In an emergency situation doctors may have to watch one patient die in order to save another. This is part of the process known as triage, an evaluation of who to treat and who to leave. A technical decision with great moral implications.

This dilemma is at the heart of a documentary about Dr James Orbinski, formerly a doctor with aid agency Medecins Sans Frontieres (MSF) who became the organisation's president and accepted the Nobel Peace Prize on their behalf.

The film follows Orbinski back to the sites where he worked for MSF. He recalls his time in a hospital in Kigali, Rwanda in 1994 at the height of the genocide there. He and the other doctors put small pieces of paper on patients' heads assigning them a number, one, two or three. The "threes" were irretrievable. They were placed in an area to the side of the hospital yard so that resources could go towards aiding those that had a chance of survival.

In the city of Baidoa in Somalia, where he worked during the famine of the early 1990s, Orbinski says the memory that haunts him is of the silence of 150,000 people as they waited for food and medical attention. They were too weak to make any noise.

In Baidoa you can still see the lettering on the medical clinic building spelling out Artsen Zonder Grenzen, the Dutch name of MSF, but MSF hasn't worked in Baidoa since 1997. This is when one of their staff, Dr Ricardo Marques, was killed and the organisation pulled out. There is now only one doctor, a Somalian, serving the hospital in Baidoa.

It's a powerful personal film, but still touches on the dilemmas around humanitarian action. There's "no humanitarian highway, no fast-lane" so aid agencies must constantly negotiate with the local powerbrokers. Sometimes this means paying ransom fees to save a colleague being held hostage as Orbinski did in Somalia. Or it means agreeing to a curfew after which time all vehicles on the road are fair game to militants.

In the refugee camps formed by those fleeing Rwanda in 1994, in what's now Democratic Republic of Congo, MSF recognised that their work was aiding those who had carried out the genocide and were now using the camps as a base to attack Rwanda. So the organisation withdrew. "To be politically neutral in a way you have to be the most political of animals," says Orbinski.

But how does this sit with their humanitarian principles? To pull out because of staff security, as in Somalia, or because of a questioning of what activities your work is supporting, as in DRC, are technical decisions, again with great moral implications.

Orbinski revisited many of these places as part of writing a book about his work with MSF. Read more about "An Imperfect Offering: Humanitarian Action in the Twenty-first century" here.

The film was screened at the Frontline Club in London.

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