On 3rd and 4th February 2022, the CRASH organised a workshop aimed principally at the directors and operational managers of MSF Operational Centre Paris (OCP) to reflect on current debates, and to determine which elements of the discussion would be the most relevant to resolve to support the advancement of MSF OCP’s operational projects. Is access to medicines the same issue today as it was when MSF first became interested in the mid-1990s? Rather than just concentrating on the obstacles to accessing medicines, should the debate be broadened to encompass what are now called ‘health products’ or even further, towards access to care and thus largely structural problems of human resources, financing, or the absence of national health insurance policies?

On 13 June 2016, Médecins Sans Frontières teams discovered with dismay the extent of the famine decimating civilian populations forcibly gathered by the army in towns in north-eastern Nigeria recaptured from Boko Haram. This disaster, known to the Nigerian authorities and United Nations agencies for several months already, had escaped the attention of MSF operational managers. Subsequently, MSF redoubled its efforts to help the starving people of Borno State, despite extreme insecurity. On 17 July, a team narrowly escaped death when the convoy in which they were travelling came under attack.

This study, conducted among the men of Homa Bay in Nyanza Province, Kenya, assesses the representations of HIV and impact on care seeking. It reveals that simply setting up a testing or care campaign does not necessarily mean that the entire population will participate; the message has to be tailored to the target population and fine-tuned even within that population.

Ce cahier présente les discussions qui ont eu lieu à MSF dans le cadre d'une journée de réflexion portant sur les stratégies de sortie, en s'appuyant sur trois projets: Rutshuru, Chiradzulu et Port Harcourt.

The question of quality in the work of Médecins Sans Frontières has been asked from the very beginning of MSF's existence. On the one hand, the issue of improving the quality of practice is a part of ordinary professional activity; on the other hand, Médecins Sans Frontières' work involved working in distant lands and very specific environments, which demanded adjustments to medical practice as a result.

Our survey bears something of a resemblance to a study carried out by Vanja Kovacic in Homa Bay, Kenya, in which she investigated patients’ disease coping mechanisms and their “dependence on medical institutions”.

It seemed appropriate to assemble these texts now, at a time when the history of our AIDS missions is compelling us to formulate new goals. 

Four hepatitis E epidemics have occurred in the areas in which we operate since 2000, prompting a reflection on the quality of the water produced and distributed to their populations by humanitarian organisations.

This study started out looking at the shift to a post-conflict situation in Katanga; the intention was to describe how MSF’s sections negotiated the transition from war to post-war.

Four years after the Nigerian crisis, many things have changed in the nutrition field. This Cahier du Crash aims at considering this evolution and explore new possibilities for action for MSF.

This study sheds light on the mechanisms producing the official data used by humanitarian aid decision makers. It views Early Warning Systems (EWS) as tools that facilitate consensus between the decision-makers involved in the allocation of food aid, enabling them to reach institutional agreements. 

To embark upon a study of this theme is to enter a field strewn with contradictory representations linked to a highly sensitive issue – the limits of our responsibility – that has generated endless disagreements and debates on our “identity” and the existence or nonexistence of a role for MSF “beyond care”.