Inside MSF's hospital in Qayyarah, Iraq

The Challenges of Globalization of International Relief and Development


Researcher at MSF-Crash, François Jean died on December 25th 1999. He wrote numerous books and articles, some published in Revue Esprit. He worked particularly on Afghanistan, Caucasus, North Korea and analyzed the evolution of humanitarianism without compromise.

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.


The creation of Médecins Sans Frontières (MSF) in 1971 not only reflects evolution in Western societies, it also shows a response to the shortcomings of international aid as it was then configured.

The founding of MSF coincided with the democratization of both air transport and information. The Biafran war, which ended in 1970, was contemporary to the diffusion of television sets in European households. The instantaneous visibility of disasters and conflicts on television made it less and less acceptable to do nothing in the face of mass suffering or to offer only a confused effort at emergency assistance. In the meantime, the conflict over Biafra clearly revealed the constraints of the Red Cross (ICRC) in responding to emergencies. The ICRC was not entitled to intervene in a country without the approval of the country’s authorities, and its personnel had to adopt a reserved attitude toward the events that they witnessed during a mission. The group of doctors who created MSF on December 20, 1971 in Paris intended to change the way humanitarian aid was delivered by providing medical assistance more rapidly and by being less deterred by legal constraints at a time of crisis.

MSF remained a small organization in the 1970s. Its growth was fueled by the multiplication of refugee camps at the end of the decade, which forced the organization to take on a more professional approach. At the beginning of the 1980s, MSF introduced logistics and medical departments, a salaried administrative system, and the organization of marketing and fundraising activities. To guarantee its independence, MSF set a clear policy that at least 60% of funds raised must come from private sources. To increase its technical expertise, MSF created several affiliated organizations that are committed to pursuing specific areas of research in the field of emergency medicine: in 1984, AEDES; in 1986, Epicentre; and in 1992, HealthNet.

Meanwhile, the movement continued to gain momentum with the creation of Belgian and Swiss sections in 1981, a Dutch section in 1984, and Spanish and Luxemburg sections in 1985. These sections share the same charter and are able to carry out missions abroad. The whole movement represents an average of 1,200 volunteer positions (2,400 departure / year) in 60 to 70 countries, with an overall budget of U.S.$231 million in 1997.

Between 1986 and 1995, this expansion continued further with the setting up of supporting sections in Australia, Austria, Canada, Denmark, Germany, Greece, Hong Kong, Italy, Japan, Norway, Sweden, the United States, and the United Kingdom. These delegate offices were meant to raise funds, recruit volunteers, and enlarge the capacity of MSF to mobilize public opinion. In 1997, all the delegate offices were invited to become sections. They joined the International Council of MSF composed of the heads of the 19 sections. An international liaison office staffed with four people is situated in Brussels; however, there is no umbrella organization topping the sections. The organization is trying to develop into a coordinated network of independent and accountable sections, rather than into a federation or a confederation.

In the 1980s, wars and refugee camps were MSF’s main field of intervention. Three principles guided its action: the right of access to victims, the need for independent evaluation of the situation, and the monitoring of assistance. To enforce these principles, MSF was ready to speak out in the face of major human rights abuses and to conduct clandestine missions when its presence was not officially authorized. MSF’s conception of operational neutrality means that the organization never takes sides or supports a party in a conflict. However, in the event of massive human rights violations, we feel that it is our duty to speak out and, in the most serious cases, denounce the crimes against defenseless people, even at the cost of antagonizing the party responsible. Despite this departure from the strict conception of neutrality, our ability to gain access to victims is based on the strong respect of the principles of independence and impartiality.

Although war related situations and refugees movements remain an important focus for MSF in the 1990s, the organization is increasingly facing the challenges of new health care crises: the reemergence of once controlled diseases, the emergence of new epidemics, the failing health system in the former Soviet Union, lack of access to heath care for excluded populations in Western countries, and so forth.


Over the past decade, the context in which humanitarian assistance is being provided has changed dramatically. However, we will not elaborate here on the changing nature—or perception—of conflicts since the end of the cold war. Our aim is to throw some light on the institutional changes in the international aid system and to look at their implications for humanitarian organizations.

The past 10 years have witnessed a swift and far-reaching transformation of the international aid system. By the mid-1980s, a noticeable change in donor policy had occurred, from direct donor assistance to recognized governments to favor of international support for private, nongovernmental actors. In the past decade, government funding of humanitarian aid has grown considerably and NGOs are playing an increasingly important role in delivering that assistance. This restructuring of the humanitarian aid market has been accompanied by an enlarged distribution of aid from the periphery to the center of conflicts. NGO expansion is partly linked to the changing status of the refugee. Apart from its welfare function, the policy role of relief is to help prevent large-scale population movements crossing international boundaries and, through humanitarian assistance, to help keep conflict-affected populations within their home countries. Since the 1980s, the trend has been increasingly to internalize the effects of political crisis within unstable regions. Consequently, humanitarian aid has no longer just been distributed in refugee camps, but increasingly within war-torn countries in the very heart of combat zones. These evolutions have raised important questions for humanitarian organizations.

Humanitarian aid has become the West’s favored response to political crises that are not of major strategic importance. As such, it has become a foreign policy tool and a factor of legitimization of international intervention. This has brought with it the risk of humanitarian organizations becoming mere instruments in the hands of government authorities. At the same time, increasing intervention by governments in the humanitarian space—including armed intervention—has blurred the distinctions between the political and humanitarian rationale. Such confusion throws doubt on the independence and impartiality of humanitarian actors.

Humanitarian organizations also contribute to the confusion between the humanitarian and political fields by becoming more and more involved in the decision-making process. The humanitarian traffic that reaches the United Nations (UN) Security Council has greatly increased and NGOs have gained an unparalleled access to decision makers in the north. NGOs are not only providers of information but also shapers of policy.

Donor countries and official agencies are channeling increasing amounts of money through NGOs. The growing part of state financing in the budgets of NGOs raises the issue of just how independent humanitarian organizations are from states and donor countries. The degree to which individual NGOs are dependent on donor funding can vary. Some organizations have remained independent and are able to define their own strategies, whereas others have become little more than subcontractors of donor countries. However, even established NGOs that regard themselves as having an independent capacity by virtue of public support generally find themselves relying on donor funding in large-scale emergencies. At the same time, the emergence of a supply-side aid economy may lead some organizations to define their assistance programs on the basis of availability of funds, rather than on an impartial evaluation of people’s actual needs. Hence the growth of mushroom agencies or opportunistic NGOs with no mission other than the winning of donor governments’ contracts.

The development of donor / NGO subcontracting reflects the globalization process, the growth of nongovernmental service providers, and the liberal restructuring of the welfare state in Western countries. The increasing importance of subcontracting public functions to private or nongovernmental organizations has been particularly marked in countries characterized by internal war, disintegration of governance, and public sector decay. With the internationalization and privatization of public welfare, NGOs have taken over state functions (such as the provision of public services) at the risk of a further politicization of humanitarian action. Although the development of donor / NGO welfare safety nets raises the question of accountability—or dependence—to donors’ countries, NGO substitution for the state in the provision of public welfare raises the question of accountability—or rewriting of the social contract—between a government and its citizens.

The expansion of the aid market in war zones, based on negotiated access and integrated relief programs, has been characterized by an expansion of UN / NGO subcontracting. Since the early 1990s, humanitarian aid has been provided through a complex system of delegation and subcontracting that involves an ever increasing number of governmental, intergovernmental, and nongovernmental actors. The growth in the number of actors involved has encouraged the emergence of new coordinating bodies or mechanisms, such as the Department of Humanitarian Affairs of the United Nations (DHA) created in 1992 and replaced in January 1998 by the Office for Coordination of Humanitarian Affairs (OCHA), or the European Community Humanitarian Office (ECHO), the main public donor in the emergency field. To work within a mandated system, NGOs have to become affiliated bodies. This often involves accepting notions of neutrality and security guidelines agreed by the lead agency. The increasing complexity of the aid system is likely to have an effect on the way NGOs operate and make procedures more cumbersome—to the point of encouraging the bureaucratization of humanitarian organizations.

To respond to those challenges, humanitarian organizations should take a distance from institutional logic. At a time when MSF is in the process of internationalization, it is all the more important to control growth, to avoid bureaucratization, and to resist becoming resource driven. Accordingly, we should maintain a high level of militantism and insist on the presence of volunteers in the field, we should keep a good balance between experience and innovation so as to adapt to new forms of human distress, we should increase our capacity to raise decision makers’ awareness while avoiding politicization and instrumentalization of humanitarian action, and we should strengthen our relationship with the society in general and our public in particular.

The instrumentalization of humanitarian action, the growing dependency on donor countries, and the ever increasing complexity of the aid system is a real challenge for humanitarian organizations. The changing institutional context raises the question of the relationship between humanitarian organizations and political powers, the aid market and society. To maintain a distinct identity and a real connection with the most threatened populations, humanitarian organizations should emphasize the principles of independence and impartiality.

Independence is a principle that is essential to humanitarian aid. It is not only a matter of moral standard or institutional positioning, it is a relationship—in essence conflictual—with political powers. This tension is all the more acute in crisis situations where humanitarian organizations should resist pressure and instrumentalization from political forces. In the meantime, humanitarian organizations should strengthen their relationship with society, both in their countries of origin and in countries of intervention.

To cite this content :
Philippe Biberson, François Jean, “The Challenges of Globalization of International Relief and Development”, 27 novembre 2019, URL :

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