Articles

Sanitation activities in urban slum, Haiti MSF/Lauranne Grégoire Review

About "Choléra, Haïti, 2010-2018, Histoire d’un désastre" by Renaud Piarroux

12/23/2019 Rony Brauman

The cholera outbreak in Haiti in October 2010 was among the deadliest in modern history, with 800,000 people infected and 10,000 fatalities. And these are just the official figures. The actual death toll was far higher, as evidenced by numerous retrospective mortality surveys, and can only be expressed as an order of magnitude: to wit, several tens of thousands.   
This book recounts eight years of struggle on two fronts that the author shows to be closely linked: the field, with the implementation of measures of prevention and case management; the scientific debate, in the form of a shattering of the dominant environmental theory concerning the origin of the epidemic.

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MSF logistician Jennifer Bock and her colleagues unload 58 boxes one ton of medical supplies, mainly malaria testing kits, destined for the MSF-supported health centre in Boguila. Giorgio Contessi/MSF Review

To work

12/16/2019 Judith Soussan

We’d like to share with you today some recommended reading around the issue of management, work, and ways of working. This choice will probably surprise some regular CRASH readers; isn’t this a far cry from the usual subjects of our critical analysis? Far from being chosen at random, the selection that follows in reality grew out of several years of reading.

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Inside MSF's hospital in Qayyarah, Iraq Maya Abu Ata/MSF Analysis

The Challenges of Globalization of International Relief and Development

11/27/2019 Philippe Biberson François Jean

First Published December 1, 1999 - Nonprofit and Voluntary Sector Quarterly (NVSQ) - Volume 28 Issue 1.

This article begins with a look at the role played by Médecins Sans Frontières (MSF) since its inception in 1971, and then looks at the challenges facing MSF today. It focuses on the confusion of humanitarian and political roles and on the goals MSF has laid out for itself to address this confusion. Humanitarian aid has become the favored response of governments to political crises, and governments have increasingly turned to NGOs to carry out their policies. In turn, NGOs have become increasingly dependent on governments for financial support. These changes have politicized aid delivery and made it difficult for NGOs to maintain their independence. In addition, as the number of NGOs increases and their activities become more specialized, there are pressures toward institutionalization and bureaucratization. To respond to these challenges, MSF has identified several goals, including maintaining organizational independence and flexibility and avoiding bureaucratization.

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Vue de l'intérieur de l'hôpital MSF à Kunduz, après son bombardement, octobre 2015 Victor J. Blue Analysis

War Breaks Out: Interpreting Violence on Healthcare in the Early Stage of the South Sudanese Civil War

11/22/2019 Xavier Crombé Joanna Kuper

This article seeks to document and analyse violence affecting the provision of healthcare by Médecins Sans Frontières (MSF) and its intended beneficiaries in the early stage of the current civil war in South Sudan. Most NGO accounts and quantitative studies of violent attacks on healthcare tend to limit interpretation of their prime motives to the violation of international norms and deprivation of access to health services. Instead, we provide a detailed narrative, which contextualises violent incidents affecting healthcare, with regard for the dynamics of conflict in South Sudan as well as MSF’s operational decisions, and which combines and contrasts institutional and academic sources with direct testimonies from local MSF personnel and other residents. This approach offers greater insight not only into the circumstances and logics of violence but also into the concrete ways in which healthcare practices adapt in the face of attacks and how these may reveal and put to the test the reciprocal expectations binding international and local health practitioners in crisis situations.

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The shared MSF / ICRC helicopter exchanging passengers in Gumuruk. In the rainy season helicopter is the only reliable way to move around Pibor County in South Sudan. Robin Meldrum/MSF Analysis

Ending the Code of Silence on Abductions of Aid Workers

11/22/2019 Fabrice Weissman

This article discusses the policy of absolute secrecy on abductions adopted by aid organisations. It argues that the information blackout on past and current cases is to a large extent a function of the growing role of private security companies in the aid sector, which promote a ‘pay, don’t say’ policy as a default option, whatever the situation. The article contends that secrecy is as much an impediment to resolving current cases as it is to preventing and managing future ones. It suggests abandoning the policy of strict confidentiality in all circumstances – a policy that is as dangerous as it is easy to apply – in favour of a more nuanced and challenging approach determining how much to publicise ongoing and past cases for each audience, always keeping in mind the interests of current and potential hostages.

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Ebola outbreak - Bunia John Wessels Interview

Ebola outbreak: a failure in social mobilisation

09/10/2019 Jean-Hervé Bradol Elba Rahmouni

On August 1st 2018, the Democratic Republic of Congo’s health authorities declared the country’s tenth outbreak of Ebola virus disease (EVD), this time in North Kivu province.  Just over a year later, this outbreak is still ongoing, with several dozen new cases reported each week. In the space of 12 months, 3000 people contracted the disease and 2000 of them have since died. This latest outbreak can be seen as a failure at two levels: first, it is already the second biggest EVE outbreak ever recorded, and second, two out of three patients have died. What are the reasons for this failure? What operational strategies should we develop in response? 
Interview with Jean-Hervé Bradol, Director of studies at CRASH, by Elba Rahmouni.

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Food distribution in Borno state Shaista Aziz/MSF Interview

Borno, Nigeria : a critical look at our operations

07/01/2019 Isabelle Defourny Elba Rahmouni

In 2016, the Operations Department commissioned a critical review of the operations carried out between 2015 and 2016 in Borno State by MSF France in the north east of Nigeria. In response, and with the help of Epicentre, Judith Soussan and Fabrice Weissman from CRASH produced a detailed historical account of the analyses made of the situation by the teams, capital and headquarters at the time, as well as the objectives they set themselves, the actions they undertook, the obstacles they encountered and the results they achieved.  As part of this project, some of the directors and operations managers who had been involved in these operations took a retrospective look at their own practices: were they late in responding to the catastrophic situation in the IDP camps in rural areas and on the outskirts of Maiduguri, the capital of Borno State, in 2016 and, if so, why?  What conclusions can be drawn a posteriori about the operational choices made and the effectiveness of MSF intervention strategies? And, to take things a step further, what does this experience teach us about how MSF functions and how our teams work? Interview with Isabelle Defourny, Operations Director at MSF-OCP. By Elba Rahmouni. 

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The shared MSF / ICRC helicopter exchanging passengers in Gumuruk. In the rainy season helicopter is the only reliable way to move around Pibor County in South Sudan. Robin Meldrum/MSF Analysis

Oases of Humanity and the Realities of War. Uses and Misuses of International Humanitarian Law and Humanitarian Principles

06/28/2019 Rony Brauman

The rehabilitation of international humanitarian law (IHL) has become a priority for those who think that the horrors of contemporary wars are largely due to the blurring of the distinction between civilians and combatants and for those who think that campaigning for the respect of IHL could result in more civilised wars. Similarly, respect for humanitarian principles is still seen by many as the best tool available to protect the safety of aid workers. In this text, I argue that both assumptions are misled. The distinction between civilians and combatants, a cornerstone of IHL, has been blurred in practice since the late nineteenth century. In addition, humanitarian agencies claiming to be ‘principled’ have been victims of attacks as much as others. History and current practice tell us that neither IHL nor humanitarian principles provide safety or can guide our decisions. Accepting their symbolic value, rather than their unrealised potential to protect and solve operational dilemmas, would free humanitarian agencies from endless speculations.

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Yemen, Hodeidah, 1 May 2019 - on the road to Sanaa Agnes Varraine-Leca/MSF Analysis

Yemen: questions about an aid system

06/20/2019 V TLR

The situation in Yemen is often presented as the world’s worst humanitarian crisis, long ignored by the media, and requiring assistance vital to the survival of almost the entire country. Cholera outbreaks, famine, and destruction are invoked to support that argument. In reality, however, the situation of the country’s 25 to 30 million inhabitants is impossible to know with any accuracy. Nor do we know exactly what is happening in Yemen in terms of aid, although the amount of funding is very large. Noting these diagnoses and its field teams’ perspective on certain points, Médecins Sans Frontières has launched an effort to better understand this field of action using a quantitative and qualitative approach. A review of aid organisation documents and a series of interviews with aid actors in Yemen – in Houthi areas, in particular – has yielded a number of different conclusions.

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Condition of migrants in Paris Antoine Kremer/MSF Analysis

Médecins Sans Frontières-France: tensions arising from the “Migration” projects

05/07/2019 Michaël Neuman

In the summer of 2015, the French section of Médecins Sans Frontières started aid projects for migrant populations in Greece and France. The launch of these operations was the occasion for lively discussions within the association, both in terms of public positioning (how to justify an intervention in a rich country and not get lost in "political" territory?), and in terms of revising our operating methods, knowing that the primary needs of migrants were not primarily medical. Some people then recalled the association's militant practices in the 1990s, which were sometimes considered as abuses. By retracing the history of the French Mission, Michaël Neuman seeks to understand, with regard to the migration issue, the complex articulation between operational constraints, political positioning and militant practices.  

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Analysis

Literature review on the evaluation of the quality of care from a patient’s perspective

02/15/2019 Hannah BARNETT

The study The Patient Perspective of Quality of Care: A Review of the Literature, which we present here was carried out by Hannah Barnett a public health student at George Washington University, intern with CRASH from June to August 2018. This work sums up seventy articles from a variety of disciplines including medicine and public health. It is part of a reflection initiated by MSF a few years ago on medical quality and the patient-centered approach.

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