The term “acceptance” became part of the humanitarian vocabulary in the late 1990s, with the publication of the first manuals and training programs dedicated to the security management of aid operations. It refers to one of three strategies proposed to humanitarian actors to reduce risks in violent environments: using passive protection measures (helmets, bulletproof vests, armoured vehicles, fortified compounds, etc.), deterring potential attackers through local or international armed forces, or eliminating threats by earning everyone’s appreciation (acceptance). But how does one become appreciated, tolerated, and accepted? Two approaches coexist: one, political, emphasises the importance of caring for one’s friends; the other, marketing-oriented, emphasises the need to cultivate an image as a “principled organization”—neutral, independent, and impartial.  

To what extent should a medico-humanitarian organization become concerned with the field of environmental health? Written in 2025, Fabrice Weissman has conducted a brief literature review on the links between health and the environment to help MSF address this question. Identifying around a dozen paradigms, he encourages the organization to pay particular attention to extreme climatic events, health crises linked to various forms of contamination, and the implications of “environmental justice.”

Back from Gaza, Jean-Guy Vataux gives a rare and harrowing account of the daily lives of Palestinians and rescue teams facing the Israeli army's "apocalypse strategy." He notably describes the perverse workings of a food rationing system designed to create chaos. This system has caused the deaths of hundreds of young Palestinians employed by shopkeepers to collect or loot food aid, while Israeli snipers enjoy shooting them in the back. The interview concludes with a chilling question: how can we respond to the Palestinians' call to flee this hell at any cost?

Since 2009, Médecins Sans Frontières has been recording events affecting the physical security of its staff deployed in the field in an online database called SINDY. Over the past two years, there has been a sharp increase in the number of severe security incidents recorded by MSF. Whereas in 2021, only 5 severe events were recorded, and one death reported, 37 severe events were recorded in 2024, resulting in the death of 10 people. How can this trend be explained?

Since the return to power of the Taliban in August 2021, the Islamic Emirate of Afghanistan (IEA) has introduced a whole series of measures drastically limiting women's rights, their freedom of movement, their access to work and education as well as their participation in political life. How has Médecins Sans Frontières reacted to these measures, which openly contradict its commitment to combating gender inequality in access to healthcare as well as in its own internal management?

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Challenging the idea that humanitarian actors can act free from politics by virtue of their principles, this chapter argues that the politicization of humanitarian aid is in fact the primary condition for its deployment. Humanitarian actors can only act if they maintain a balance between their own interests and those of people in positions of power. This raises a crucial ethical question: At what point do humanitarian organisations consider that deals reached with political powers cross the blurred but very real line beyond which humanitarian assistance does more harm than good?

The central question raised in this discussion relates to two profoundly intermeshed issues for humanitarian practitioners and organisations: the use of history for humanitarian organisations, and the need for them to preserve and maintain archives

Based on a reflection regarding how patient rights have changed, in France in particular, Fabrice Weissman discusses humanitarian medicine’s shortcomings in that regard and proposes several avenues for improvement at MSF.  This text was originally posted on MSF’s associative website, The Souk.