On December 10, 1999, the Nobel Peace Prize was presented to James Orbinski, a 39-year-old Toronto doctor, who accepted the honour as president of the global relief agency Médecins Sans Frontières. In his speech, Orbinski recalled for the assembled dignitaries in Oslo the story of a woman he’d tended to in Kigali five years earlier, at the height of the Rwandan genocide. Her entire body had been systematically mutilated: “We could do little more...than stop the bleeding…. She knew and I knew…. She said to me in the clearest voice I have ever heard, ‘Allez, allez…ummera, ummera-sha.’ ‘Go, go my friend, find and let live your courage.’ ”

Orbinski has never been short on courage. Born in England and schooled in Ontario and Quebec, he joined MSF in 1992. The organization now brings emergency medical aid to more than 80 countries, sending some 3,000 doctors, nurses and midwives into crisis zones every year. On his first mission—in Somalia during the civil war and famine—he worked in Baidoa in a sand-floored shack that became a makeshift emergency ward. At the time, the city had the highest mortality rate ever recorded during a famine.

Fifteen years later, Orbinski returned to Somalia and Rwanda to research a memoir, having finally decided to tell his story. His book, An Imperfect Offering: Humanitarian Action for the 21st Century, which is part personal history, part manifesto, is due out this month. The book’s title comes from Leonard Cohen’s ballad “Anthem” (“Forget your perfect offering…. There is a crack in everything”).

Patrick Reed, the Canadian who co-produced Shake Hands With the Devil, asked to go along after hearing of Orbinski’s plan to return to Africa. The result is a full-length documentary, Triage: Dr. James Orbinski’s Humanitarian Dilemma, which screened at Sundance in January and will play at the Hot Docs Festival this month. During Orbinski’s experience in Somalia, triage meant not just evaluating and prioritizing patients, but also marking hundreds for death with pieces of tape. “There are moral implications,” he concedes of the process that saw him choosing which patients could be saved. “I don’t have regrets about the decisions. I have complete outrage about the circumstances.”

He points to the wilful blindness of governments, international agencies and pharmaceutical giants that have been complicit actors in some of the most shameful episodes in modern history. As an example, he cites the UN’s involvement in Kosovo in 1999: “It was possible to stage a humanitarian bombing campaign. It’s a complete oxymoron.”

Earnest, articulate and razor-sharp, Orbinski projects the controlled persona you might expect of someone who has remained calm in the face of brutalized rape victims, emaciated infants and 16-year-olds wielding machine guns, which is not to say that he escaped un­scarred. Crippling depression followed his time in Rwanda, and while his mother worried, it was his father who reminded him, “James, you can’t just lie down in the snow.” He saw a therapist to treat his trauma and eventually found a form of catharsis in marriage and family. In April, he and his wife, Rolie Srivastava, are expecting their third child (joining four-year-old Rohin and his three-year-old brother, Taigdh). “Through their eyes, I have become re-enchanted with the beauty of the world,” he says. The family lives in the Annex and has a cottage in Haliburton.

His professional life, no longer a montage of warring militias, has also settled into a more conventional routine. Orbinski lectures at the University of Toronto, with prestigious cross-appointments in medicine and international relations, and has a research position at St. Michael’s Hospital. He also chairs Dignitas International, an agency he co-founded in 2004 to streamline delivery of HIV/AIDS care in Africa; it now handles a 10,000-patient case­load in Malawi.

Can he talk to his sons about what he has seen? He can, he says, and does, at a level he hopes they will comprehend. The world they will inherit may well be tougher than his own, and he is not afraid to acknowledge that. But awareness alone is not sufficient. “The other part,” he insists, “is to tell them, ‘This is what I’m doing to change it.’ ” Not to lie down in the snow. “In that sense, I’m an optimist. Because I choose to be.”