Among the first aid groups to go into conflict zones or disaster areas, and the last to leave, is Doctors Without Borders, known primarily by its French name, Médecins Sans Frontières. But even MSF has had its staffers expelled from Sudan and Sri Lanka and pulled its staff from aid camps in some of the neediest sections of Somalia and the northern Kenyan border because of attacks in recent years.
Michael Neuman, who has headed MSF missions in North Sudan and Niger and has run logistics in battle zones like Chechnya and Kosovo, recently co-wrote a book, "Humanitarian Negotiations Revealed," about the strategies MSF uses in an increasingly hostile world. He says the key in a war zone is to make the best of a bad situation, mediate with local authorities to create working space, and judge success by how many lives one saves.
"People have to realize there was no golden period of humanitarian aid," says Mr. Neuman. "In 1990, after the fall of the Berlin Wall, we hoped the world would be easier to work in.... But then we faced Somalia in the early '90s and the Bosnian war and the genocide in Rwanda, and we had enough examples to let you know that times had not changed."
Neuman's book looks at a number of case studies in which local MSF staff made judgment calls, at times deciding to overlook a government's inhumane actions – such as the aerial bombing of civilian areas in Yemen in 2009 or the shelling of Tamil civilians by the Sri Lankan Army in 2009 – in order to maintain health facilities for larger dependent communities.