A haunting documentary revisits Dr. James Orbinski’s dilemma treating victims of brutal conflicts in Africa

The Rwandan genocide of 1994 was one of the most violent episodes in modern history. About 800,000 people were killed in 100 days. Most of them were hacked to death with machetes.

Through the worst of the brutality, Dr. James Orbinski led one of the very few nongovernmental organizations to remain active in Rwanda. Heading Médecins Sans Frontií¨res’ humanitarian mission, he was forced to choose who would survive and who would die.

“I don’t have regrets about the decisions,” Orbinski says in the opening scene of Triage: Dr. James Orbinski’s Humanitarian Dilemma. “I have complete outrage against the circumstances that created that situation where that kind of decision had to be made.”

Around hospitals in Rwanda during the genocide, the wounded would gather in numbers that overwhelmed Orbinski and his staff. To keep the mission afloat, a system was devised.

“We labelled them one, two, three, with little pieces of tape on their foreheads,” Orbinski, a Toronto native, says in the film.

A one meant that the person must be treated immediately; a two gave the patient 24 hours; and a three let hospital staff know that the person was still alive but could not be saved.

“Triage: there are moral implications but it is a technical decision,” he explains on camera.

Throughout the 1990s, Orbinski’s work for MSF saw him respond to humanitarian disasters in Afghanistan, Somalia, Rwanda, Democratic Republic of the Congo, and Kosovo. He was eventually appointed president of the organization and accepted a Nobel Peace Prize on behalf of MSF in 1999.

Triage—which previously played in Vancouver at the DOXA Documentary Film Festival and the Amnesty International Film Festival this year—documents Orbinski’s return to Africa after working in conflicts that engulfed parts of the continent in the early 1990s. Patrick Reed makes his feature-length debut with the film, which opens Friday (November 21) in Vancouver, and brings a haunting feel to the project while simultaneously managing to capture hope that drives MSF’s work.

Speaking with the Georgia Straight in Vancouver at the Century Plaza Hotel, Orbinski described one of the greatest challenges of working in war zones as remaining apolitical.

“There are circumstances where moral neutrality is an obscenity,” he said. “Genocide is probably the most extreme. But in order to work in war as a humanitarian, one has to accept that war exists and one has to avoid taking sides in the war.” He said that that means adhering to very basic principles: impartiality, neutrality, and independence.

Orbinski argued that since the Cold War, humanitarianism has been increasingly co-opted by politicians of the West. NATO’s intervention in Kosovo—which Orbinski said he believes was a legitimate military action—was sold to the public as a “humanitarian ethos”.

“Afghanistan and Iraq and the ways in which those wars have been raised under a humanitarian rubric are just simply extensions of what happened in Kosovo,” he continued.

For aid organizations, “it means our workers are assassinated, they’re kidnapped, they’re raped, they’re beaten,” Orbinski said. He noted that five MSF workers were assassinated in Afghanistan in 2004, which led to MSF’s evacuation from the country after having worked there for 30 years.

Orbinski expressed a firm belief that just as aid organizations must remain apolitical in order to operate in conflict zones, governments must refrain from getting too close to NGOs. When governments do associate themselves with NGOs, he explained, civilians will no longer view the people trying to help them as neutral. The failure in trust can translate into a loss of lives.

But when a relationship is established between an aid worker and someone in need, the bond can last for a very long time.

In the film, Orbinski visits a town in Somalia called Baidoa. There, in 1992, he helped care for a population of 80,000 that lived under constant threats of violence and famine.

Upon Orbinski’s return, he finds an old Somali friend, Adam Hussein, running an orphanage with 300 children in his care.

“Why do you do it?” Orbinski asks.

Taking a piece of paper out of his pocket, Orbinski answers his own question by reading an answer Hussein gave him 15 years earlier. “These children have lost everything but they are still seeds waiting to grow,” Orbinski says. “They are our seeds for tomorrow’s Somalia. Tomorrow’s Somalia will be better. We want them to care for their country and so we must care for them today.”

Leaving Baidoa, Orbinski attempts to put the highs and lows of his return to Somalia in perspective.

“Was it worth it for me? You’re damn right it was,” he says. “If you ask those 80,000 people, I think they’d say the same thing.”