I am honored to be speaking to you here today to commemorate 25 years of the UN International School.

The year 2001 also marks an anniversary for Médecins Sans Frontières, or MSF as we are known in the field, as we enter 30 years of operation. As a volunteer medical organisation, MSF works to provide medical assistance to vulnerable populations caught up in conflicts, natural and man-made disasters and epidemics, as well as longer-term medical emergencies. Operating in such crisis situations, we at MSF are confronted on a day-to-day basis with the obstacles and pitfalls of humanitarian action, and I shall therefore raise today some of the challenges that we continue to face.

When MSF began in 1971, it changed the nature of humanitarian action. The doctors refused to wait for the approval of all parties before acting and insisted on the right to speak out in the face of violations of humanitarian law. Putting the needs of populations in danger above political considerations is engrained as core to our mission - and in this, MSF has helped shape the humanitarian movement worldwide. It is for this reason that the creation of MSF was said to herald a small revolution in humanitarianism. And in 1999, by awarding the Nobel Peace Prize to the 'rebellious humanitarianism' of MSF, the Nobel Committee chose to reward the sometimes controversial choices made by MSF, which sees acting and speaking as two inseparable elements of providing relief to endangered people.

In effectively carrying out our work, MSF faces many challenges and ethical dilemmas brought about by the complex dynamics of modern society. The past 25 years have seen particularly bloody and violent civil wars and also a proliferation of actors involved in the provision of aid, each working under their own specific mandates. International wars fought between states have become less common. Internal conflicts involve a multiplicity of actors, each intent on pursuing their own interests, invariably at the expense of the civilian population.

Denied the protection of their own governments, civilians are targeted by armed groups in policies of 'ethnic cleansing', genocide, systematic rape and mutilation and other crimes against humanity. Those who survive the conflict are often forced to leave their homes through violence and persecution.

We only need to look at the current situation in Africa, where millions of refugees and internally displaced persons - or IDPs -are trapped in extreme conditions between the warring parties to know that the mechanisms established by the international community to protect vulnerable populations so often fail to achieve their goal. In the absence of credible and effective enforcement mechanisms, the humanitarian community can do little to help the targeted populations.

Furthermore, in the face of continued inability or reluctance on the part of governments and the international community to prevent humanitarian crises and to adequately protect those at risk, humanitarian organisations like MSF are being called upon to fill the void and to cope with the consequences of brutal conflicts.

In understanding the role of MSF in providing assistance to vulnerable populations caught up in conflict and disaster situations, it is important to underline the guiding principles of neutrality, impartiality and independence that characterise our work. These principles are not unique to MSF, yet we have deliberately chosen to move beyond the approach of 'silent neutrality' such as that historically taken by the ICRC, to an interpretation of impartiality that places the needs and interests of those at risk at the heart of the equation. Where strict neutrality may imply a principle of abstention from action if this could be perceived as taking sides, the concept of impartiality allows MSF greater scope to address the needs of the vulnerable when and where most required. By focusing on need as the driving principle of action, MSF may adhere to the principle of impartiality in administering essential medical care to those most affected, yet may speak out about the humanitarian law and human rights violations that are witnessed by our staff in the field.

Disturbingly, the perception of humanitarian organisations as independent may be jeopardised by the rise of the dangerous slogan of 'military humanitarianism' which creates confusion about the mandate of NGOs.

For example, although the humanitarian nature of some UN agencies is asserted, it remains difficult for them to enjoy the absolute political freedom required to be called 'independent and impartial humanitarian organisations.' This difficulty is aggravated when the UN is also engaged in measures such as sanctions or peacekeeping operations.

Humanitarian NGOs have been under increasing pressure to coordinate with the UN - which in practice means coordinating under it. While this might be politically efficient or expedient, it jeopardises the necessary political independence of humanitarian action. Despite the fact that MSF never takes sides in a conflict, we can be viewed as not being impartial by warring parties.

In the Ituri district in the northeast of the Democratic Republic of the Congo (DRC), the conflict between the Hema and Lendu ethnic groups had left, by the beginning of the year 2000, an estimated 7000 civilians dead and a further 180 000 displaced. In January 2000, MSF was providing essential medical assistance to wounded persons from both the Hema and Lendu tribes, in addition to helping to support medical facilities and train medical staff. However, rather than being allowed free access to the populations at risk, MSF staff were themselves targeted by warring parties who accused them of taking sides in the conflict. MSF teams operating in Bunia were attacked and were forced to withdraw from the region, meaning that humanitarian assistance was denied to those most in need. In such complex emergency situations, where often the entire structure of governance has broken down in a country, a further obstacle to securing access to populations at risk is that there may be no clear authority over a region or that the leaders of rebel groups may be difficult to identify.

MSF is often faced with the threat that access to those in danger may be denied by the parties controlling a region who seek to prolong the conflict. Equally disturbing is that, even where aid is provided to assist the vulnerable populations, the effects of this assistance may do more harm than good. In a context where political battles are being fought out by various actors, with little regard for the cost, aid may be manipulated or diverted as a ploy to further the interests of one particular side.

MSF was one of the first agencies to come and assist the million Rwandan refugees in Goma who stepped across the borders in the late summer of 1994. But we were also the first to abandon those camps, run by the Hutu majority, a few months later when it became clear to us that they were in reality nothing more than military sanctuaries, holding refugees hostage. MSF argued that no aid was better than aid manipulated by the 'genocidaires', who were re-engineering further violence in the region and controlling through terror the population in the camps. We refused to let our aid strengthen the leadership and monetary power of the 'genocidaires', and directly or indirectly help fuel violence in the region.

Leaving needy patients was hard, but remaining as accomplices could not be contemplated. In such cases, where aid for vulnerable populations becomes the subject of manipulation by warring parties, the continuation of humanitarian assistance may serve only to prolong the conflict.

In 1999, the government of Burundi set up 38 regroupment camps in the province of Bujumbura into which it herded around 350,000 displaced persons who had been driven from their homes through fighting. The living conditions inside the camps were terrible with a lack of access to drinking water, food, medical care, sanitation and shelter. Disease and mortality rates were disproportionately high as a result of these conditions. MSF responded to this situation by sending volunteers to work in three of the camps, providing essential health care, drinking water and shelter to those affected. However, in spite of the extreme needs of the population, it became clear that, in providing assistance, humanitarian agencies were inadvertently endorsing the camps which in themselves constituted a violation of the most basic human rights of those forced to live there. For this reason, MSF withdrew its teams from the regroupment sites in Bujumbura.

Today, the label of 'humanitarianism' can be too selectively employed, as reflected in the past year in the very different international response to Kosovo and East Timor for example, when compared to Africa. In Kosovo, NATO governments gave a humanitarian label to the war to generate public support for military intervention. They supplied vast resources to humanitarian activities, apparently for the same reason. A number of these so-called 'humanitarian actions' were provided through NGOs from their own countries, which further blurred the line between independent humanitarian actors and parties to the conflict. MSF was so concerned about this deliberate confusion of military and humanitarian labels that we refused all government funds from NATO countries for our work related to the conflict. MSF insisted that the armed forces involved in the conflict be removed from the refugee camps to avoid endangering the people seeking shelter. The scale of aid that poured into Kosovo also highlighted one of our ongoing concerns regarding the different responses offered in the face of the same need.

Another example is East and West Timor. A lot of international resources went to the UN intervention in East Timor for both peacekeeping and humanitarian action. At the same time, in West Timor, which remained part of Indonesia, large numbers of people were regrouped and abandoned without protection or help. We question the different responses offered in the face of the same need. Progressing down the scale of international concern and response, the picture gets worse.

When the Russian government indiscriminately and disproportionately bombed civilians in Chechnya, the idea of 'morally-based intervention', justified in Kosovo on humanitarian grounds, seemed no longer to apply. This contributed to the fact that humanitarian organisations were denied access - despite our protests - to people who were most in need of help.

At the bottom of the scale, Africa seems to have been totally abandoned. Poorly equipped and supported peacekeeping operations in Sierra Leone and the Democratic Republic of Congo are in stark contrast to the well-equipped peacekeepers in Kosovo, a vivid illustration of the lack of interest for Africa. So often when Africa is concerned, it is easy for the outside world to sit back and push the idea of a 'regional approach' - let Africa take care of Africa.

Where humanitarian assistance is used as a political tool rather than to benefit the population in need, or where it serves only to prolong the conflict, the best course of action may be to speak out publicly and at the level of governments and the United Nations, rather than to endanger the lives of those we seek to assist by a continued presence on the ground.

Given the political context within which conflicts are fought and humanitarian actors are engaged, it is essential for MSF to have a mechanism by which the concerns of the field may be presented within the political arena.

The MSF UN Liaison Office plays a crucial role in this respect by bringing to the attention first and foremost of the primary UN actors (both agencies and Member States), the humanitarian and especially medical needs of the population, the obstacles faced by volunteers in the field and the violations of humanitarian and human rights law that they have witnessed. The insight that these volunteers have may be used by these political actors whether to highlight the failings of governments and the UN and its agencies to respond adequately to the needs of people caught up in crises, or to enact concrete change.

As MSF's delegate to the United Nations, upon receiving information from the field on the situation of populations in danger, I enter into dialogue with UN officials and representatives of Member States of the UN and the Security Council, in a bid to ensure that the MSF field perspective is taken into consideration in seeking the most effective response to the situation.

Concerns that are consistently raised by MSF before the UN and its Member States are lack of access to areas of conflict, the problems of security of civilian populations caught up in the tensions, the politicisation and manipulation of aid and the usurpation of humanitarian action by political actors.

There is also a frequent failure on the part of various actors, such as the UN, governments and the warring parties to uphold their responsibilities. The demand that humanitarian principles, international law and medical ethics be respected by all those involved in humanitarian crises constitutes a motivating force in our advocacy campaigns and in the work that is addressed within the UN Liaison Office.

The events of the past quarter of a century have created enormous challenges both for the UN and for humanitarian organisations such as MSF. Ethnic conflicts have created vast problems, such as massive numbers of refugees and IDPs, that the international community has been unable to deal with adequately, and the pressures put on civil society to cope with the aftermath have raised questions as to the role of NGOs and the limitations of humanitarian assistance.

For MSF, humanitarian action is much more than the provision of simple technical or medical assistance. To protect populations at risk, humanitarian action must be specific to civilian needs and vulnerabilities. More than this, it must also be perpetually analytical of the violence and conditions of war, as they affect the status and well-being of the civilian. And in this drastically changing world environment, it is the pursuit of these values, carried out 'without borders', that will continue to drive our work.