Interview with Julian Ginzo, “They Said So”
Why was I interested in interviewing Mukesh? He is a physician, humanitarian leader, and global health scholar whose career spans medicine, diplomacy, and international crisis response. Born in India and educated in the United Kingdom, he trained in medicine at the University of Oxford and later specialised in public health. Over more than three decades he has held senior roles across the international system, including leadership positions in the United Nations, the World Health Organization, the International Federation of Red Cross and Red Crescent Societies, and the UK government’s development agencies. He served as the United Nations Resident and Humanitarian Coordinator in Sudan during the early stages of the Darfur crisis, where his public warnings about mass atrocities drew global attention and made him one of the earliest whistleblowers on the genocide. He continued his work in international advocacy, serving as Special Representative of the Aegis Trust for the Prevention of Crimes Against Humanity and advising several global institutions, including the Parliamentary Assembly of the Mediterranean. Today he is Professor Emeritus of Global Health and Humanitarian Affairs at the University of Manchester and remains active in international advocacy, including as Special Representative of the Aegis Trust for the prevention of crimes against humanity and adviser to several global institutions. In addition, he has published two deeply revealing memoirs, Against a Tide of Evil and No Stranger to Kindness.
This interview is particularly compelling because it challenges many of the comforting assumptions that shape contemporary humanitarian and global health discourse. Drawing on decades of experience in some of the world’s most complex crises—from Rwanda and Darfur to global pandemic governance—Mukesh offers an unusually candid assessment of the limitations of international institutions, the politics behind humanitarian action, and the moral dilemmas faced by practitioners on the ground. Rather than presenting idealised solutions, the conversation confronts uncomfortable truths about power, institutional inertia, and human nature, making it both provocative and deeply reflective for readers interested in the realities of global health, humanitarian policy, and international governance.
Here’s our exchange:
Where are you originally from, and what aspects of your childhood there most shaped who you are today?
I was born in the remote village of Hirakud in the neglected eastern state of Odisha in India. But my childhood was mostly spent in the relatively prosperous northern state of Punjab, where I was sent for schooling. The values and discipline that were inculcated, and the great education I received at the missionary-run St John’s School in Chandigarh, set me up for life. And before people jump to conclusions, there was no religious proselytising in this Irish Catholic-operated institution: it provided a secular, all-inclusive education. And I only got caned once—not for doing something naughty, but for lying about it afterwards. Thus, truth-telling, however inconvenient, was a lifelong lesson learned at an early age.
How would you describe your family environment growing up, and who were the most influential figures in your early life?
I was brought up by my maternal grandparents and received everything I could want, especially an all-encompassing love from which came security and self-confidence. On the material side, there was an unlimited budget for reading materials—from comics to serious books as I got older. I had the best home library in my part of town and developed a lifelong interest in reading and crafting words.
Were there particular family or cultural traditions that played a lasting role in shaping your values or worldview?
Accompanying my beloved grandmother to her temple was more about expressing solidarity with her than holding any firmly held religious views of my own. More influential was her bedtime storytelling to help me get to sleep on unbearably hot nights when we rested on the rooftop under the stars. Her stories were derived from classical Indian lore, but later I realised that she embellished them in her own way—her themes being the victory of good over evil and courage over cowardice. And so I was suitably indoctrinated.
What initially drew you to the field you chose to study, and was there a moment when you realized it was the right path for you?
I studied medicine—or more accurately, I was press-ganged by parental pressure. As per stereotypes, all Indian parents want their children to be engineers, lawyers, or doctors (nowadays, it is IT). I thought medicine would be the least boring. But I never thought it was the right path for me.
It was only through stubbornness that I endured six years of medical training—at Oxford after I got a scholarship to come to the UK—and several more years of mandatory clinical work in Cambridge to gain the necessary certificates. When I started working as a doctor, it was mind-numbing because it was so routine, especially among the somewhat elite population that I served. So I concluded that a lifetime of this would drive me crazy.
Salvation came by going into public health, which built on—but moved me beyond—the same endlessly repeated preventable and avoidable diseases to tackling more fundamental questions around health and society.
At what age did you begin working, and what did your first job teach you about responsibility or independence?
My scholarship to the UK did not cover school vacation periods, so I had to get jobs. My first was as a bar assistant at the age of 17 in a smart hotel bar in the posh seaside resort of Eastbourne. It was a very responsible role because I was entrusted with ordering the correct quantities of champagne, cognac, whisky, fine wines, and so on from the cellars.
Get it wrong and run out on a busy Saturday—or over-order for a Monday—and my bosses got very annoyed. I learned through experience—there was no AI in those days. Of course, I was too young to drink myself. But that was compensated for by the independence of buying all the books I wanted with cash in my pocket (staff were paid in brown envelopes in those pre-electronic days).
How would you describe your current professional role, and what aspects of it do you find most meaningful?
I am not sure how to answer this question because I don’t know how to describe my role. I have titles and designations, but roles are a different dimension. If they could be captured, they might be summed up by saying that I am a permanent critic of the status quo.
The most meaningful aspect for me is being able to think, speak, and write without fear or favour and expect nothing from anyone. In short, perfect freedom—which is a luxury nowadays.
Global health is often framed as a technical discipline, yet your career suggests it is deeply political. Where do you believe the global health community still underestimates the role of power, ideology, and geopolitics in shaping health outcomes?
In common with other global “isms”, global health consistently undervalues the role of individual foibles and choices in shaping outcomes and systematically exaggerates the power of globalised externalities. That is why we are seeing the current necessary backlash to uncritical globalisation, which has disempowered individuals and communities in so many places.
You have been vocal about early warning and prevention failures in humanitarian crises. Looking back, what systemic incentives most strongly discourage institutions from acting early, even when evidence is clear?
Institutions—including big UN agencies or multi-billion-dollar NGOs—are just organised receptacles of people and, by themselves, they are not responsible for anything. It is the people who work in institutions and breathe life into them who can be called to account.
People—especially leaders—tend to be conservative and risk-averse, which means there is an inbuilt tendency to act as late as possible and do as little as possible. That is the best preservation strategy for any organisation and the people within it. That is why I believe all organisational receptacles should periodically be broken up and reconstituted.
The humanitarian system frequently proclaims neutrality and impartiality. In practice, is neutrality still viable in today’s conflicts, or has it become a convenient fiction?
There is very little difference in today’s conflicts—such as Gaza, Ukraine, or over Iran—compared to past ones like Biafra or Vietnam. Wars have always been brutal, driven by the logic of winning at any cost.
Neutrality was always a fiction and remains so. Of course, the lawyers of humanitarian agencies such as the Red Cross and UN systems define neutrality in a very precise and scholarly way that differs from the everyday use of the term. That does not help in fostering the underlying noble notion of humanitarians serving the victims of all sides of conflict.
In your experience, when humanitarian action intersects with counterterrorism policies and sanctions regimes, who ultimately pays the price, and how should global health actors respond?
We live in a world of many asymmetric risks to civilians created by terror groups, including now in cyberspace. A highly securitised world is the understandable response of nations. Counterterror policies obviously take precedence over humanitarian concerns because of the “greater good” and “preventing harm” arguments. Also because, in democracies, that is what fearful citizens want.
It tragically means that needy and innocent victims of crises suffer despite efforts made to avoid hurting them through counterterror strategies. We have seen that in many places in the Middle East and West Asia. There is no special dispensation or exemption for global health actors, as we have seen in Gaza. This is even more evident at a time of competition over resources for bolstering national health security, as we saw during the Covid-19 pandemic.
Many global health interventions prioritize measurable outcomes and short-term impact. How has this focus distorted long-term health system strengthening in fragile and conflict-affected states?
I don’t think building long-term health systems in actively conflicted states is a viable proposition. In my experience of scores of such contexts, such as Myanmar, these efforts have always unravelled after wasting a lot of money and time.
When it comes to fragile or weak states such as Afghanistan—that is, very poor countries repeatedly dipping in and out of instability—there is no agreement among health experts or any proven strategies to construct robust or sustainable health systems. In these places, we should be nimble and opportunistic—that is, “unsystematic”—to maximise health gains from limited available resources.
You have argued that genocide and mass atrocities are predictable rather than inevitable. Why does the international community continue to treat them as unforeseeable, and who benefits from that narrative?
Mass atrocities, including genocidal ones, have taken place in all cultures and continents and across all eras of time. They will continue to happen because they are part of the human condition.
If I have said in the past that they were not inevitable, then I have been proved wrong after witnessing first-hand most of the major mass atrocities of recent decades. So “never again” will always happen “again and again”, as it did in Rwanda—with many “test” genocides before the big one in 1994 that I saw from within. Or earlier, the repeated European pogroms before the Holocaust.
Mass atrocities are foreseeable and repeated, but—as with earthquakes and volcanoes—they are unpredictable. We are simply not good at determining when and where they will happen. That is so despite documenting underlying risk factors at great length. The theorists who postulate that genocides progress through logical step-by-step stages are wrong in practice.
Thus, the task for good people is not to waste energy trying to change humanity’s inbuilt tendency to inflict cruelty and horror on others, but to react as fast as possible to interrupt and stop such outbreaks and reduce casualties. That is what I tried to do as UN Coordinator in Sudan when the millennium’s first genocide erupted in Darfur in 2003–04, which is, of course, being repeated now.
From your UN experience, where do accountability mechanisms most clearly fail when humanitarian leaders speak truth to power?
If you define a humanitarian leader as someone who heads an international humanitarian institution, then I have never seen this happen—at least as far as UN and Red Cross/Red Crescent agency heads are concerned.
I have worked at high levels in both systems and resigned from both when I could not speak up. In the rare cases when humanitarian leaders do speak up—as with UNRWA and UN agencies in Gaza—it is usually when they have nothing left to lose, including political capital.
Humanitarian speaking-up is often selective and inconsistent and hence open to accusations of being self-serving. Big NGOs are the same. The only noteworthy exception I know is MSF—the only truly independent international humanitarian agency we have—which has spoken up even when it cost them access. So to answer your question, I don’t know what happens when humanitarian leaders speak truth to power, because they largely don’t. If they did so in large enough numbers and consistently, we would know what happens instead of merely fearing what might happen.
There is growing emphasis on localization in humanitarian and global health responses. Is this a genuine transfer of power, or largely a rhetorical shift without structural change?
There you go again, confounding humanitarian and global health responses. They overlap but remain separate sectors. Health is not automatically a humanitarian topic.
On humanitarian localisation, including the so-called Grand Bargain, history will record this as among the greatest cons of the sector. Nothing significant has shifted since the idea was first mooted around 2016 at the first World Humanitarian Summit in Istanbul, which I helped organise.
The same—or worse—applies to global health localisation, which has actually seen the bloated expansion of global health organisations over the past decade. There are far too many of them now, and they are far too big—like the proverbial giant tree under whose shadow not even grass can grow.
Thus, I think that aid cuts resulting from the shifting business models of US and other donors provide an opportunity. Continuing with the tree analogy, by lopping off the heights of the oversized ones, perhaps more light and oxygen will reach the grassroots. It is too early to say yet, but one can hope.
How do donor priorities and funding cycles shape not only what humanitarian crises receive attention, but also how those crises are framed and understood?
Government donors are not private charities acting on the whims of their founders. They allocate taxpayer funds—including for foreign aid—according to their perception of national interest. This has always been the case and includes deciding which crises to respond to and setting conditions for that response. He who pays the piper has always called the tune.
If self-respecting recipient nations do not want to dance to donor tunes, they should wean themselves off foreign assistance. It is encouraging to see that this is progressively happening.
In conflict settings, global health professionals often face ethical trade-offs between access, advocacy, and safety. How should practitioners navigate situations where speaking out may cost lives in the short term but save lives in the long term?
This is not as difficult a problem as armchair philosophers make it out to be. Ethical behaviour is about doing the best right thing you can for the person or community in front of you at the moment when action is required—without worrying too much about theoretical future trade-offs, which we are often wrong about anyway.
If you do the right thing in the present, you are more likely to have done the right thing for the future. For example, we now know some of the side effects and complications associated with certain Covid-19 vaccines that were developed and rolled out in a hurry. Considering the threat posed by the coronavirus, that rapid deployment was the correct public policy rather than waiting for longer safety trials.
Some individuals with particular vulnerabilities were harmed—as happens with many medical interventions. That is why compensation programmes exist for those who, despite best efforts, become casualties of policies designed to protect the greater public good.
The COVID-19 pandemic exposed deep inequities in global health governance. What lessons have already been forgotten, and what structural reforms are still being actively resisted?
The real problem is that the wrong lessons have been learned. For example, that closing borders, imposing quarantines, and stopping schools and workplaces from functioning are effective ways to stop disease spread. The socio-economic disruption caused by those policies is still extracting generational costs.
Another mistaken lesson is that every nation must become self-sufficient in its essential supplies of medicines and vaccines. That makes little practical sense for many low- and middle-income countries. The corollary lesson—that we need to build up global multilateral bodies like WHO or GAVI to act as wholesalers and intermediaries for medical supplies—creates a new form of dependence.
Countries obviously need to cooperate to protect their populations from emerging diseases. But that cooperation should be built on strong national capacities for disease surveillance and response, not on the dictates of so-called “global health governance.” That is why it is healthy that countries are taking their time to question and debate international health regulations and the proposed pandemic treaty—including its pathogen-sharing provisions—to ensure that they are not re-colonised by global health structures.
You have worked at the intersection of health, human rights, and humanitarian law. Where do you see the greatest tension today between legal frameworks and operational realities on the ground?
Health, humanitarian, and human rights work are grounded in norms and values that are realised—however imperfectly—through voluntary moral exhortations encouraging people to behave decently.
Legislation is largely ineffective and sometimes counterproductive in these areas, except in narrow technical domains that determine the quality of specific products or services. For that reason, I am sceptical of the current legislative impulse that seeks to solve global dysfunctions simply by producing more laws.
This is particularly problematic when there is little or no enforcement, which only brings the idea of a law-based international order into greater contempt. Therefore, I do not think we need more global health, humanitarian, or human rights laws. That is different from criminal law—such as laws addressing genocide—which falls under the jurisdiction of the International Criminal Court – and are concerned with the accountability of individuals.
To what extent does the professionalization of humanitarian work risk dulling moral courage and political accountability?
Professionalisation through training can be beneficial in improving the skills and competencies of humanitarian workers, particularly when it incorporates advances in science and technology. It is a moral duty to ensure that the most needy among us get the best attention. However, if that process turns humanitarians into bureaucrats devoid of empathy, it drains the heart out of humanitarian work. Increasingly, people enter humanitarian work not as a vocation but as a career.
Those individuals should not be allowed to climb organisational ladders and run humanitarian institutions like businesses. Courage, moral instinct, and compassion cannot be taught in management schools. Either you possess them or you do not. Professionalisation should help people apply those instincts more effectively, not replace them with technocratic techniques.
How should global health education change if we are serious about preparing future leaders for ethical failure, institutional resistance, and political backlash?
I do not believe it is possible to produce such ideal leaders through education or careful design. They tend to emerge through some mysterious process of personal formation. If we are fortunate, a generation might randomly produce one or two such leaders.
If you were advising the next generation of humanitarian leaders, what uncomfortable truths about the system would you insist they confront early rather than discover too late?
I would not waste time advising future humanitarian leaders about systems. First, because most leaders believe they already know everything; and second, because they are usually in such a hurry to leave their personal mark on whatever institution they inherit that they begin by dismantling it. Instead, my “uncomfortable truth” would be a gentle reminder—adapted from Robert Jackson Bennett: all careers end in failure. Some careers are long, others short. Some end gracefully and peacefully, others less so. But beloved or hated, powerful or weak, right or wrong, effective or irrelevant—eventually all careers end in failure.
Humanitarian leaders should therefore tread lightly and humbly, especially given that their well-paid careers are built upon the misery and misfortune of others.
Has there been a book, film, or work of art that significantly influenced the way you see the world or think about your work?
As a teenager I read Gormenghast by Mervyn Peake. Published in 1950 as a fantasy, it had a profound impact on me. It depicts a world of stagnation and insularity, filled with time-consuming, complex, and pointless rituals whose origins have long been forgotten. The story essentially goes from nowhere to nowhere—and that is precisely the point. A metaphor, perhaps, for the international system.
Looking at younger generations today, what gives you the greatest sense of hope, and what concerns you the most?
I am neither especially hopeful nor particularly worried. I am not inclined to romanticise Generation Z or any other generation. Young people today will experience the same mixture of successes and mistakes as their predecessors—only in different forms.
If you could spend a full day with any historical figure, who would you choose, and what questions would you want to ask them?
Meeting saintly figures such as Gandhi or Mandela might actually be somewhat tedious. What more could they tell us that they have not already expressed in their writings or that has not been elaborated by their admirers? Instead, it might be more instructive to understand someone deeply unpleasant such as Hitler or Pol Pot. But even they have left extensive records of their views.
A more interesting encounter might be with someone who chose to live in proximity to them. Why did they do so? For that reason, a day with the enigmatic Eva Braun—the mistress and brief wife of Adolf Hitler—might be illuminating. It would be fascinating to understand how and why that relationship existed. Could we thus learn something about the seductive power of evil?
If you were asked to teach a class on a subject completely unrelated to your profession, what would it be, and what would you hope students take away from it?
Perhaps a course on black holes, exploring the astrophysics behind immense gravitational bodies that capture everything and from which nothing escapes—not even light. Paradoxically, I find that idea liberating because it frees one from the endless human search for meaning in everything.
Students could then enrol in my follow-on course on “optimistic nihilism”. Some of its modules would be inspired by my grandmother’s bedtime stories, whose endings I never heard because I usually fell asleep halfway through.
If you could ensure that one human value is never lost in society, which value would you choose, and why?
Selfishness will survivie with or without our intervention. Because it is the foundation of evolutionary human behaviour and survival. It also generates the counterbalancing value of selflessness.
The constant tension between selfishness and selflessness brings out the best in humanity. Without that eternal struggle between bad and good, there would be no nobility of thought and no humanitarianism—and I would never have built such a lucrative career from it.
Humanity is facing radical changes. To name just ten: geopolitical instability, climate change, economic inequalities, technological risks, public health challenges, political polarization, resource scarcity, humanitarian crises, misinformation, and disparities in global healthcare access. If, in an imaginative exercise, you had the power to solve one of these problems, which one would you choose first and why?
Change is not necessarily bad. But I do not consider your ten challenges particularly radical. They are largely predictable consequences of how human societies evolve. Solutions already exist for many of them and are being applied, albeit often too slowly.
What do you believe human beings owe one another, both as individuals and as members of a global society?
If each person simply tried to be the best version of themselves without burdening others unnecessarily, society would function better overall. Some might see that as an overly individualistic philosophy. But I believe the well-being of global society is ultimately built from the well-being of individuals.
Interviews often focus on successes. Could you share something from 2025 that did not unfold as you expected, and what that experience taught you?
I am often invited to join boards and committees of NGOs and other organisations, and I usually accept because it allows me to pass on whatever knowledge and experience I have accumulated.
In 2025 I joined one such body—best left unnamed—that turned out to be little more than a vehicle to advance the ego of a wealthy benefactor and polish their reputation. I realised that my name might be used to lend credibility to something questionable. Extracting myself from the situation took time and effort.
The biggest lesson was recognising the value of my own name. I had never considered myself important enough to worry about that. But one’s name—big or small—is the only one we have.
Are there any personal or professional goals you feel comfortable sharing for 2026?
I am inspired by the release of the Epstein papers. Over the years I have known many people and observed the inner workings of many organisations. I am waiting for certain individuals to die so that I can speak honestly about them without risking legal repercussions. I am not referring to sexual misconduct but other forms of wrongdoing. Of course, they may outlive me—which would be frustrating. Alternatively, I could publish my account after my own death. But where would be the fun in that?
When you imagine the final moments of your life, what kind of news would you most hope to hear, and why?
I cannot imagine a more dreadful prospect than my final moments being spent listening to a news bulletin about the world I am about to leave. Instead, I would much prefer—even if only for a few milliseconds—a glimpse of whatever comes next. Anything at all would suffice. I would be delighted if my nihilism were proved wrong—even if it happened too late to do me any good.
