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Copyright © The Nobel Foundation, Stockholm, 1999.

Few aims can be more praiseworthy than to combat suffering: to help those in the most desperate situations, whatever their race and wherever they may be, to return to a dignified life. Some persons even have the necessary strength and drive to live up to this ideal. We welcome a few of them today. We do so humbly, recognising that they are representatives of a much greater number of self-sacrificing men and women all over the world. Our thoughts go not least to those who, at this very moment, are working under the most difficult conditions, often putting their own lives at risk, in scenes of the profoundest suffering and degradation.

Every year, Médecins Sans Frontières send out over 2,500 doctors, nurses and other professional helpers to more than 80 countries, where they co-operate with a good 15,000 local personnel. They go where need, suffering and hopelessness are greatest, indeed often catastrophic in nature, regardless of whether the catastrophes are human or natural in origin. We find them in the world's countless refugee camps, as well as among Chinese peasants, Russian prisoners, or the western world's modern city slum-dwellers. They are present in large numbers in Africa - the forgotten continent.

The modest beginnings of Médecins Sans Frontières go back to the early 1970s, and a small group of French doctors formed under the leadership of Bernard Kouchner. What triggered them was their experience of emergency aid work in two disasters, one natural - the great flood in East Pakistan (later Bangladesh) - and one man-made - the cruel conflict in Biafra from 1967 to 1970. Some of the doctors who provided emergency aid in those disaster areas were frustrated at finding their work impeded by complicated procedures and principles of neutrality. The new organization would have to be unbureaucratic, flexible, and willing to take risks.

Médecins Sans Frontières blazed new trails in international humanitarian work. The organization reserved the right to intervene to help people in need irrespective of prior political approval. The essential points for Médecins Sans Frontières are to reach those in need of help as quickly as possible, and to maintain impartiality. They demand freedom to carry out their medical mandate, and to decide for themselves whom to help according to purely humanitarian criteria. What is more, they insist on making human rights violations known. In addition to helping, in other words, they also seek to draw attention to the causes of humanitarian catastrophes. To alleviate distress one must also get to its roots. These were new principles in the field of aid, and have not been uncontroversial. Some said that this was to confuse the issues in ways which might block access to suffering people. Médecins Sans Frontières have been called emergency aid rebels.

The first Nobel Prizes were awarded in 1901, nearly a hundred years ago, at the beginning of the century which will draw to a close in less than a month's time. The first Peace Prize went to Henri Dunant, founder of the Red Cross, who shared it with the peace activist Frédéric Passy. Dunant was goaded into action by happening to be an eye-witness to the incredible carnage at the battle of Solferino in northern Italy in 1859. The award to Dunant came in for criticism. Humanitarian work was not relevant to peace, ran the argument, but simply «humanised» war. There were, however, grounds for the decision in Nobel's will, which mentions «fraternity between nations» as one of the criteria for the Peace Prize. What better or more direct expression can there be of this idea of fraternity than to hold out a helping hand to a sufferer, regardless of identity or party?

The peace Alfred Nobel was thinking of when he established the prize was a peace that is rooted in men's hearts and minds. By showing each victim a human face, by showing respect for his or her human dignity, the fearless and selfless aid worker creates hope for peace and reconciliation. That brings us to the heart of the matter, to absolutely fundamental prerequisites for peace. The decision to award the first Peace Prize to humanitarian work was one of the most important decisions in the history of the prize. That we are continuing, at the end of the century, and the millennium, to recognise humanitarian work confirms that the course plotted then was the right one.

But in the meantime, the world has changed. We are constantly having to face new challenges. The historian Eric Hobsbawm has labelled the century which is now ending «The Age of Extremes». What he has in mind is this century's totalitarian regimes. We have witnessed man-made catastrophes that spread far beyond the battlefields, systematic violations of human rights, ethnic cleansing and genocide. We have been forced to acknowledge the close connection between war or the threat of war and those systematic breaches of human rights. The threat to peace, to real peace, was more extensive than the peace campaigners had imagined at the beginning of the century.

This way of thinking began making itself felt in international work after the second world war, but only slowly. Measures against violations of human rights necessarily present challenges to the established principle of non-intervention. This principle has for a long time been regarded as fundamental to peace work, and is still current, although today it is being confronted ever more strongly by demands for intervention against breaches of human rights. The Norwegian Nobel Committee made its first purely human rights award in 1960, to Albert Lutuli of South Africa. Since then this has been a major criterion for Peace Prize awards, as can be seen from the awards to Martin Luther King, Andrei Sakharov, Lech Walesa, Aung San Suu Kyi, and Carlos Belo, among many others. Those awards, too, were criticised for not being relevant to peace. Many of them gave rise to disputes and protests, principally from the laureates' home countries, as amounting to intervention in internal affairs.

A characteristic feature of Médecins Sans Frontières is that, more clearly than anyone else, they combine in their work the two criteria we have mentioned, humanitarian work and work for human rights. They achieve this by insisting on their right to arouse public opinion and to point to the causes of the man-made catastrophes, namely systematic breaches of the most fundamental rights. The award to Médecins Sans Frontières is first and foremost a humanitarian award, maintaining the tradition that goes back to the first award, but it is also a human rights award, and as such it links up with more recent developments in the history of the Peace Prize.

Like the Nobel Committee's human rights awards, the exposures by Médecins Sans Frontières of violations of human rights began during the cold war, when they were chiefly aimed at the brutality of communist regimes. Since the end of the cold war, the need for humanitarian intervention has certainly not diminished; meanwhile, however, the situations have grown more complex, more chaotic. «War» has turned into something other, and much less clearly definable, than a struggle between the armed forces of identifiable nations. Military units have been dissolved into armed bands. It is often difficult to name those responsible, or to find anyone to negotiate with. And the victims of these wars are not first and foremost the soldiers, as at Solferino, but the civilian populations, the women and the children.

The changed nature of war requires reassessments of strategies for peace. Humanitarian interventions, with or without peace-keeping or other forces, are figuring ever more prominently in such strategies today. Humanitarian interventions have also become important features of the foreign policies of many states. In this connection, voluntary organizations (NGOs) are finding ever more important parts to play. But the politicization of aid work, with voluntary organizations integrating ever more closely with governments, is creating new problems. Situations may easily arise in which motives are unclear and the allocation of functions can be questioned.

On the other hand, we hear talk of «the humanitarian trap». How can you help the victims without at the same time helping their executioners? There have been cases of military groups imposing starvation on a region and then stealing the aid when it arrives. There are brutal regimes which deliberately exploit the aid organizations. Knowledge that someone will care for them swells the flood of refugees - which can contribute to ethnic cleansing. For these reasons, Médecins Sans Frontières have on one or two occasions withdrawn from involvement. The genocide in Rwanda in 1994 led to a huge influx of refugees into the neighbouring state of Zaire. Médecins Sans Frontières were on the spot throughout, but for a time the organization withdrew from the refugee camps in Zaire, in protest against the abuse of aid and the terrorising of refugees by extremists. Médecins Sans Frontières followed their protest up with an appeal to world opinion. That was also the first occasion on which the organization called for military intervention to put a stop to brutality.

Médecins Sans Frontières are generally highly critical of humanitarian intervention by military force. They believe experience has shown them how a humanitarian/military alliance can introduce the logic of war and break down the humanitarian aspect of a mission. In some cases it also increases the risk to the humanitarian aid workers themselves, as happened in Iraq, Somalia and Bosnia. Médecins Sans Frontières do not want military protection, and all their vehicles are clearly marked with a symbol showing that they are unarmed: a submachine-gun with a heavy cross painted over it.

Henri Dunant imagined that there was a neutral zone, which lay outside the spheres of interest of the warring parties and which one could therefore enter with humanitarian aid. Today we see such «humanitarian zones» invaded by both sides, obliging aid organizations to make political choices and take positions on complicated moral issues. It is precisely in such situations that it becomes especially necessary to preserve one's independence. Médecins Sans Frontières are among the organizations which attach the greatest importance to independence, insisting among other things that half their revenues must come from private donors.

A large number of aid organizations are extensively and selflessly engaged in alleviating suffering all over the world. They all deserve our gratitude and our attention. Médecins Sans Frontières have a distinctive profile, and have managed to preserve many of their original virtues. They are frequently the first to arrive at the scene of a disaster. The organization remains pervaded by idealism and willingness to take great risks. It has kept its independence, and seeks systematically to draw attention to violations and distress.

Equally important is the fact that Médecins Sans Frontières have indicated, more clearly than any other organization, how burdened aid work is in our chaotic world with political and moral dilemmas. The organization has tried in various ways to adapt to this, and has, sometimes through provocative initiatives, set in motion an absolutely essential discussion of the problematic nature of humanitarian interventions, not only in their aims but also and chiefly in their consequences. Good deeds are important, but they should also lead to good results. Here as so often in life, a balance has to be found between an ethics of conviction and an ethics of responsibility. Through their strategy and their initiatives, Médecins Sans Frontières have unquestionably influenced the whole development of international aid work.