OFF THE CUFF is a participative blog run by the Crash. Its purpose is to expose the diversity of experiences and opinions that exist among humanitarian aid practitioners. Online comments as well as direct contributions are more than welcome.
Views expressed on this blog are those of their authors and do not necessarily reflect the official positions of Médecins Sans Frontières
The biggest oversight in the response to this epidemic has been the EHPADs. For the staff, the directive was clear: continue to work and provide an alternative to hospitalisation. No matter the conditions. For the residents, it was to die alone without treatment to alleviate their suffering.
Following an article co-written by members of the Swiss and Canadian sections of MSF, Fabrice Weissman presents a critical analysis of the arguments put forward by his colleagues. An analysis that could be useful to the entire movement, and to the humanitarian community as a whole.
In exceptional circumstances where the demand for care exceeds the supply, how do you decide who to start with? Triage is necessary where there is exceptional demand, leading to the use of a specific procedure to establish priorities. Interview of Jean-Hervé Bradol conducted by Elba Rahmouni based on the article “In a disaster situation: get your bearings, triage and act” published in the book La médecine du tri. Histoire, éthique, anthropologie edited by Céline Lefève, Guillaume Lachenal and Vinh-Kim Nguyen.
Michaël Neuman spent ten days in Libya with Médecins Sans Frontières teams working in detention centres for migrants. From his stay, he brings back the following impressions that illustrate the gloomy situation of the people who are held there, for months or years, and the even more difficult situation of all those subject to kidnapping and torture.
In this interview, different issues related to management at MSF are broached with Marion Péchayre, Director of Studies at the CRASH, such as the fragmentation of different components of our work, professionalisation drifting towards an attitude of control as embodied by the multiplication of management tools and the omnipresence of requests for validation, and the devaluation of the role of the individual against the promotion of a pseudo-scientific presentation of facts and projects.
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.
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.
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.
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.
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.
To mark Editions MFSH’s publication of Les coulisses du monde des catastrophes « naturelles », on 14 November 2018, CERI (Centre de recherches internationales Sciences Po - CNRS) presented a discussion with its author, Sandrine Revet, CERI anthropologist and co-founder of the Association pour la Recherche sur les Catastrophes et les Risques en Anthropologie (ARCRA), and Rony Brauman. CRASH recommends this book to anyone with an interest in natural disasters and international relations.
Rebecca Grais, Research Director at Epicentre, MSF’s epidemiology arm, and Pierre Mendiharat, Deputy Director of Operations for MSF-France, offer their insights on the Ebola outbreak in North Kivu Province in the eastern Democratic Republic of the Congo (DRC). This joint interview in four parts (the outbreak, social context, treatments, and vaccination) aims to show how science and practice interact around each outbreak.