There is an intersection in this book of the macabre and the ecstasy of moral clarity. The backdrop is the Rwandan genocide, the heroes are the altruistic humanitarian aid workers. The victims and killers have eerily indistinguishable faces as they trudge along. Doctors without Borders – best known internationally by their French acronym MSF and founded during the Biafran War in 1971 – refer to each other only by their first names.

There are currently about 3,000 of them in the field from Afghanistan to Zimbabwe, and they include – as well as doctors – nurses, nutritionists, administrators, logisticians, and sanitation specialists. They confront plagues of cholera, typhoid, dehydration, diarrhea, and malaria – often the African by-products of random atrocities.

Author Elliott Leyton is a leading anthropologist and an authority on the psychology of killing and death. He witnessed his first autopsy at age six in Saskatchewan. His collaborator is the internationally published and seasoned photojournalist Greg Locke. Together, they strive for a symphony of text and photography, intending the photos to provide a narrative in their own right.

Leyton offers perceptive, punchy, personal portraits of individual MSFers and their endeavours. He probes their personalities and motivations. The “obliteration of alienation” in Western industrialized society drives many of them. So too, the intoxicating exuberance of focused collective action.

But, the laudable efforts have their ambiguous complexities too. Consider the moral dilemma of saving a life today that may be extinguished by renewed butchery next week or by starvation next month.

Courageous and cosmopolitan aid workers may also be cynical, sanctimonious and disputatious. Some have died because they made the decision to remain in situations deemed too generous by others. And yet, aid supplies often prolong war, ending up with the military rather than their victims.