Bernard Kouchner

"No one deserves to die of a curable disease because he is poor," Kouchner told an audience of more than 170 people packed into Snyder Auditorium. The lecture was also watched live via a webcast over the Internet.

Kouchner is a co-founder of the Nobel prize-winning humanitarian organization Doctors Without Borders (Médecins Sans Frontières) and was at HSPH through February and March as a visiting professor at the Francois-Xavier Bagnoud (FXB) Center for Health and Human Rights.

"To send doctors all over the world is magnificent," said the former Minister of Health of France. "We must carry on. But this is not enough. It will take five, ten or thirty years, but we must imagine a world health insurance: Patients Without Borders."

Stephen Marks

HSPH Dean Barry Bloom opened the lecture, praising Jonathan Mann's work to stake out the relationship between human rights and HIV/AIDS.

"He created a ferment, an excitement, a recognition of something of enormous importance that had hitherto really been off the radar screen," said Dean Bloom, who remarked on how Mann inspired the continuing tradition of distributing the Universal Declaration of Human Rights to every HSPH student at graduation.

Dean Bloom observed that Bernard Kouchner exemplifies the spirit that Jonathan Mann created, working as a visionary, physician, healer, political figure, and activist.

The lecture pays homage to Mann's vision and action, said Stephen Marks, director of the FXB Center. "Jonathan's three characteristics that most significantly reflect the legacy we wish to perpetuate are his belief that human rights are essential for health, his courage to question authority and act in new ways, and his capacity to inspire others with a life-transforming vision."

In 1971, Médecins Sans FrontiÀres (Doctors Without Borders) started with a small group of French doctors. The organization now sends out more than 2,500 doctors, nurses, and other professional helpers from several countries every year to more than 80 nations, where they cooperate with an estimated 15,000 local personnel.

In their early days, Kouchner remembered, they were unprepared for the cruel reality of poor countries. "Fresh out of school, coming from our highly efficient hospitals, and used to excess in medicine, we were confronted with the ravages of lack--lack of means, lack of food, lack of work, lack of hope," Kouchner said.

After a schism in Médecins Sans FrontiÀres, Kouchner subsequently founded Médecins du Monde (Doctors of the World, with a US affiliate founded by Mann); European Volunteers for Development; "Globus," the Association for Humanitarian Action; and the newest "Ingerence Sante," through which he is suing the Raelian group Clonaid for violating the French anti-eugenics law. Now, Kouchner dreams of Patients Without Borders, or what he describes as world health insurance. The idea is to call upon public and private sectors to ensure care for people in poor countries.

AIDS tops the priority list, followed by care for tuberculosis, malaria, and other diseases associated with poverty. Kouchner is working with researchers, business leaders, and others. He anticipates starting with three or four countries, probably in Africa and perhaps in Asia or Latin America, and concentrating efforts on women and communities. His previous efforts have focused mostly on emergency care; this effort focuses on prevention, with treatment as a necessary component to prevent further spread of infectious diseases.

Paul Farmer

Kouchner describes Patients Without Borders as a practical extension of a report issued in 2001 and led by Columbia University economist and former Harvard professor Jeffrey Sachs for the World Health Organization Committee on Macroeconomics and Health. For $34 dollars' worth of health care a year per person, the world would see a positive return on investment by other economic measures. Kouchner believes the costs will be higher, but a good investment nonetheless.

"In my country, we spend $2,000 a year per capita on health care," said Kouchner. "Isn't it possible to ask people to spend $2,034? The idea that we must communicate from AIDS is this: The planet of diseases no longer knows any frontier--viruses without borders, bacteria without borders. In protecting the poor, we protect the rich."

	Dean Bloom (r) shakes hands with Ida Mann, Jonathan Mann’s mother.

Paul Farmer, the Maude and Lillian Presley professor of social medicine at HMS and co-founder of Partners In Health, a non-profit organization that focuses on health crises in poor and sick communities, served as respondent to Kouchner's comments at the lecture.

He reflected Kouchner's call to "interfere" with the root causes and effects of problems that burden the poor and vulnerable and said that public health professionals must do a better job of doing so. Otherwise, there will be hundreds of millions of injured and sick people in the world--not "patients without borders," he said, but "patients without limits."

"We need an alternative vision, and that vision requires no less than a movement," said Farmer. "We owe a great debt to Jonathan Mann and to the delightful, entertaining, and 'interfering' Bernard Kouchner for their reminders."

--Carol Cruzan Morton

Kouchner Calls for Removal of Saddam Hussein without War

While strongly denouncing war in Iraq, Doctors Without Borders (Médecins Sans Frontieres) founder Bernard Kouchner called for the removal of Iraqi leader Saddam Hussein from power at a special lecture, "Iraq: The International Dilemma,"  on March 14 in Snyder Auditorium.

Ethnic cleansing continues, said Kouchner, who has traveled to Iraq several times. He said that Hussein's regime is responsible for the deaths of hundreds of thousands of people. Hussein's leadership is illegitimate, maintained through violence against his opposition, Kouchner asserted. Three coups attempts have been put down in a bloody fashion, he said.

Based on that, how can people believe that Hussein is a man to be defended as a representative of the Iraqi people, of the Arabic region, and of a developing nation, asked Kouchner.

He emphasized the need to listen to what the Iraqi people wish to do with their own country.

Removal of Hussein from power can be achieved through the United Nations (UN) and international cooperation, backed by continuing military pressure, said Kouchner. Although he fears it may be too late, Kouchner views the next few days as critical in forming a strategy that would avoid war and delegitimize Hussein. As a remaining hope, he referred to a Canadian proposal floated at the UN that would use increasingly smaller circles of military forces to first contain Hussein and then employ international negotiation to kick the Iraqi leader out of office.

The presentation was webcast live over the Internet and questions were taken from both the live and virtual audiences. Questions were e-mailed from as far away as Norway.

Sitting in the audience, HSPH Dean Barry Bloom asked if it were possible to remove Hussein from power by charging him as a war criminal, similar to what was done with former Yugoslav President Slobodan Milosevic. Kouchner said it was too late now, despite a UN Security Council resolution passed before the Gulf War that would provide the legal groundwork for such a charge.

An audience member who identified himself as an Iraqi insisted there is no alternative to the war, but Kouchner replied that removal of Hussein "by any means" is not the way to go.

HSPH faculty member James Robins questioned if the human rights movement has been "highjacked" in a post-September 11th world. In the case of Iraq, the movement is playing into the hands of the US government, which stands to benefit from rebuilding Iraq after a war, Robins asserted. While acknowledging some truth to Robins' comments, Kouchner replied that the pessimistic assessment ignores the plight of the Iraqi people. He believes that thousands of Iraqis are waiting to be liberated.

The webcast of "Iraq: The International Dilemma" is available at http://www.hsph.harvard.edu/iraq.

The event was sponsored by the Office of the Dean and the FranÁois-Xavier Bagnoud (FXB) Center for Health and Human Rights, where Kouchner is a visiting professor.