robust democratic system. Instead, strong authoritarianism has become the foundation of the country and has increasingly "prospered" the famine outbreak.
Judging from the position of NGOs in the context of the law, NGOs have been proven to be involved in setting international standards, especially regarding human rights (Martens 2002). This position makes NGOs supposed to have power, especially in the history, NGOs also sit as drafting committees in the process. We could see from the story of Amnesty International in the process of making the Convention of the Abolition of Torture (Cook 1996in Martens 2002. Even though they have a large enough influence in international dynamics, NGOs do not yet have a legal international personality (Martens 2002). Surely it portrays a difficult position for NGOs; cannot go against a state that legally has the force of law. Problems can occur again if NGOs transform into INGOs that cross the national borders. Because, when an actor crosses national borders, the actors or NGOs must follow the rules in the host country. Charnovitz (in Simmons 1998) reveals that the involvement of NGOs is quite dependent on two things, the needs of government and the capabilities of NGOs. The capability of NGOs is a concept that NGOs can create themselves, by adjusting their resources and development. Meanwhile, the needs of the government are quite relative; what if the government changes and is no longer friendly to NGOs? Of course, this condition will be returned to the context that NGOs do not have the authority as strong as the state, especially in domestic conditions. The explanation above regarding the dismissal of MSF is justification for the conceptual understanding that NGOs still have limitations, especially when dealing with the state. Thus, the oppression carried out by the state by expelling it has a clear legal justification compared to the statements of NGOs which defend their vision of providing humanitarian assistance.

IV. Conclusion
From the explanation above, several conclusions can be drawn. First, an INGO almost always has a noble vision and values. These visions and values are proven by the programs carried out, according to the basis of the INGO. Medecins Sans Frontieres or Doctor Without Borders is a humanitarian-based INGO. MSF has a program to send doctors and other health workers to conflict areas, especially to refugee camps, to apply the vision and values of the founding of MSF. Second, as an INGO that emerged as a reaction from the International Red Cross due to their inability to respond to the conditions of the country concerned, MSF faced a dilemma. This dilemma is related to ethics, where MSF must be faced with a reasonably severe condition in Ethiopia and the local government actually uses assistance from INGOs to save them from rebel groups.
Second, In this paper, it can be concluded that the weak position of NGOs in front of the state can be explained through the legal context. This is because NGOs do not have a legal national personality compared to the state. Moreover, if NGOs have to cross national borders and become INGOs, then the rules that must be agreed upon are the rules in that country. The dismissal of MSF from Ethiopia is proof that in front of the state, NGOs do not have greater authority even though they have nobler goals in the international community's perspective.