Hope in Hell: Inside the World of Doctors Without Borders / Edition 2

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More fascinating and harrowing accounts of the volunteer professionals who risk their lives to help those in desperate need.

Praise for the second edition:

"Direct and evocative, this well-written book pushes readers to the edge of a world of grueling realities not known by most Americans."
— Choice

Doctors Without Borders (aka Medecins Sans Frontieres, or MSF) was founded in 1971 by rebellious French doctors. It is arguably the most respected humanitarian organization in the world, delivering emergency aid to victims of armed conflict, epidemics and natural disasters as well as to many others who lack reliable health care.

Dan Bortolotti follows the volunteers at the forefront of this organization and its work, who daily risk their lives to perform surgery, establish or rehabilitate hospitals and clinics, run nutrition and sanitation programs, and train local medical personnel. These volunteer professionals:

  • Perform emergency surgery in war-torn regions of Africa, Asia and elsewhere
  • Treat the homeless in the streets of Europe
  • Honor cultural customs and understand societal differences that affect health care
  • Witness and report the genocidal atrocities so often missed by mainstream media

This new and revised third edition includes updates and new inside stories from recent relief operations, and it covers changes within the organization, such as its new emphasis on nutrition. There are also many new and revealing color photographs and insights gained from the author's 2009 trip to Haiti, where he found three different arms of MSF operating in dire conditions.

Hope in Hell is a widely acclaimed portrait of a renowned Nobel-winning humanitarian organization, revealing how Doctors Without Borders provides immediate and outstanding medical care.

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Editorial Reviews

Dumbo Feather (Aus.) - Kate Bezar
Reveals the human face of MSF. Bortolotti has captured the expats' varied voices and personal stories.
Saskatoon Star Phoenix - Jenni Mortin
A fine read, compelling in its story. Just the pages on its fight against malaria are worth a lot.
Victoria Times Colonist - Carl Cavanagh
Goes deep into MSF, showing how it has become the go-group for rapid response... lays bare the intense philosophical struggles that animate MSF.
Quill and Quire - Jennifer Prittie
A gripping tale as it describes how the group manages to care for patients in the most inhospitable and dangerous corners of the earth... a solid read.
Hamilton Spectator - Moira L. MacKinnon
You will meet a few of these extraordinary people and hear their stories. In the midst of some of the worst hells on Earth, they really do bring a glimpse of hope.
Deseret Morning News - Dennis Lythgoe
Well written and filled with excellent color photographs that give the reader a realistic picture of the work these amazing volunteers undertake.
Dan was in some of the world's most dangerous countries, chronicling the stories of volunteer medical workers.
Quill and Quire
Gripping... a solid read.
— Jennifer Prittie
New England Journal of Medicine
Authentic and inclusive... informative and touching.
— Jerry R. Dwek, MD
Emergency Medical Services Magazine
A nicely balanced book about this type of work/volunteerism that I've been curious about for years.
— Norm Rooker
The Lancet - Amanda Walters
(about the first edition) Comprehensive picture of the essence of volunteerism.
The Lancet
Comprehensive picture of the essence of volunteerism.
— Amanda Walters
Hamilton Spectator
Meet a few of these extraordinary people and hear their stories... they really do bring a glimpse of hope.
— Moira L. MacKinnon
Deseret Morning News
Well written and filled with excellent color photographs... alistic picture of the work these amazing volunteers undertake.
— Dennis Lythgoe
Chronicle of Philanthropy
Emphasizes that much of the organization's work takes place not in war zones but in remote, impoverished locales.
— Caroline Preston
Inspired...What Bortolotti reports is noticeably absent from the daily headlines, so this eye opening account is all the more chilling.
— Donna Chavez
Direct and evocative, this well-written book pushers readers to the edge of a world of grueling realities.
— D.B. Hamilton
Dumbo Feather (Aus.)
Reveals the human face of MSF. Bortolotti has captured the expats' varied voices and personal stories.
— Kate Bezar
Saskatoon Star Phoenix
A fine read, compelling in its story. Just the pages on its fight against malaria are worth a lot.
— Jenni Mortin
Medical Post
Bortolotti interviewed hundreds of medical personnel who spoke frankly... allows the reader a very honest look at MSF.
— Alison Delory
Globe and Mail
Some physicians still do manifest the noblest virtues of medicine... a worthwhile read for prospective international aid volunteers.
— Philip B. Berger
Chronicle of Philanthropy - Caroline Preston
(about the first edition) Emphasizes that much of the organization's work takes place not in war zones but in remote, impoverished locales.
Booklist - Donna Chavez
(about the first edition) Inspired... Much of what Bortolotti reports is noticeably absent from the daily headlines, so this eye opening account is all the more chilling, and MSF's efforts achingly more compelling.
Choice - D.B. Hamilton
(about the first edition) Describes but never romanticizes... Direct and evocative, this well-written book pushers readers to the edge of a world of grueling realities not know by most Americans. Recommended.
Globe and Mail - Philip B. Berger
(about the first edition) Some physicians still do manifest the noblest virtues of medicine... a worthwhile read for prospective international aid volunteers.
New England Journal of Medicine - Jerry R. Dwek
It is in the considerable space that Bortolotti gives to the emotions of the group's staff members that the book really shines... authentic and inclusive... informative and touching.
Emergency Medical Services Magazine - Norm Rooker
(about the first edition) All in all, I found Hope in Hell to be a nicely balanced book about this type of work/volunteerism that I've been curious about for years.
Book News
Bortolotti, a journalist and author, visited doctors, nurses, and nonmedical staff in Doctors Without Borders programs in Angola, the Afghanistan-Pakistan border, Haiti, and other countries, and reveals their experiences in the program. He provides historical information on the organization and its origins in France and describes stories of its volunteers, what they do, and the patients they treat, within the context of the political and cultural climate of specific countries. This edition adds a postscript to the chapter on Haiti.
Medical Post - Alison Delory
Allows the reader a very honest look at MSF.
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Product Details

  • ISBN-13: 9781554071425
  • Publisher: Firefly Books, Limited
  • Publication date: 9/12/2006
  • Edition description: Updated
  • Edition number: 2
  • Pages: 304
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.75 (d)

Meet the Author

Dan Bortolotti is a journalist whose work appears regularly in the North American press. He is the author of seven other books.

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Read an Excerpt

Chapter 9:
New Fridge Syndrome

Kenny Gluck knew something was up when he saw a car slide out from the roadside to block the convoy he was traveling in. "We had left the hospital in four vehicles, and we hadn't even gotten out of the town yet when two cars cut us off — one in the front, one in the back — and a bunch of people in masks and carrying Kalashnikovs got out." The men opened fire, but no one was hit — their goal wasn't to kill but to scare. "And they succeeded," Gluck says dryly. "They pulled me out of our car and pushed me into theirs. They whacked me over the head with a rifle butt and then put a coat over my head so I couldn't see."

It was January 9, 2001, and Gluck, 38 at the time, was MSF-Holland's head of mission for the North Caucasus, which includes war-torn Chechnya. On the day he was abducted, Gluck was leaving the town of Stariye Atagi, about 12 miles from the
Chechen capital of Grozny. It's an area he knows well, having worked in Chechnya from 1994 to 1996 with another NGO, and since early 2000 with MSF. He's fluent in Russian, too, though it didn't help him that day in the kidnappers' car. "They didn't say anything except, 'Shut up and keep your head down.' We drove for about an hour, switched cars, then they put me in a house where we waited for a while." Gluck was moved three times that first night, before being forced into the root cellar of another house. The floorboards were just a few feet above him, making it difficult to sit up. Onions, cabbages and carrots lay on the rocky dirt floor, along with a mattress that would be Gluck's bed for the next nine nights.

Kidnapping is something of a national pastime in Chechnya, and expats are not exempt from the violence. In 1995, veteran aid worker Fred Cuny visited Chechnya on behalf of billionaire philanthropist George Soros, only to disappear in April. It's assumed he was murdered, along with three colleagues, though their bodies have never been found. The following year, six Red Cross workers — four Europeans, a Canadian and a New Zealander — were sleeping in their hospital compound, not far from where Gluck was abducted, when they were executed by masked men carrying guns fitted with silencers. Then Camilla Carr and Jon James, British psychologists working with a small Quaker NGO, were abducted in July 1997 and held for 14 months. By the time Carr and James were released, MSF had pulled out of Chechnya because of the insecurity, but by February 2000 they were back. And so were the kidnappings — that August three more Red Cross workers were abducted, though they were released after a week. In all, at least 50 humanitarian aid workers have been kidnapped in the North Caucasus since 1996.

Finding those responsible for these attacks is extremely difficult. To begin with, the abductors do not usually make ransom demands; often there is no negotiation at all. The region's power politics are complex — Gluck estimates there are 50 or 60 active military groups, and their alliances are rarely clear. So, when he was dragged from the car and MSF received no communication from his attackers, the trail quickly turned cold. The organization immediately suspended all its activities in the area and called on the Russian authorities to investigate, but even Gluck himself didn't know why he was being held. "They talked to me quite a bit, but I didn't feel that the people talking to me were the decision makers; they were just guards. They said they were hoping to trade me for captured people, but I don't know if that was true. They were Chechens, I could tell that, but I didn't know whether they were fighting on the Russian side or the anti-Russian side. I didn't get to those questions."

Gluck's case is proof that the best type of security is being known in the community.
"All the Chechen doctors there knew me, and I had a lot of friends in this area, and they were getting in touch with everybody — Russian groups, criminal groups, pro-Chechen groups — saying this was unacceptable. People who deal in these activities get wounded a lot, so the Chechen surgeons had operated on a lot of people, and they just went to all their contacts and started pushing for my release. To each of the groups they thought could be involved they would say, "Look, your mother or your cousin was treated in an MSF-built surgical facility, with MSF drugs that Kenny himself brought in here. How can you do this? You have to take responsibility for getting him out.' Partly they were saying unethical things, like, "We're going to stop treating your people if this keeps going on.'

"My conditions improved dramatically after that first nine or ten days, and I'm pretty sure that around this time some of these doctors got lucky and talked to the right group. Someone was getting through to the kidnappers and saying, 'Treat him nicely.' After that, I was moved to a room that was about two meters by a meter and a half. They surprised me — they came and asked what kind of food I wanted, what I needed. I didn't ask for any change in the food — I thought it was fine before. They were just giving me normal Chechen village food, nothing surprising, and more than enough of it. What I said was, I need news, things to read, and they gave me that."

A few days after he was moved from the cellar, Gluck's captors assured him he had nothing to fear. "According to them it was settled, and it was just a matter of working out how I would be released. I was talking with them a lot about how to do it, and in the end they did exactly as I requested." He suggested that the kidnappers drop him off at the home of a Chechen surgeon who was a personal friend of his as well as being known among both the separatist and the pro-Russian groups. But the days dragged on and he began to wonder if it was false hope. "Things happened that were terrifying — there were moments when I thought they were taking me outside to shoot me. There were times when the house shook so hard from the shelling that plaster was falling off the walls."

Finally, on the night of February 4, Gluck was told he was going to be freed. They put a mask over his head and bundled him out of the house and into a car. "In the car they were very apologetic. These were different people — by their voices, I could tell these were older people, clearly with more authority. They were apologizing to MSF, saying, 'This group didn't know who you were, we're very sorry, we re going to punish them,' all of that. While I was blindfolded, they gave me back my passport. I had passes from the Russian military to travel in Chechnya, and they gave me those back, as well as my MSF ID card. I'd had seven hundred dollars in cash in my pocket, because we needed to make some advances on construction material, and they gave me that, which surprised me a lot. I'd had a very cheap watch which I always carried — you know, seven dollars on Canal Street in New York — and they said, 'We're really sorry, we can't find your watch.' I was like, 'I'll live.'"

Around midnight, the mystery voices stopped the car and pushed Gluck out. He asked whether he could remove the blindfold, but they refused, telling him simply to walk away from the cat Then they drove off. "I heard someone yelling at me in Chechen, so I said, 'I don't speak Chechen, speak to me in Russian.' And he said in a very crude way, 'Who the hell are you?' I lifted off the mask and I realized it was the Chechen surgeon." Gluck's liberators had driven him right into the doctor's compound. "He yelled at his wife, 'Get up! We have a guest. Put food on the table.'"

the Russian secret service, the FSB, took credit for securing Gluck's release, but it soon became clear that claim was nonsense. The Russian authorities had been as ineffective as they usually are when aid workers are abducted. MSF says it doesn't know exactly who was responsible for the kidnapping or the release, but before Gluck was pushed from the car, the libe

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Table of Contents

  1. Introduction: Fixing Up the Humans

  2. Under the Angolan Sun
  3. Biafra and the Bumblebee
  4. We Don't Need Another Hero
  5. Doc in a Hard Place
  6. In the Yellow Desert
  7. Ugly Realities
  8. How the Other Half Dies
  9. Best Performance in a Supporting Role
  10. New Fridge Syndrome
  11. You Can't Stop a Genocide with Doctors
  12. "Ours is Not a Contented Action"

    Author's Note
    Notes on Sources
    Photo Credits

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