Dr. James Orbinski- Ethics, War and Doctors Without Borders

12 mins read

A related fact is that our society until recently found it acceptable that millions of poor would die from AIDS because it was unwilling to make retroviral drugs available at a price they could pay. “You see the barbarity when you unpack those assumptions.”

Many people would be morally paralyzed by these insights. But Orbinski decided to climb out of the pit. He did it, he says,“by being realistic about what we’re capable of. We’re not good, by definition. Goodness is a choice. But it’s a wise choice, as long as you’re not being Pollyanna-ish. You can take realistic steps to make a difference.”

In Rwanda, for example, “we spoke out, knowing we might be expelled. But that’s not always the wise thing to do. Sometimes you can speak informally to the Minister of Health. There’s no algorithm.” Meaning: no rulebook, no method.

In Triage, he describes finding a dying Hutu woman with her breasts cut off and semen on her legs, as well as fatal machete wounds in her body. What really stunned him, however, was that the attacker had then taken a knife and carefully sliced a pattern of crosshatched lines on her cheeks and forehead. They were straight and evenly spaced. Crafted.

Even today, he can’t say he understands what went through that attacker’s mind. But he has made a study of moral thinkers who lived in genocidal times—Simone Weil and Hannah Arendt are two that he mentions—and has come to agree with them that collective evil is not done by people who are deranged or depraved. Normal people who have convinced themselves that somebody else isn’t as human as they are do it.

These were the matters that Patrick Reed discussed with Orbinski when they finally made their way to Somalia with a film crew three years ago. Since the country’s civil war still continues, there were no commercial flights. With difficulty they chartered a private aircraft (“the pilot didn’t want to go,” recalls Reed) and flew to Baidoa, the city where Orbinski’s clinic wasbuilt.

Back in 1992, clan warfare and war-lordism made every move dangerous. When Orbinski would leave the fortified clinic to visit famine areas, he had to travel in trucks with heavy machine guns and half a dozen guards quite prepared to use them. On occasion these guards, who also protected the Red Cross and many others NGOs, turned on their employers and murdered them. Orbinski one day had to walk in to his clinic’s courtyard—an act of great courage—because the guards were going to kill Lesto, his highest-ranking Somali employee. He bought them off, and (understandably) one of the film’s most moving scenes is his reunion with Lesto, who is still running the clinic ten years after Doctors Without Borders abandoned it.

Reed and John Westheuser spent many days observing Orbinski and his old friends, waiting for them “to forget we were there” and learning to understand their body language and rhythms so that the camera could follow them naturally. One day Orbinski was recalling how he had pinched a woman with his forceps, to stop her hysteria so he could treat her. “When James suddenly shaped his hand like a forceps and made a ‘forceps’ movement with it, John tilted the camera downward and caught the gesture,” says Reed. “It’s like knowing your poker partner; you can sense what he’s going to do.”

Reed had taken genocide studies as a young student in Montreal, and he knew that the bond between Orbinski and the Baidoa staff was based on experiences that his film crew could not truly imagine. “Especially when James would pause on camera, remembering something that he couldn’t describe. It was difficult, as a filmmaker, being in these moments when he’s so far away. But you get up the next morning and do it again, because you’re with a crew you can trust.”

Back in Toronto, editor MichelleHozer worked with Reed to assemble the film. Orbinski was the narrator, both on camera and off, and sometimes Hozer wanted to cut away to other footage to show the viewer what he was describing. “In [James’] silent moments especially, we tried going to stock footage [of the Somaliwar],” she says. “But it broke the special space, the tension that James created by his silence.”

In part this was because Westheuser had kept his camera very close to Orbinski’s face as he was speaking. “We wanted to stay there,” says Hozer. Of course she did sometimes cut away to other footage, but almost always she was able to use footage that the crew had shot elsewhere in Baidoa during the same visit. Sometimes she went to stock footage from 1992, but as a rule restricted herself to the rare bits where a younger Orbinski is visible.This, says Hozer, allowed her to maintain the narrative intensity.“Trial and error brought those scenes together.”

The rest of the film, shot in Rwanda and in Congo, posed a different challenge. In those places Orbinski’s old staff was no longer present. In Rwanda the crew filmed him meeting with the new European administrator of his former hospital. The remarkably incurious gentleman did not know who Orbinski was, and expressed surprise on learning that genocide victims had been treated there less than ten years before. Orbinski’s frostiness is palpable. “James doesn’t open up to just anyone,” comments Hozer. “Like when you saw him with the director of that hospital in Rwanda.”


The events recounted in Triage ended in Congo in 1996. Orbinski and his team, having done what they could during the Rwandan Genocide, had followed the vast column of refugees who fled to Congo. But the tribal bloodletting continued, and when yet more Doctors Without Borders staff were killed, Orbinski and his colleagues were forced once again to withdraw. Back in Canada, he told his friends that he had seen enough horror and faced down enough gunmen. He wanted a normal life.

“That’s when I got married—but not to Doctors Without Borders. To an actual human being!,” laughs Orbinski. His long face and pliable mouth transform themselves into a radiant smile. Eight years would elapse before his chance meeting with Patrick Reed in Rwanda in 2004. In spite of his declaration of marital monogamy he did, in a sense, also marry Doctors Without Borders. When the organization received a Nobel Prize in 2000, its president was Orbinski and it was he who went to Oslo on its behalf.

Although he tried to keep his promise to himself and his family that he would never again risk his life, Orbinski did visit the battle fields of Kosovo and Afghanistan on the organization’s behalf. And he found himself unable to stay away from Rwanda, which he visited “many times” during those eight years.

It was on one of those visits, in 2004, that his chance encounter with Patrick Reed took place. They remained in contact because Reed wanted to make the film. Orbinski was not so quick to decide. “It took two years for us to get to know eachother as people,” he says. Only then did he decide “to trust Patrick, and Peter Raymont, with this story that is not yet clear. And they were willing, on camera, to see where the story went.”

Orbinski’s one condition was that Triage couldn’t be “another version of scripted talkingheads.” What it would be, however, he didn’t know. “I’m not a filmmaker,” he says. “My relationship with Patrick as director was crucial. And knowing that John Westheuser and [soundman] AoLoo had worked together before and had a warm relationship was important. It was fun and it was serious. Ao would feel the nuance of sound. I’d watch him discern the complexity of sound, and get what he wanted. And John, with that huge camera on his shoulder, somehow became invisible. Not only to me, but to all the people we talked to.”

The doctor also exacted an agreement that people would be filmed only with their permission. Only a few refused. “The surprising thing is how much people want to be heard. They need a sense of validation that [what they went through] was outrageous, and to have that confirmed by someone listening.”

This observation echoes Patrick Reed’s belief that the making of a genocide film must be both amoral and a creative under- taking. “When James talks about what he saw, he’s not just telling stories. He is bearing witness.”

Reed and his crew also attempted, although burdened with cameras and microphones, to bear witness by preserving the stories they heard. In the end, says Orbinski,he and the filmmakers of Triage were united in the same task.

“People who lived through genocide just want someone to listen to their story,” observes Dr.Orbinski. “The listening tells them that they have not been expelled from the human family.” He pauses and says,“One day, [it] will make it possible for them [all of humanity] to say, ‘I am responsible for what happened here.’”

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