Romance and Reality in Humanitarian Action

The Institute of International Humanitarian Affairs

Romance and Reality in Humanitarian Action Kevin M. Ca h i l l , m . d.

O ccasional Paper

5

may 2008

a

The Institute of International Humanitarian Affairs (IIHA), issues Occasional Papers that provide background and reflections on our work in humanitarian assistance. This Commencement Address was delivered at The College of the Holy Cross, in Worcester, Massachusetts. It offers personal memories that explain my own evolution in medicine and international relief operations as well as encouragement to young graduates to become involved in the challenges of our time.

Kevin M. Cahill, M.D.

Ab ou t the Au thor Kevin M. Cahill, M.D., is President and Director of The Center for International Humanitarian Cooperation (CIHC), and University Professor and Director of the Institute of International Humanitarian Affairs (IIHA) at Fordham University in New York City. He also serves as Chief Advisor for Humanitarian Affairs to the President of the United Nations General Assembly. He is Clinical Professor of Tropical Medicine at New York University Medical School, Director of the Tropical Disease Center at Lenox Hill Hospital, Professor of International Humanitarian Affairs at The Royal College of Surgeons in Ireland, Chief Medical Advisor for Counterterrorism for the New York City Police Department, Senior Medical Consultant to the United Nations Health Service, and an advisor to numerous foreign governments.

b

G

raduates of the Holy Cross Class of 2008, your families and friends; Father McFarland and the Administration, Deans and Faculty of this great College; Dr. Collins and other members of the Board of Trustees, thank you for allowing me to be part of your very special day.

C.P. Snow once wrote that, “No one I have read has found the right answers. Very few have even asked the right questions. The best I can do is tell a story.”1 So I will offer you a few connected, very personal, stories that may, hopefully, tie up some of those loose threads that remain to be woven into the education you have now partially completed and, in another way, just begun. I will try to convince you that in those difficult periods of your lives – those times of strife and challenge that each of you will unexpectedly but surely face – there will be flowers hidden amidst the weeds. As most of you know from your own periods of community service, you are likely to find more understanding and consideration, and experience more growth, on those harsh frontiers than in the refined, protected environments of the establishment.

Fifty years ago this month I arrived in Calcutta, and fell in love with a way of life. I find romance in settings that others might – quite legitimately – see only as dirty, broken down wastelands. Surely those negatives existed in Calcutta. But amidst the fetid stenches of Indian urban decay, I mainly recall the strong aroma of exotic spices. I close my eyes but usually see saffron robes rather than soiled rags. I hear music in the cacophonous sounds of the slums, and in the long silence of a city surviving numbing heat after monsoon rains. Like our graduates today, I was armed with a Jesuit College education and, even then, I knew that that probably prepared me more than the skills and knowledge gained in medical school.

1

Over the next four months I attended, every morning, clinical rounds at the All India Institute of Tropical Medicine; but being young and indefatigable, I also spent every afternoon helping to tend the dying in a gutter with a then unknown Albanian nun who the world now remembers as Mother Theresa.

I was immersed in a wonder – filled, strange culture, and faced utterly new challenges and, just as importantly, new opportunities.

One of the most important lessons of India that has remained with me for life, and helped determine what I have tried to do and how, was the realization that one must stay calm and focused in the midst of chaos if one wanted to help others. There was no time for self indulgent, personal concerns. The petty needs that so often dominate our lives distract us from getting critical tasks accomplished. One quickly learned, with embarrassment, that our own individual cares simply didn’t matter much in the face of what others were suffering every day, all day, in the disaster that life offered them.

I returned from Calcutta completely and forever changed. I recall an early welcome home dinner when I tried to explain to my very puzzled Irish – Catholic family that one might come back in the afterlife as a cow or an insect. This, I told them, was why the Hindu treated cattle as sacred, and why the very devout wore masks – in case one inhaled a parent or grandparent. While I was not certain where I stood on this important spiritual matter, I do recall that the dinner was a disaster.

Since then, during a very full, joyous career – if that is an appropriate description for a journey where there were few guideposts along the way – I’ve worked in 65 countries, mostly in refugee camps and war zones. I saw plenty of tragedy during those travels, and no amount of rhetoric can transform scenes that are seared into my soul – the appalling waste of life, and of human dignity; pain that I was often helpless to relieve; the stares of starving children or gang raped young girls. But I always realized how privileged I was to serve, to share, and even begin to identify with those caught in the cross fires of conflicts not of their making. A spiritual solidarity develops in just being with them. They were my brothers and sisters.

I found myself in situations that, at least for me, were without precedent.

2

I soon came to understand that tradition and culture were as essential as aspirin or bandages in running a basic medical program. One quickly realized that prejudice and economic exploitation, pride and politics, racism and religion, weather and witchcraft, corruption and incompetence, were all integral parts of the problems one had to address. It is necessary to appreciate the cry of the oppressed, and the burden of ignorance, fear and poverty, if one is to practice medicine in a developing land, especially during periods of natural or man – made disaster.

There had been no lectures in the American medical school curriculum that would help me establish refugee camps. Our training in diagnosis and therapy had prepared one for the well – stocked consulting room, but not for the grand scale of humanitarian crises that I faced. Solutions were discovered more frequently in the intellectual foundations I received at Fordham in Aristotelian logic and Thomistic reasoning than in the technical formulae of the medical sciences we had been taught. One learned to adapt, on the spot, to be imaginative and flexible, and to try to build life – saving programs based on an understanding, and humility, fostered in earlier courses in comparative religion, and in the bitter lessons of history.

In the most sordid situations I have always felt inordinately humbled to see, often with amazement, always with admiration, the courage and resiliency of the downtrodden, those who seem to have been totally overwhelmed, but then, like the Phoenix, rise again from the ashes. I have always returned – but, in some important ways, I never returned – from refugee camps grateful to be allowed to participate in their valiant efforts.

Relief work in the developing world is often frustrating, and progress can be very slow indeed. Accomplishments are rarely grandiose. I recall asking a former professor, one of the great academic mentors in my life, what he thought he had accomplished after 5 years trying – and ultimately failing – to establish a medical school in the Southern Sudan. “What have you really done?” I asked. After a few minutes, he responded, “I think the drain in front of the clinic works.” Such is life.

I have helped, even healed, many desperate victims in humanitarian

3

crises, but, in turn, they helped, healed, instructed and changed me. I have been the recipient of their kindness – they who had so little gave their meager supplies to me, and, on more than one occasion, offered to protect me with their lives, for that is the obligation of a host in the remote Islamic lands that were, for years, my home. I learned much about the values of clan loyalty and family love around campfires in the deserts of Somalia and Sudan, with elders who were guided by values as noble as our Judeo – Christian traditions. My outlook, and my hopes for you, are influenced by them.

I have been caught behind the lines in armed conflicts, and seen senseless slaughter from Beirut to Managua, and all across the scarred landscape of modern Africa. Somehow in the twisted wreckage of war, and in the squalor of refugee camps, the incredible beauty of humanity prevailed for me, as it does for most of those privileged to work in humanitarian assistance. It is that perspective that sustains us on what otherwise might seem like a journey through hell on earth.

Being dog-dirty and exhausted was a very small price to pay for knowing one could slowly bring order out of confusion, hope out of despair, determination out of fear; these were the incalculable, almost indescribable, rewards. It takes time to refocus the romance of youth into reflective, lasting programs in humanitarian crises, to change the passion of love into healing projects. One learned from errors and failures, and then struggled ahead, with more hard work. As Samuel Beckett wrote, we must “try again, fail again, but then fail better”.

And it didn’t end when I left the camps. After returning to our comfortable American way of life my wife, Kate, was determined that I do whatever was necessary to expose the wrongs inflicted on others. I can still hear her saying, “If you don’t do something – write a book, give an interview, take the heat if necessary, then your silence is adding to the problems of those left behind.” I had to report what I had seen – in professional journals, newspapers, magazine articles, and in a series of related books – to tell the stories of human struggle and the ravages of disease.

4

Kate came with me to troubled areas around the world; she was not a physician or a health worker, but she was my indispensable partner, sharing in all the bizarre chores that are part of humanitarian work. She was my moral compass. It would certainly have been easier – and safer – to reap the rewards assured by a predictable medical practice at home. But that was not what fate offered us. We discovered a new world – and ourselves – in the midst of revolutions; several of them were planned in our living room. We were able to share in the dreams and aspirations of men and women in the third world who were fighting for freedom, for equality, for basic human rights, and, often, for their very survival.

Now you, our graduates, inherit these dreams. You must provide aid to those who suffer, and do so without robbing the oppressed of their last shreds of dignity. Holy Cross has given you the fundamentals. Whether you like it or not, you are part of the tragedies that plague our worlds.

Hopefully you will develop better solutions than has my generation.

Silence and isolation are not viable options. In this era of instant communications your Jesuit education, and your own moral values, make it impossible for you to hide from massive sufferings. And mere compassion is an utterly inadequate response. You simply are not free to stay in a blissful state of denial, to think that expressions of concern, or endless discussions, will suffice.

Somehow everyone must get involved – formally or informally. Maybe it will be in teaching your own children about the reality that faces others of a similar age in less fortunate lands, out there in that harsh world that is getting closer all the time. Maybe you will contribute in a soup kitchen, coaching on a ball field, helping another on the job, or assisting aging parents. Maybe prayer, or some form of art, will be your chosen vehicle – think of the impact that the layers of paint in Picasso’s Guernica, or the juvenile script in Anne Frank’s Diary, had on the 20th Century’s appreciation of the evils of war.

Whatever tools you choose can be multiplied by a philosophy reflecting the early Jesuit missionaries who saw no boundaries in their vocation,

5

who refused to accept any limitations imposed by the restrictive customs of the era. They constantly went “beyond the box” in their zeal to share the good news of Christ throughout the world. Their example was cited so often to me at a college level that by the time I was a doctor in the tropics I could neither understand, nor accept, that there was some rigid definition of medicine that should constrain my professional activities. Why should wearing a stethoscope prevent me, for example, from developing the diplomatic implications of my work?

Just think of the opportunities waiting to be seized if you were in my situation. Why not utilize the credibility and legitimacy one had acquired in healing to reach out to combatants in conflict zones and encourage dialogue? Could humanitarian work be A Bridge to Peace2? Was there not an Untapped Resource linking Medicine and Diplomacy3? Some of us used the good will we had earned to create “corridors of tranquility” in the middle of war zones, establishing brief, but significant, cease fire zones. Could we apply the strict methodology of public health to the softer discipline of diplomacy? While some of these efforts provoked almost predictable skepticism, that book, Preventive Diplomacy,4 has become one of the formal bases for Sweden’s foreign policy.

I have worked among the very rich and the very poor, both on the international and domestic scene, and the experiences – and lessons – are usually the same. You can learn, right here in Worcester, from drug addicts, from the homeless, and the helpless, both rich and poor, and your experiences would, I will wager, be as important as my tales of the tropics.

Each of you must find your own way, hone your own tools, as you continue the incredible journey of life – a trek on which you will find beauty and companionship and joy, where the initial impression may seem like only blood and sweat and tears. That at least has been my experience.5 I share it with you as part of the celebration of your graduation day, in the hope that it will resonate with your own dreams and goals. Maybe my tales will broaden your horizons, and even help you in love, for that is what drives us onwards. Love, ultimately, is all that matters. It is the substance and

6

cement that binds us together. Verities do not change with continents; they are the same in America or Africa. There will be shoals to navigate, but you have the map. You know where the false temptations lead, and, if you are very lucky, as I was, someone will help guide the way. You can get there – don’t allow yourself to be fenced in by the futile concerns of security or fear or despair. One way or the other, it’s time to go for it.

Congratulations and Godspeed on the journey.

notes 1. Snow, C.P., Science and Government, Harvard University Press, 1961.

2. Cahill, K., A Bridge to Peace, Haymarket Doyma, 1988.

3. Cahill, K., Untapped Resource: Medicine and Diplomacy, Orbis Books, 1971.

4. Cahill, K., Preventive Diplomacy: Stopping Wars Before They Start, Basic Books, 1996; Routledge, 2000.

5. Cahill, K., To Bear Witness: A Journey of Healing and Solidarity, Fordham University Press, 2005.

7

The Institu te of International Humanitarian Affairs B o ok Series The Pulse of Humanitarian Assistance To Bear Witness: A Journey of Healing and Solidarity* Tropical Medicine: A Clinical Text†Preventive Diplomacy: Stopping Wars Before They Start* Basics of International Humanitarian Missions* Emergency Relief Operations* Traditions, Values, and Humanitarian Action* Human Security for All: A Tribute to Sergio Vieira de Mello Technology for Humanitarian Action

*Available in French †Available in Spanish

The Institute of International Humanitarian Affairs (IIHA) offers an academic base for the study and development of international health, human rights, and other humanitarian issues, especially those that occur in periods of conflict. At a time when terrorism and war are at the forefront of world affairs, the Institute trains humanitarian workers in the critical skills needed to aid in crises situations. The Institute identifies fundamental needs and uses its talents, contacts, and resources to define practical solutions, while initiating dialogue, understanding, and cooperation among people and nations divided by war an devastated by natural disasters.

The IIHA offers multi-disciplinary training in humanitarian assistance, negotiations, and disaster management through both graduate and undergraduate education, symposia, publications, humanitarian networking, and panel discussions. It provides consultations on humanitarian issues, both within the Fordham academic community and for the larger academic and aid world. The IIHA creates a unique bridge between the Fordham community and the front lines of humanitarian action.

Recent Occasional Papers include Francis Deng on The Sudan, Mark Malloch Brown on Humanitarian Action, and Kevin M. Cahill M.D. on The University and Humanitarian Action.

9

The Institute of International Humanitarian Affairs Fordham University 33 West 60th Street, Suite 804 | New York, New York 10023 Tel: +1 212 636 6294 | Fax: +1 212 636 7060 Email: iiha@fordham.edu | Website: www.fordham.edu/iiha

10

11