Having this wonderful opportunity to give the Nansen lecture here in Japan, I would like to begin with a quote from a haiku written by Basho in 1694:

Sick on a journey:
Over parched fields
Dreams wander on.

Haiku are best left in peace, undisturbed by our often trivial analysis. But since it is the achievements of Fridtjof Nansen that are bringing us together today, I thought these few lines could serve as an inspiration. Journeys, parched fields – dreams that wander on.

The samurai Basho was well known for his travels, and this, his last haiku, conveys some of the same dreamy, but slightly tortured restlessness that made Fridtjof Nansen the unique explorer, scientist and philanthropist we know today.

This description of Nansen as a tortured, restless dreamer may come as a surprise to many. Steely determination, will power, and almost superhuman perseverance are the characteristics for which he is best known. And rightly so. These are the qualities which got him across Greenland on skis, brought him next to the North Pole and made him survive the harsh Arctic winters.

But there is no contradiction here. It is hardly an original observation that greatness only occurs when passion and reason meet. Often this encounter leads to violent clashes, torturing the poor soul who has to balance their intense desires with their sense of duty and discipline.

These clashes are so evident in Nansen, who despite his great exploits rarely seemed at peace, and who – we may observe - was never able to fully enjoy his own achievements. Nansen, it seemed, always wanted to be somewhere else, with someone else and do something else. Yet, he always completed what he set as tasks for himself, and he did them brilliantly.

A fundamental element in understanding his achievements is to realize how he – despite his continuous internal battles – was able throughout his life to combine passion with reason and harness the energy this fusion created to do great things.

Through his work as researcher, explorer and his path-setting humanitarian work after the First World War, he mobilized fellow citizens and world opinion. In surmounting obstacles and sometimes bursting regular conventions, he led the way to actions in humanitarian assistance which have become a national pride to his own country and an inspiration for other people and nations. He developed ways to assist women, men and children in need and he bore the torch for human rights, long before they were put down on paper as we know them today.

Through all this he helped politicians to realize that "charity is Realpolitik", as Nansen put it. When all is said and done, this may be his greatest humanitarian legacy.

I am particularly pleased to speak about Nansen’s legacy here in Japan. There is a clear and consistent line from Nansen which leads directly to Japan. Nansen was the world’s first High Commissioner for Refugees. Through his work, the world came to respect the notion of protection for those who have been driven from their homes by war or persecution. Among the long line of High Commissioners who followed Nansen, a few stand out and among them is the current one, Mrs. Sadako Ogata. Since she took office in 1991, Mrs Ogata has steered UNHCR through some of the most difficult years the High Commissioner’s office has seen. And she has done so in a way that should make every Japanese proud.

Under her leadership, UNHCR has not only coped with an onslaught of huge and immensely complex emergencies, but it has also dealt intelligently and humanely with some extremely difficult protection and human rights issues. It has done so with woefully inadequate means. Through Mrs Ogata – as well as through its direct involvement in Cambodia and other emergencies around the world – Japan has made a substantial contribution to humanism and to furthering the principles of protection which Nansen and his colleagues pioneered.

When Nansen arrived in Paris in early March 1919 to attend the Peace Conference convened by the victorious allied powers of the First World War, Europe was in upheaval. Along with the millions of dead on the fields of Verdun and Marne lay the ruins of an entire world order. Bismarck and the Habsburgs were gone, and with them, many of the values, rules and ideals that their rule had encompassed.

Modern technology had shown its shocking efficiency: foremost by enabling slaughter on a scale never seen before in history. But it also had demonstrated its potential for doing good.

Art and culture also underwent dramatic transformations. Left lying on the battlefield were Edwardian romantic poets like Rupert Brooke and Wilfred Owen, while out of it came the likes of
E.E. Cummings. Modernism was a phoenix that rose out of the great shock and trauma, but also of the great creativity and optimism Europe felt at the time.

Onto this confusing stage, where it seemed like many had forgotten their lines and some even no longer knew which play they were taking part in, Fridtjof Nansen entered with a single-minded, even old-fashioned morality. A German delegate to an international conference in Berlin in 1920, in which Nansen participated, noted that Nansen’s "humane attitude and integrity raised him far above the surroundings into which the chaos of post-war Europe had plunged him."

Since the days when Nansen was charging around Europe to raise funds for and organize repatriation of prisoners of war, and later relief for Russian famine victims, we have been through another World War and a 45-year long Cold War. As we face a new century, we may be in a better position than at any other time since the 1920s to understand the problems and uncertainties Nansen and his fellow humanitarians faced during those chaotic post-war years.

Because let us remember: Nansen was not only a pioneer as the Arctic explorer. He was also a pioneer into humanitarian relief work. Knowing the complexities of such assistance today, we can only imagine the complexities of the 1920s. The whole international order was reshaped.

The concept of global public goods started to take hold – struggling to manage emerging interdependence and – yes – the first striking signs of globalization. The League of Nations brought high hopes, and those hopes fell equally low as the League proved unable to carry the contradictions of sovereign nation states.

Last week we counted the first ten years without a wall separating East and West Berlin – symbolizing a world simplistically divided by ideology. The end of the Cold War reduced the danger of a nuclear confrontation between superpowers, although the danger of the use of nuclear weapons continues to haunt us. Millions were allowed to think and express themselves freely. All of these count as major gains.

But we were also left with a more unpredictable world than that we had grown accustomed to over the previous 40 years. We can draw several parallels between the failed internationalism of Woodrow Wilson after the First World War and the isolationism that followed it, and the hot-again / cold-again approach to solving the complex conflicts of the past decade, ranging from Kuwait and Somalia through Bosnia and Rwanda to Kosovo and East Timor.

We do see fewer wars between countries, but we see many more within states and no less killing, mutilations and traumas for civil populations.

Like then, governments today are struggling to find a balance between a foreign policy which emphasizes traditional notions of national self-interest, and one which includes the notions of concern for fellow human beings. This concern stretches across frontiers and difference in race, and it is based on a common platform of universal human rights.

Into this discussion of self-interest versus humanism we should bring Nansen’s words: "charity is Realpolitik".

This statement has only gained in validity over the years, and in our globalized society on the brink of the 21^st century, it is an obvious one to those of us who work with development and in particular, with health.

In a world where the HIV/AIDS pandemic is spreading across borders – where malaria and tuberculosis are on the rise – where people travel like never before – in such a world there is no health sanctuary. Not even for the affluent. There have been recent cases of West Nile Fever in Manhattan, a Norwegian recently died from drug resistant tuberculosis and a German from Yellow Fever. Throughout large parts of Asia people have to fear diseases such as dengue, also on the rise.

Also, in a world where several hundred million potential voters see atrocities on their TV screens in real time and judge their political leaders on how they react to such events, there is no localized war.

Politicians are caught by the demands from their voters who swing between their sense of outrage against massive human rights abuses and what one writer has termed "the seductiveness of moral disgust". In short, we don’t know whether we have a duty to assist all who need it or whether we should leave the warring parties to fight it out until they are exhausted and the conflict dies out by itself.

By complex emergencies, we mean armed conflict that is not a war between two nation states. Often, these conflicts are civil wars or insurgencies, with one or several factional groups fighting against a sitting government. But they can also involve outside powers which are engaged either directly or through proxies, making it almost impossibly difficult to establish who is in charge and to whom relief agencies should relate.

Complex emergencies are by definition chaotic and confusing. But for us, whose tasks are relief and development, the choice is as simple as it is demanding. If we are to succeed in our mission we must find a way through the confusion. We must take sides. Our side must be for health and social development. This is what Nansen did in his day, and this is what we must continue to do today.

When Nansen began his work to repatriate several hundred thousand prisoners of war between Russia and Europe – and later, when he began his famine relief – at least he was dealing with a clearly defined government and a functioning infrastructure. When Alexander Eiduk, the man Lenin had put in charge of prisoners of war, promised that the prisoners would arrive at the Baltic ports where western ships would pick them up, they did, trainload after trainload. When Lenin authorized Nansen’s famine relief, the grain poured into Russia.

In our modern conflicts, relief workers often have to deal with warlords of dubious authority and they must move supplies and refugees through countries where all infrastructure has been destroyed.

In these increasingly difficult situations, can we offer hope to victims of complex emergencies? Yes, we can and we must do so.

During the 1990s, the international community has built up an unrivalled capacity to assist people in times of emergencies. Relief agencies have shown an ingenuity, a courage and a persistence which have allowed them to save thousands of lives in the most hopeless and difficult situations. This is an excellent legacy to build on for the future.

But we all know that it is no easy task. The old solutions don’t apply anymore. Again we could draw inspiration from Nansen.

Nansen was among the last great explorers of the Age of Discovery. Before he crossed Greenland, many believed he thought the hinterland of this huge island would hide a tropical climate and fauna. But Nansen had no such experiences. Ice, cold winds and an inhospitable environment, but also the beauty and loneliness of the enormous glacier – that was what he found.

When he set out on his first great expedition over Greenland, there were still large white spots on the maps of the world. By the time he died in 1930, there were hardly any left. Nansen was clearly sad about this. What drove him in both his research and his exploring was the call of the unknown, the uncharted lands.

For us, the uncharted lands lie in our way of managing a growing population and an earth that is showing signs of having reached its environmental limits. We must not shrink back from these tasks, but attack them with an enthusiasm and intelligence similar to what Nansen brought to the challenges of his time.

Nansen had a strong belief in progress – in the notion that our cumulative actions slowly, but surely would create a better world for humanity. Like most of us, he had strong doubts at times, especially when he saw for himself the terrible Russian famine of 1921. And he also felt increasingly alien to the society which developed around him during his last years of life. But both his explorations and his research, both in neurology and later in oceanography, showed a drive towards progress which should inspire us all.

Would he have approved of the progress we have made during the seven decades since he passed away?

Both yes and no, I think. Yes, because through science and good work we have been able to drastically reduce disease and lengthen the healthy life span of the majority of the world’s population. Half a century ago the majority of the world's population died before the age of 50. Today, average life expectancy in developing countries is 64 years and is projected to reach 71 years by 2020.

But also no, because poverty has been eating away at many of the health gains. In absolute numbers, there are considerably many more poor people living today than during Nansen’s time. More than 1.3 billion people are living in extreme poverty, which means they have to survive on less than one US dollar per day. Another nearly 2 billion people scrape along on twice that amount. Almost one third of all children are undernourished.

Inequalities between rich and poor have grown. The developing world carries 90% of the disease burden, yet poorer countries benefit from only 10% of the resources that go to health. One fifth of humanity does not have access to modern health services. Half of us lack regular access to essential drugs. The average African household consumes 20% less today than it did 25 years ago.

I believe Nansen would be appalled by how little the rich world spends on helping to overcome these inequalities. Only four out of the richest countries live up to their obligation of providing at least 0.7% of their GDP for development assistance. The average is falling towards a record low 0.2%. This is – in my view – a shame, and all groups in civil society committed to development should hold their leaders to account. I know Nansen wouldn’t mince his words if he were able to speak on the subject today.

Being a product of his time, which was strongly influenced by Darwin, Nansen during most of his life believed in the survival of the fittest and the need to give the best and the brightest the opportunities to excel. Over the last decade of his life, however, his experiences in Russia and in Greece and Turkey, made him considerably more concerned for the weakest among us.

He realized that competition is well and good when all the participants share the same resources. But there are large parts of the population in any country, which come to the starting line with great handicaps.

Today, when unfettered competition and the rules of the market are again celebrated as all-powerful, we should keep Nansen’s discovery in mind. Our work for the poorest and for the victims of emergencies and war must aim at reducing their handicaps – at making them better equipped to compete on the world stage.

In health, the concept is simple. Healthier people are more productive and better able to improve their lives. The same is true for emergency relief. The aim must be to get people back on their feet equipped with the best resources possible. Relief work must therefore be geared not only towards the most urgent needs, but in ways that lead to reconstruction and development.

We are facing an enormous challenge. With the exception of the Second World War, the world has never seen so many people displaced as it has witnessed over the past 15 years. About 50 million people - about 1% of the world population – have been uprooted and driven from their homes.

At the end of a century of magnificent scientific and human progress we are witnessing the mindless stunting of social development by conflicts that disorganize and demoralize civil society and erode its institutions, including health care systems.

Tragically, many of these conflicts are occurring in the world’s poorest countries, where they are not only inflicting tremendous damage today but also denying the opportunities of tomorrow. For irrespective of who eventually wins these conflicts, the health of countries and people is being destroyed. And where there is no health, there can be no sustainable development.

It would take too long to go into a detailed discussion on the challenges these complex emergencies pose for governments and relief workers alike. But let me list some of the dilemmas they create:

• How do we distribute relief in an equitable fashion when the oppressors turn victims, like in for example Rwanda and in the Balkans?
• How do we help populations that are held hostage by their own tyrants?
• How do distribute aid on the basis of need when such distribution conflicts with the political interests of the big powers?
• Our work is often dependent on the support of generous populations in the industrialized countries and donor agencies. How can we keep continuity in our work when the public attention span is short and determined by the media?
• How do we work in areas where authority is unclear and all normal social and political infrastructure have broken down?
• How do we protect civilians from atrocities when no sides respect the Geneva Convention or any other rule of war?

These are questions field workers and decision-makers have to deal with on a daily basis. Often, even the best possible answer is an appalling compromise. But we must not despair.

The casualties of Verdun and the Marne were on the battlefield; the victims were soldiers. The victims of modern war are mostly unarmed, defenceless civilians. They are mothers, children, families. The battle pursues them into their own homes. In a particularly cruel twist, terror and bringing trauma to whole populations have become preferred fighting tactics among the modern war’s generals.

Let me give you an example from my own country.

One late autumn day in 1995, a family of refugees arrived in a small village in central Norway. Over a three-day period two years earlier, this family had witnessed how most of their own village’s population in Bosnia had been massacred. They had themselves been set up for execution and survived purely by a stroke of luck. Later, both parents and the children had been maltreated for months in prison camps, including witnessing repeated gang rapes of dozens of women. The husband, who had been set to dig trenches at the frontline, had suffered a mental breakdown and was periodically psychotic and suffered from paranoia and deep trauma.

These refugees didn’t need only some food, shelter and basic health care to recover. They needed years of attention and treatment by the Norwegian health system in order to be able to function again as normal human beings. When we multiply this by hundreds of thousand of victims, we begin to understand the enormity of our task.

So, it is exceedingly difficult. And yet I remain optimistic. For rarely have we seen such willingness to work with and for people in complex emergencies. Donors and people on the street are heeding public appeals in ways they have rarely done before. The number of humanitarian groups has grown, and people are increasingly willing to help, give their time, and - as we so tragically know, sometimes their lives – in an effort to alleviate suffering and safeguard peace.

If we are to really offer hope, we must go further than relief and learn to talk about relief and social reconstruction in the same breath. Sustainability is a guiding principle for the World Health Organization.

We must be on the site of an emergency early, but our job is also to stay on when CNN and the evening news leaves. Rehabilitation must guide our immediate actions from the very first day. When the Kosovo refugees flooded into Albania and Macedonia, we urged that healthcare should as far as possible take place through existing facilities. Investing millions of dollars in temporary health facilities while Albanian and Macedonian health centres remain under-equipped would be an ineffective use of resources. By strengthening the existing facilities, we could leave a lasting contribution.

Critically needed health campaigns such as immunization go beyond the reactive dispatch of relief. Impressive results have been achieved in Thailand to protect refugee populations against malaria. Effective action against malaria during emergencies can make the difference between sending home a strengthened population free from – and informed about – malaria, or one weakened by repeated bouts of disease.

By recognizing that refugee populations are not just passive receivers of handouts, but resourceful participants in their own emergency within the limitations forced upon them, we can tap an important resource. Too often, the victims’ attempts at improving their lives are seen by relief agencies as unwanted meddling into their well-oiled relief operations. Our job is to put the victims at the centre of our activities, and reduce the limitations they face – not increase them by rigid logistics and bureaucracy. Displaced populations should not only be objects for assistance; they should be subjects of their own choices and welfare.

This includes unorthodox working methods. Take the example of the Bosnian family that came to Norway. Taking a chance, the local physician and the municipality’s psychologist went against the medical advice from Bosnia, which said the man needed hospitalization. Instead he helped the family face their real problem - the traumas from the war. After a number of anguishing months, the family even chose to testify at the International War Crimes Tribunal in the Hague. By choosing this, and by carrying it out, the man of the family managed to pull himself out of his own mental illness.

Today, the family lives a normal life in this village: they work, they are integrated into the local culture, and their mental health condition lies, according to the local psychologist, among the better half of the village’s population.

In working strategically for long-term gains even during acute emergencies – both on a large scale and on the level of the individual as in this case, I believe we can use health as a bridge for peace. The fact that Fridtjof Nansen received the Nobel Peace Prize for what was mainly his relief work, stands testimony to this. There is a clear and consistent line to the Peace Prize of this year, awarded to Médecins Sans Frontières.

Co-operation in health can be key for communities divided by conflict. Diseases respect neither borders nor frontlines. Many health workers have reported that health concerns can bring about co-operation and even reconciliation. We saw that so clearly a few years ago during the polio immunization campaign in Central America, where warring factions united to get their children vaccinated. They had a common future to safeguard, so the first bridges of common understanding were built.

In Afghanistan and the Democratic Republic of Congo we are now forging a polio eradication campaign with UNICEF and other partners, seen by all parties as a common thread to everyone’s future health and development.

But we do not want those children, having been safely vaccinated, only a few years later to carry guns. The goals for respect and advancement in international humanitarian law are so vital in this and other fields. We need advocacy and moral force: we need to build on the success of campaigns like the one against landmines.

We need the forceful support of Non Governmental Organizations and civil society, not least in keeping the attention of governments fixed on emergencies and human suffering.

I have no illusions that this will be easy. In Kosovo and East Timor, the UN administration is trying to rebuild a health sector where there is no functioning local government, and a severely damaged human infrastructure. In Afghanistan and in Myanmar, we have to take a cautious course between responsibility towards the population and unacceptable infringements of their human rights. In several areas, we have to deal with regimes or warlords who, even if they wanted to make an effort for long-term rehabilitation of health services, don’t have the budgets or the ability to go to donors and ask for funds to do so.

If we are going to make a positive impact against such tough odds, the humanitarian agencies that work with health must operate together as part of one, technically sound international effort. Unless we do, we will duplicate where we should be complementing. We will divide where we should unite. We will be wasteful when what the victims need is consolidated action.

We must avoid situations such as in Bosnia and Kosovo, where hundreds of tons of unwanted drugs were sent and could not be used. Similarly, we are discovering that too little time has become available to NGOs and international agencies for training and briefing staff going into humanitarian work. Obviously, the level of training varies enormously, but the overall level of training is dangerously low. We must train and support our staff in the field more actively. They are faced with new ethical as well as technical dilemmas on a daily basis.

Fortunately today we have a body of knowledge that can help us predict, prevent and mitigate the health impact of complex emergencies. We must build on that knowledge and ensure that our responses to emergencies are science-based and sound. Not to do so would be a grave injustice against the victims.

In his recent biography, Roland Huntsford joins those who criticized Nansen for being naïve, and for allowing himself to being used as a pawn in the political battles of the day. For anyone who in recent years has attempted to bring relief to the victims of war and political strife, these accusations sound tediously familiar.

Next to that should be kept in mind that the opposite of naivety most often is not realism but cynicism. And cynicism usually offers the arguments for why one should not act – and very rarely provides any inspiration for charting a new course.

We can offer assistance to the victims that are accumulating around our imperfect globe. Some will say this is yet another utopian dream. They said the same of Fridtjof Nansen’s rhetoric. They didn’t think he could bring the prisoners of war home. They didn’t think it would be possible to deliver famine relief to a Bolshevik state, and they didn’t believe it would be possible to find a solution to the several hundred thousand stateless Russian refugees that languished in Europe.

The cynics were wrong. Sergey Rachmaninoff, Igor Stravinsky and Marc Chagall could all testify to this. They were among the many who were given new legitimacy with the "Nansen passport", an identity document guaranteed by the League of Nations which gave these Russian refugees a legal status and allowed them to travel freely.

Fridtjof Nansen knew the urgency of an emergency. One tale from his arctic adventures is frequently told to young generations of Norwegians, and I would like to end on this note.

Nansen had nearly reached the North Pole with his companion Hjalmar Johansen. Very close to the magnetic pole they had to turn around to head towards the mainland further south, running short of food as they were.

As they had to cross open stretches of water, the two men turned their sledges into kayaks. As they prepared to enter their small unstable boats, Hjalmar Johansen was attacked by a huge polar bear. The bear threw the man onto the ice. Johansen, known for his incredible strength, stretched his arms and held on to the cheeks of the bear.

Nansen, in the meantime, desperately reached for his gun which he had already placed in his kayak. But the boat slipped away and the great explorer had to struggle to get hold of his kayak and his rifle.

Johansen, looking into the terrifying teeth of the polar bear could hardly hold on for much longer. But he kept his calm and respectfully spoke these famous words to his patron and ‘senpai’:

"Sir, I do believe you need to hurry up – if not it will be too late."

Nansen finally did get hold of his rifle and shot the bear.

We too – at the doorstep to a new century – have to hurry. The life and the efforts of Fridtjof Nansen provide us with the inspiration to strive for human progress, dignity and development – for this generation and those to come.