Audio Transcript:

Marco Werman: I'm Marco Werman and this is The World, a coproduction of the BBC World Service, PRI and WGBH Boston. African Union troops in Somalia have launched a major assault on the Islamist militant group al-Shabab. The group controls large swaths of Somalia. Also, al-Shabab this weekend announced that it had merged operations with al-Qaeda militants in the country. The instability and violence in Somalia, along with drought, have created a humanitarian crisis there, but few aid groups venture to work in areas controlled by al-Shabab. One of the few that does is Doctors Without Borders. The group has just released a new book about the complexities of its work. It's called Humanitarian Negotiations Revealed. Duncan McClean manages Doctors Without Borders' operations in Somalia. He says the group's hospital on the outskirts of Mogadishu treats everyone, including injured al-Shabab fighters.

Duncan McClean: We've always treated anyone who would basically turn up, so we're well aware that amongst the patients will be fighters, civilians, we don't make that distinction. And in terms of releasing them back to the population, we don't incarcerate them. We treat them as we would anyone else as in any other hospital would work anywhere in the world.

Werman: And treating those injured without distinction, that position has drawn some criticism as you know, the African Union has called Doctors Without Borders the opposition's war surgeons. How do you respond to that?

McClean: I gently remind our colleagues in the African Union that we also operate medical programs throughout the country, including Mogadishu and areas under control of the transitional federal government supported by the African Union. And we don't make a distinction actually in terms of where we operate, on who we operate, and we base it on where the needs are the greatest.

Werman: Still, I imagine the ethical dilemmas you face in Somalia must be pretty mind boggling. Most international aid groups have left. And here's something from your group's new book about the trials of working there. Doctors Without Borders says, "While we were able to appeal to the African Union not to bomb residential neighborhoods, we have never asked al-Shabab not to use civilians as a human shields when its members take cover in the market. And then it goes on to say we are afraid of losing what we have managed to put in place. It sounds like you have a go softly softly approach. Is that kind of risky?

McClean: Yeah, certainly it is and we're very well aware of the almost double standard that we use to maintain operations, notably in areas controlled by the al-Shabab. And what we did last summer awas atually suspend operations in the hospital that you were referring to at the start of the interview, a hospital called Daynile, and we suspended it because we considered the pressures that the staff, the team were facing in the hospitals, the pressure by the al-Shabab to be unacceptable. We considered that we crossed I suppose a red line of sorts and that the only responsible action would be to cease operations.

Werman: Now, apparently al-Shabab wanted money, is that correct?

McClean: Yeah, the pressures that we face from not just al-Shabab, but basically anywhere we work, including areas under control by the transitional government is generally about resources and money being the most obvious one. And extortion is certainly rampant.

Werman: Still, that's gotta be a very tough decision. I mean what are your guidelines about making the decision of when to pay the price of extortion and when to leave.

McClean: What you've just described is one of the themes of the book you introduced at the start of the interview, and that there is no guiding principle set in stone that we can apply to every situation and every circumstance. When we talk about Somalia, part of the explanation of the compromise that we've made and which created an enormous amount of internal debate as well, not just public, has been that the needs are dramatic and there are very few actors around, so we manage to convince ourselves to a certain degree that we can go further than what we would perhaps to elsewhere where other actors are available, other types of support are available. To give you a clear guiding line to say this is where you know, as I said earlier, the red line, now we crossed that and it's simply we withdraw, or we suspend or we do whatever. Unfortunately, it's a shifting line that we have to adjust to constantly and have to reanalyze constantly to try and have some type of responsible behavior in what is a profoundly irresponsible situation.

Werman: It seems like it's just a hard fact of life and maybe you can confirm this, if you're going to work in Somalia you're going to directly or indirectly be helping the warring parties.

McClean: Yeah, I would carry that much further and say there are many, many parts of the world where we basically accept that a certain degree of aid that we're providing will be used for other ends than what we intended it to be. And it would be naive to consider it otherwise to sort of maintain this idealistic image of aid work that only goes in greatest need, only civilians, only the intended beneficiaries are receiving. In our case, it's medical aid, but we could be talking about food aid, water, sanitation programs, we could be talking about all sorts of things. That's simply a fact of humanitarian work today I would say as much as it's unpleasant to consider.

Werman: Duncan McClean manages the Doctors Without Borders' Somalia operation. Duncan, thank you very much.

McClean: Thank you very much to you.