Médecins Sans Frontières
A major contributor to this article appears to have a close connection with its subject. (December 2022) |
International non-governmental organisation | |
Focus | Humanitarian aid |
---|---|
Headquarters |
|
Area served | Worldwide |
International President | Christos Christou |
Main organ | International General Assembly |
Revenue (2020) | €1.9 billion |
Employees | 45,375 |
Website | msf |
Médecins Sans Frontières (MSF; pronounced
MSF was founded in 1971, in the aftermath of the
MSF has general consultative status with the United Nations Economic and Social Council. It received the 1999 Nobel Peace Prize in recognition of its members' continued efforts to provide medical care in acute crises, as well as raising international awareness of potential humanitarian disasters.[6] James Orbinski, who was the president of the organisation at the time, accepted the prize on behalf of MSF. Prior to this, MSF also received the 1996 Seoul Peace Prize.[7] Christos Christou succeeded Joanne Liu as international president in June 2019.[8]
History
1967 to 1970 Biafra
During the Nigerian Civil War of 1967 to 1970, the Nigerian military formed a blockade around the nation's newly independent south-eastern region, Biafra. At this time, France was one of the few major countries supportive of the Biafrans (the United Kingdom, the Soviet Union and the United States sided with the Nigerian government), and the conditions within the blockade were unknown to the world. A number of French doctors volunteered with the French Red Cross to work in hospitals and feeding centers in besieged Biafra.[3] One of the co-founders of the organisation was Bernard Kouchner, who later had a career in French politics, rising to the position of Minister for Europe and Foreign Affairs, which he held 2007–2010.[citation needed]
After entering the country, the volunteers, in addition to Biafran health workers and hospitals, were subjected to attacks by the Nigerian Armed Forces, and witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticised the Nigerian government and the Red Cross for their seemingly complicit behaviour. These doctors concluded that a new aid organisation was needed that would ignore political/religious boundaries and prioritise the welfare of survivors.[3] Apart from Nigeria, MSF exists in several African countries including Benin, Zambia, Uganda, Kenya, South Africa, Rwanda, Sudan, Sierra Leone, and others.
1971 establishment
The Groupe d'intervention médicale et chirurgicale en urgence ("Emergency Medical and Surgical Intervention Group") was formed in 1971 by French doctors who had worked in Biafra, to provide aid and to emphasize the importance of survivors' rights. At the same time, Raymond Borel, the editor of the French medical journal TONUS, had started a group called Secours Médical Français ("French Medical Relief") in response to the 1970 Bhola cyclone, which killed at least 625,000 in East Pakistan (now Bangladesh). Borel had intended to recruit doctors to provide aid to survivors of natural disasters. On 22 December 1971, the two groups of colleagues merged to form Médecins Sans Frontières.[9]
MSF's first mission was to the Nicaraguan capital,
Between 1975 and 1979, after South Vietnam had fallen to North Vietnam, millions of Cambodians immigrated to Thailand to avoid the Khmer Rouge.[12] In response, MSF set up its first refugee camp missions in Thailand.[9] When Vietnam withdrew from Cambodia in 1989, MSF started long-term relief missions to help survivors of the mass killings and reconstruct the country's health care system.[13] Although its missions to Thailand to help victims of war in Southeast Asia could arguably be seen as its first wartime mission, MSF saw its first mission to a true war zone, including exposure to hostile fire, in 1976. MSF spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in Lebanon, during the Lebanese Civil War, and established a reputation for its neutrality and willingness to work under fire. Throughout the war, MSF helped both Christian and Muslim soldiers alike, helping whichever group required the most medical aid at the time. In 1984, as the situation in Lebanon deteriorated further and security for aid groups was minimised, MSF withdrew its volunteers.[citation needed]
Original founders
- Jacques Bérès
- Philippe Bernier
- Raymond Borel
- Jean Cabrol
- Marcel Delcourt
- Xavier Emmanuelli
- Pascal Grellety Bosviel
- Gérard Illiouz
- Bernard Kouchner
- Gérard Pigeon
- Vladan Radoman
- Max Récamier
1970s
Claude Malhuret was elected as the new president of Médecins Sans Frontières in 1977, and soon after debates began over the future of the organisation. In particular, the concept of témoignage ("witnessing"), which refers to speaking out about the suffering that one sees as opposed to remaining silent,[14] was being opposed or played down by Malhuret and his supporters. Malhuret thought MSF should avoid criticism of the governments of countries in which they were working, while Kouchner believed that documenting and broadcasting the suffering in a country was the most effective way to solve a problem.
In 1979, after four years of refugee movement from South Vietnam and the surrounding countries by foot and by boat, French intellectuals made an appeal in Le Monde for "A Boat for Vietnam", a project intended to provide medical aid to the refugees. Although the project did not receive support from the majority of MSF, some, including later Minister Bernard Kouchner, chartered a ship called L'Île de Lumière ("The Island of Light"), and, along with doctors, journalists and photographers, sailed to the South China Sea and provided some medical aid to the boat people. The splinter organisation that undertook this, Médecins du Monde, later developed the idea of humanitarian intervention as a duty, in particular on the part of Western nations such as France.[15] In 2007 MSF clarified that for nearly 30 years MSF and Kouchner have had public disagreements on such issues as the right to intervene and the use of armed force for humanitarian reasons. Kouchner is in favour of the latter, whereas MSF stands up for an impartial humanitarian action, independent from all political, economic and religious powers.[16]
1980s
In 1982, Malhuret and Rony Brauman (who became the organisation's president in 1982) brought increased financial independence to MSF by introducing fundraising-by-mail to better collect donations. The 1980s also saw the establishment of the other operational sections from MSF-France (1971): MSF-Belgium (1980), MSF-Switzerland (1981), MSF-Holland (1984), and MSF-Spain (1986). MSF-Luxembourg was the first support section, created in 1986. The early 1990s saw the establishment of the majority of the support sections: MSF-Greece (1990), MSF-USA (1990), MSF-Canada (1991), MSF-Japan (1992), MSF-UK (1993), MSF-Italy (1993), MSF-Australia (1994), as well as Germany, Austria, Denmark, Sweden, Norway, and Hong Kong (MSF-UAE was formed later).[9][17] Malhuret and Brauman were instrumental in professionalising MSF. In December 1979, after the Soviet army had invaded Afghanistan, field missions were immediately set up to provide medical aid to the mujahideen, and in February 1980, MSF publicly denounced the Khmer Rouge. During the 1983–1985 famine in Ethiopia, MSF set up nutrition programmes in the country in 1984, but was expelled in 1985 after denouncing the abuse of international aid and the forced resettlements. MSF's explicit attacks on the Ethiopian government led to other NGOs criticizing their abandonment of their supposed neutrality and contributed to a series of debates in France around humanitarian ethics.[18][19] The group also set up equipment to produce clean drinking water for the population of San Salvador, capital of El Salvador, after 10 October 1986 earthquake that struck the city.[9][20]
1990s
The early 1990s saw MSF open a number of new national sections, and at the same time, set up field missions in some of the most dangerous and distressing situations it had ever encountered.[citation needed]
In 1990, MSF first entered Liberia to help civilians and refugees affected by the Liberian Civil War.[21] Constant fighting throughout the 1990s and the Second Liberian Civil War have kept MSF volunteers actively providing nutrition, basic health care, and mass vaccinations, and speaking out against attacks on hospitals and feeding stations, especially in Monrovia.[22]
Field missions were set up to provide relief to
MSF first began work in
1994 Rwandan Genocide
When the
The ICRC lost 56 and MSF lost almost one hundred of their respective local staff in Rwanda, and MSF-France, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a
At the time of the genocide, competition between the medical efforts of MSF, the ICRC, and other aid groups had reached an all-time high,[28] but the conditions in Rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes was created by the ICRC in 1994 to provide a framework for humanitarian missions and MSF is a signatory of this code.[29] The code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments.[30] MSF has since still found it necessary to condemn the actions of governments, such as in Chechnya in 1999,[31] but has not demanded another military intervention since then.[9]
2020s
2020 accusations of racism
More than a thousand staffers accused the charity of white supremacy when they voiced their concerns in a 2020 petition. One staffer from Cameroon detailed her experiences with racism from the group's leaders. Many concerns involved different treatment of expatriate staff from Europe and North America, who are typically white, compared to national staff. In an interview with NPR, the president of the organisation acknowledged Doctors Without Borders was founded in racism and pledged to do better.[32]
Snakebite prioritisation in WHO
MSF played an important role for including snakebite as a WHO Category A
Activities by location
In 1999, the organisation spoke out about the lack of humanitarian support in Kosovo and Chechnya, having set up field missions to help civilians affected by the respective political situations. Although MSF had worked in the Kosovo region since 1993, the onset of the
A serious crisis within MSF erupted in connection with the organisation's work in Kosovo when the Greek section of MSF was expelled from the organisation. The Greek MSF section had gained access to Serbia at the cost of accepting Serb government imposed limits on where it could go and what it could see – terms that the rest of the MSF movement had refused.[35] A non-MSF source alleged that the exclusion of the Greek section happened because its members extended aid to both Albanian and Serbian civilians in Pristina during NATO's bombing.[36] The rift was healed only in 2005 with the re-admission of the Greek section to MSF.
A similar situation was found in Chechnya, whose civilian population was largely forced from their homes into unhealthy conditions and subjected to the violence of the Second Chechen War.[37]
MSF has been working in Haiti since 1991, but since President Jean-Bertrand Aristide was forced from power, the country has seen a large increase in civilian attacks and rape by armed groups. In addition to providing surgical and psychological support in existing hospitals – offering the only free surgery available in Port-au-Prince – field missions have been set up to rebuild water and waste management systems and treat survivors of major flooding caused by Hurricane Jeanne; patients with HIV/AIDS and malaria, both of which are widespread in the country, also receive better treatment and monitoring.[38] As a result of 12 January 2010 Haiti earthquake, reports from Haiti indicated that all three of the organisation's hospitals had been severely damaged; one collapsing completely and the other two having to be abandoned.[39] Following the quake, MSF sent about nine planes loaded with medical equipment and a field hospital to help treat the victims. However, the landings of some of the planes had to be delayed due to the massive number of humanitarian and military flights coming in.[40]
The
MSF went through a long process of self-examination and discussion in 2005–2006. Many issues were debated, including the treatment of "nationals" as well as "fair employment" and self-criticism.[43]
MSF issued a statement for safe abortion following Dobbs v. Jackson Women's Health Organization.[44]
Sub-Saharan Africa
MSF has been active in a large number of African countries for decades, sometimes serving as the sole provider of health care, food, and water. Although MSF has consistently attempted to increase media coverage of the situation in Africa to increase international support, long-term field missions are still necessary. Treating and educating the public about HIV/AIDS in sub-Saharan Africa, which sees the most deaths and cases of the disease in the world,[45] is a major task for volunteers. Of the 14.6 million people in need of anti-retroviral treatment the WHO estimated that only 5.25 million people were receiving it in developing countries, and MSF continues to urge governments and companies to increase research and development into HIV/AIDS treatments to decrease cost and increase availability.[46]
Sierra Leone
In the late 1990s, MSF missions were set up to treat tuberculosis and
Sudan
Since 1979, MSF has been providing medical humanitarian assistance in
.Kala-Azar in Sudan
Health care infrastructure in Sudan
Sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between
Democratic Republic of the Congo
Although active in the Congo region of Africa since 1985, the
Uganda
MSF has been active in Uganda since 1980, and provided relief to civilians during the country's guerrilla war during the
Ivory Coast
MSF first camp set up a field mission in Côte d'Ivoire in 1990, but ongoing violence and the
MSF has strongly promoted the use of
West African Ebola outbreak
During the Ebola outbreak in West Africa in 2014, MSF met serious medical demands largely on its own, after the organisation's early warnings were largely ignored.[68]
Burundi
MSF-Burundi has aided in attending to casualties suffered in the 2019 Burundi landslides.[69]
Asia
Sri Lanka
MSF is involved in Sri Lanka, where a 26-year civil war ended in 2009 and MSF has adapted its activities there to continue its mission. For example, it helps with physical therapy for patients with spinal cord injuries.[70] It conducts counseling sessions, and has set up an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries".[71]
Cambodia
MSF first provided medical help to civilians and refugees who have escaped to camps along the Thai-Cambodian border in 1979. Due to long decades of war, a proper health care system in the country was severely lacking and MSF moved inland in 1989 to help restructure basic medical facilities.
In 1999, Cambodia was hit with a malaria epidemic. The situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. Counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic.[72] This has prompted efforts by MSF to set up and fund a malaria outreach project and utilise Village Malaria Workers.[73] MSF also introduced a switching of first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally.[74]
Cambodia is one of the hardest hit HIV/AIDS countries in Southeast Asia. In 2001, MSF started introducing antiretroviral (ARV) therapy to AIDS patients for free. This therapy prolongs the patients' lives and is a long-term treatment.[75] In 2002, MSF established chronic diseases clinics with the Cambodian Ministry of Health in various provinces to integrate HIV/AIDS treatment, alongside hypertension, diabetes, and arthritis which have high prevalence rate. This aims to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic in contrast to a HIV/AIDS specialised treatment centre.[76]
MSF also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people.[77] MSF introduced a community-based tuberculosis programme in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. In partnership with local health authorities and other NGOs, MSF encouraged decentralized clinics and rendered localized treatments to more rural areas from 2006.[78] Since 2007, MSF has extended general health care, counselling, HIV/AIDS and TB treatment to prisons in Phnom Penh via mobile clinics.[79] However, poor sanitation and lack of health care still prevails in most Cambodian prisons as they remain as some of the world's most crowded prisons.[80]
In 2007, MSF worked with the Cambodian Ministry of Health to provide psychosocial and technical support in offering pediatric HIV/AIDS treatment to affected children.[81] MSF also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007,[82] which had more than 40,000 people hospitalized, killing 407 people, primarily children.[83]
In 2010, Southern and Eastern provinces of Cambodia were hit with a cholera epidemic and MSF responded by providing medical support that were adapted for usage in the country.[84]
Cambodia is one of 22 countries listed by WHO as having a high burden of tuberculosis. WHO estimates that 64% of all Cambodians carry the tuberculosis mycobacterium. Hence, MSF has since shifted its focus away from HIV/AIDS to tuberculosis, handing over most HIV-related programs to local health authorities.[85]
Middle East and North Africa
Libya
The
Search and Rescue in the Mediterranean Sea
MSF is providing Maritime Search And Rescue (SAR) services on the Mediterranean Sea to save the lives of migrants attempting to cross with unseaworthy boats. The Mission started in 2015 after the EU ended its major SAR
In December 2018 MSF and SOS Méditerranée were forced to end operations of the
Yemen
MSF is involved in trying to help with the humanitarian crisis caused by the
Europe
The Netherlands
In August and September 2022, MSF provided medical care to asylum seekers staying outside the overcrowded migration centre in Ter Apel, the Netherlands.[95]
Organisation of activities
Before a field mission is established in a country, an MSF team visits the area to determine the nature of the humanitarian emergency, the level of safety in the area and what type of aid is needed (this is called an "exploratory mission").
Medical aid is the main objective of most missions, although some missions help in such areas as water purification and nutrition.[96]
Field mission team
A field mission team usually consists of a small number of coordinators to head each component of a field mission, and a "head of mission". The head of mission usually has the most experience in humanitarian situations of the members of the team, and it is their job to deal with the media, national governments and other humanitarian organisations. The head of mission does not necessarily have a medical background.
Medical volunteers include physicians, surgeons, nurses, and various other specialists. In addition to operating the medical and nutrition components of the field mission, these volunteers are sometimes in charge of a group of local medical staff and provide training for them.
Although the medical volunteers almost always receive the most media attention when the world becomes aware of an MSF field mission, there are a number of non-medical volunteers who help keep the field mission functioning. Logisticians are responsible for providing everything that the medical component of a mission needs, ranging from security and vehicle maintenance to food and electricity supplies. They may be engineers and/or foremen, but they usually also help with setting up treatment centres and supervising local staff. Other non-medical staff are water/sanitation specialists, who are usually experienced engineers in the fields of water treatment and management and financial/administration/human resources experts who are placed with field missions.
Medical component
Vaccination campaigns are a major part of the medical care provided during MSF missions. Diseases such as
An equally important part of the medical care provided during MSF missions is AIDS treatment (with
In most countries, MSF increases the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff.
Since most of the areas that require field missions have been affected by a natural disaster, civil war, or endemic disease, the residents usually require psychological support as well. Although the presence of an MSF medical team may decrease stress somewhat among survivors, often a team of
Nutrition
Often in situations where an MSF mission is set up, there is moderate or severe
In emergency situations where there is a lack of nutritious food, but not to the level of a true famine,
A Therapeutic Feeding Centre (or Therapeutic Feeding Programme) is designed to treat severe malnutrition through the gradual introduction of a special diet intended to promote weight gain after the individual has been treated for other health problems. The treatment programme is split between two phases:[108]
- Phase 1 lasts for 24 hours and involves basic health care and several small meals of low energy/protein food spaced over the day.
- Phase 2 involves monitoring of the patient and several small meals of high energy/protein food spaced over each day until the individual's weight approaches normal.
MSF uses foods designed specifically for treatment of severe malnutrition. During phase 1, a type of therapeutic milk called
Water and sanitation
Clean water is essential for
Sanitation is an essential part of field missions, and it may include education of local medical staff in proper
Statistics
In order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, data on a number of factors are collected during each field mission. The rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres.[119] Various types of mortality rates are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries.[120] By compiling data on the frequency of diseases in hospitals, MSF can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs. For example, the "Meningitis Belt" (sub-Saharan Africa, which sees the most cases of meningitis in the world) has been "mapped" and the meningitis season occurs between December and June. Shifts in the location of the Belt and the timing of the season can be predicted using cumulative data over many years.[121]
In addition to epidemiological surveys, MSF also uses population
Innovation and use of technology
In 2014 MSF partnered with satellite operator
Governance and structure
List of international presidents:[128]
- 1991–1992 Rony Brauman
- 1992 Reginald Moreels
- 1992–1994 Rony Brauman
- 1994–1995 Jacques De Milliano
- 1995–1996 Doris Schopper
- 1996–1997 Philippe Biberson
- 1997–1998 Doris Schopper
- 1998–2000 James Orbinski
- 2000–2003 Morten Rostrup
- 2004–2006 Rowan Gillies
- 2006–2010 Christophe Fournier
- 2010–2013 Unni Karunakara
- 2013–2019 Joanne Liu
- 2019–Present Christos Christou
In addition to the Geneva global headquarters and five regional operational centers, as of 2020 MSF had national offices as follows:[129]
- MSF Australia
- MSF Austria
- MSF Belgium
- MSF Brazil
- MSF Canada
- MSF Czech Republic
- MSF Denmark
- MSF Eastern Africa
- MSF Finland
- MSF France
- MSF Germany
- MSF Greece
- MSF Hong Kong
- MSF Ireland
- MSF Italy
- MSF Japan
- MSF Republic of Korea
- MSF Lat (Spanish Speaking South America)
- MSF Luxembourg
- MSF Mexico
- MSF Netherlands
- MSF Norway
- MSF South Africa
- MSF SARA (South Asia Regional Association: India, Pakistan, Afghanistan, Sri Lanka, Bangladesh)
- MSF Spain
- MSF Sweden
- MSF Switzerland
- MSF Taiwan
- MSF United Kingdom
- MSF United States
- MSF West and Central Africa
In-house organisations
Epicentre
In 1986, MSF created Epicentre, an in-house research organisation, to support its activities. Epicentre conducts training, publishes scientific papers and develops new techniques for MSF. It performs epidemiological research, conducts clinical vaccine trials during outbreaks MSF is responding to, experiments on vaccine stability, and analysis of vaccine deployment strategy.[130]
Campaign for Access to Essential Medicines
The Campaign for Access to Essential Medicines was initiated in 1999 to increase access to
In 2006, MSF tried to use its influence to urge the drug maker
In March 2017, Els Torreele who had been leading the campaign from 1999 to 2003 returned to MSF as the executive director of the Access Campaign. For the following three years she led a global analysis and advocacy team whose goal was to guarantee that appropriate medicines, vaccines and diagnostics are developed, available, affordable and adapted to people's needs.[134]
As of 2022, the most critical subjects of the campaign were rising antimicrobial resistance and outbreaks of epidemic diseases such as Ebola and COVID. Still, a lot of vaccines, diagnostics and medicines were inaccessible for people in need.[135]
Security risks to staff
MSF staff are sometimes attacked or kidnapped. In some countries, humanitarian-aid organisations are viewed as helping the enemy. If an aid mission is perceived to be exclusively set up for victims on one side of the conflict, it may come under attack. However, the
Arrests and abductions in politically unstable regions can also occur for volunteers, and in some cases, MSF field missions can be expelled entirely from a country.
Incidents
Below is a partial list of notable incidents of direct violence against MSF staff or facilities, in chronological order:
- 14 August 2013: MSF announced that it was closing all of its programmes in Somalia due to attacks on its staff by Al-Shabaab militants and perceived indifference or inurement to this by the governmental authorities and wider society.[142]
- 3 October 2015: Fourteen staff and 28 others died when an MSF hospital was bombed by American forces during the Battle of Kunduz.[143]
- On 7 October 2015, US President Barack Obama issued an apology.[144] Doctors Without Borders was not satisfied by Obama's apology.[145]
- 27 October 2015: An MSF hospital in Saudi Arabia-led military coalition.[146]
- 28 November 2015: An MSF-supported hospital was barrel-bombed by a Syrian Air Force helicopter, killing seven and wounding forty-seven people near Homs, Syria.[147]
- 10 January 2016: An MSF-supported hospital in Sa'dah was bombed by the Saudi Arabia-led military coalition, killing six people.[148]
- 15 February 2016: Two MSF-supported hospitals in
- 28 April 2016: An MSF hospital in Aleppo was bombed, killing 50, including six staff and patients.[152]
- 12 May 2020: an MSF-supported hospital in
- 25 June 2021: Three MSF employees were reported killed in Tigray, Ethiopia.[154]
- 18 November 2023: An evacuation convoy of MSF vehicles was attacked in Gaza, Palestine during the 2023 Israel-Hamas war, resulting in deaths of two family members of MSF workers with one being a volunteer supporting MSF at Al Shifa Hospital. MSF reported "MSF considers that all elements point to the responsibility of the Israeli army for this attack".[155]
Awards
1999 Nobel Peace Prize
The then president of MSF, James Orbinski, gave the Nobel Peace Prize speech on behalf of the organisation. In the opening, he discusses the conditions of the victims of the Rwandan genocide and focuses on one of his woman patients:[156]
There were hundreds of women, children and men brought to the hospital that day, so many that we had to lay them out on the street and even operate on some of them there. The gutters around the hospital ran red with blood. The woman had not just been attacked with a machete, but her entire body rationally and systematically mutilated. Her ears had been cut off. And her face had been so carefully disfigured that a pattern was obvious in the slashes. She was one among many—living an inhuman and simply indescribable suffering. We could do little more for her at the moment than stop the bleeding with a few necessary sutures. We were completely overwhelmed, and she knew that there were so many others. She said to me in the clearest voice I have ever heard, 'Allez, allez...ummera, ummerasha'—'Go, go...my friend, find and let live your courage.'
— James Orbinski, Nobel acceptance speech for MSF
Orbinski affirmed the organisation's commitment to publicising the issues MSF encountered, stating[157]
Silence has long been confused with neutrality, and has been presented as a necessary condition for humanitarian action. From its beginning, MSF was created in opposition to this assumption. We are not sure that words can always save lives, but we know that silence can certainly kill.
— James Orbinski
Other awards
- 2015 Lasker Foundation.[158]
- 2016 Hamdan Award for Volunteers in Humanitarian Medical Services, from Hamdan Medical Award.[159]
Namesakes
A number of other unrelated non-governmental organisations have adopted names ending in "Sans Frontières" or "Without Borders", inspired by Médecins Sans Frontières, for example:
The French game show
Ethical concerns and criticism
Questions about the ethical treatment of MSF staff, clients and communities by MSF as a result of some of its policies and practices have arisen, with issues being canvassed by employees, others in the development sector, and the media.[160]
MSF has maintained separate employment conditions and pay for its "national staff" (those employed locally for field missions) and its "international staff" (those deployed from regional or national units to field missions in other countries). The international staff tend to hold the senior posts on a mission, with the national staff most often reporting to the senior staff who have come from elsewhere. There are ongoing complaints from national staff that they are treated less favourably, employed on more dangerous tasks, paid considerably less, and are without access to benefits of housing, health care, and other advantages afforded incoming expatriate staff. MSF stated in 2020 that this policy would be reviewed with the intent to eliminate differential treatment. These practices, amongst other concerns, were the catalyst for a 2020 statement by 1,000 of its current and former employees outlining their concerns regarding the organisation's perceived structural racism. Included in the collective staff statement was testimony of personal experiences of racism within MSF, both in the form of adverse treatment in the workplace, and what is perceived as a white supremacist and colonial mindset expressed in the formation and implementation of programmes.[160][161][162]
While MSF hires ninety percent of its staff for missions "in-country", the organisation continues to have a preponderance of Europeans in its higher management. Despite the percentage of its international programme coordinators originating from the
In 2018, there were revelations of sexual misconduct by MSF employees, including sexual harassment and abuse of patients, local community members or other MSF staff. Nineteen people were fired as a result of MSF's investigations of complaints. The complaints ranged from sexual harassment by MSF colleagues; exploitation of local (and possibly underage or solely "survival sex") sex workers by field staff, against MSF policy; and disparaging attitudes and remarks from staff regarding the supposed sexual availability of patients or community members, or an expressed intent to barter medical treatment for sex. Nearly all the resulting dismissals related to inter-staff sexual misconduct.[163][164][165][166][167]
Another controversy involved images taken without informed consent of vulnerable patients, some of whom were minors without adult guardians. Some images were criticised as exploitative and objectifying. They included a photograph of a mother mourning the death of her baby, with the boy's body visible; child rape survivors and sexual and domestic abuse survivors, with details of their experiences included. Intended to increase awareness of dire conditions prevailing in places where MSF works and the need for their programmes, the images were used on MSF and community websites and in print publications. Licensing of the images were available for sale to image databases. The ethics of exposing devastated or victimised individuals, sometimes with partially identifying information was questioned. Following the criticism, MSF decided to cease use of the images. The removal of the images was in turn also criticised.[168]
MSF's funding model has come under scrutiny after BlackRock donated $500,000 towards its COVID-19 crisis fund, leading to calls of hypocrisy from staff and other humanitarian organisations.[169][170][171]
Selected non-fiction works about MSF
- Hope in Hell, 2006 book by Dan Bortolotti
- Brown, Damien (2013). Band-aid for a broken leg: Being a doctor with no borders (and other ways to stay single). Sydney: Allen & Unwin. ISBN 978-1743315569. A doctor's memoir of his first MSF posting on the medical frontlines in Angola, Mozambique, and South Sudan
- ISBN 978-1596433755
- Living in Emergency: Stories of Doctors Without Borders, 2008 documentary film by Mark N. Hopkinsthat tells the story of four MSF volunteer doctors confronting the challenges of medical work in war-torn areas of Liberia and Congo
- Six Months in Sudan, 2009 memoir by doctor James Maskalyk
- An Imperfect Offering, 2008 memoir by former MSF president James Orbinski
- Triage: Dr. James Orbinski's Humanitarian Dilemma 2007 documentary
See also
Relevant topics
References
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{{cite web}}
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Further reading
- Bortolotti, D. (2004). "Hope in Hell: Inside the World of Doctors Without Borders". Firefly Books. 97 (11). Buffalo, N.Y.: 1575–1577. PMC 2594913.
- Katz IT, Wright AA (2004). "Collateral Damage – Médecins sans Frontières Leaves Afghanistan and Iraq". PMID 15602015. (registration required)
- McCall M, Salama P (1 September 1999). "Selection, training, and support of relief workers: an occupational health issue". British Medical Journal. 318 (7176): 113–116. PMID 9880288.
- Weber, Oliver (1995). French Doctors. Robert Laffont.
- Weber, Oliver (2002). Humanitaires. Félin.
- Zwi, A.B. (2004). "How Should the Health Community Respond to Violent Political Conflict?". PLOS Medicine. 1 (1): e14. PMID 15526042.