The Crash – MSF

This article was originally published in French on Grotius, as part of a dossier on the contribution of research to humanitarian action, on October 3, 2014.

History

Unlike most think tanks and research institutes devoted to the study of humanitarian aid, the CRASH – born of Médecins Sans Frontières leaders’ desire for a structure to support critical reflection on their own operations – is an integral part of a relief organization. Indeed, research centers now abound, and the field of Humanitarian Studies is growing; the sector is dominated by academic institutes like the Feinstein International Center, think tanks like the Humanitarian Practice Network in London and Groupe URD in Plaisians, and professional associations like Professionals in Humanitarian Assistance and Protection in Geneva.

While the entity now known as CRASH was created in 1999, the missions entrusted to it are heir to the discussions and exploration of the dilemmas faced by aid actors. It was probably with the creation of the Fondation Libertés Sans Frontières in 1984 that MSF began formalizing such reflection; though LSF’s primary objective was to join the public debate, it was a think tank focused on aid, development and human rights. In the early 1990s, MSF recruited a political analyst and then a legal expert as advisors, to help its leaders think through contexts, situations and dilemmas. It was in what became Fondation Médecins Sans Frontières that the Populations in Danger series began; four volumes were ultimately published from 1992 to 1997.

Thus the CRASH grew out of a practice of reflection by an organization confronted with mass crimes in the Great Lakes region and conflicts in the former Yugoslavia – a practice also fueled by memories of the debates surrounding the association’s decision to speak out, in 1985, in Ethiopia. The work unit – now a team of five research directors with a budget of roughly €600,000 financed with non-institutional funds – is driven by the idea that reflection and action support each other. The research is aimed at improving MSF relief operations while encouraging and promulgating reflection in the broader humanitarian world.

Activities

The CRASH works at the intersection of Médecins Sans Frontières operational practice, medicine and public health, as well as the social sciences, via the knowledge and methods they bring. Though familiar with social science practice, all of the CRASH research directors come from the field.

For their work they receive methodological guidance from the professional researchers in history, sociology and anthropology, among other fields, who form the scientific committee. This group, most of whom have a longstanding relationship with MSF, includes members of institutions like the University of Manchester’s Humanitarian and Conflict Response Institute or France’s Ecole des Hautes Etudes en Sciences Sociales (EHESS). The CRASH research agenda is guided by a steering committee made up of members of the MSF management team.

Its activities rest on three pillars: research, advice and training/dissemination.
 

1) Research

The CRASH’s research activities lead us to work on issues that, while they grow out of Médecins Sans Frontières concerns, also echo the concerns of the aid world in general. If the latest CRASH publication, Humanitarian Negotiations Revealed: The MSF Experience presents the humanitarian space as an open space for negotiation and compromise, it is because we felt it necessary to discuss the dominant stereotype among aid actors – that humanitarian action is increasingly hindered or manipulated by political power. A similar spirit impels one of our current efforts – research on the security of humanitarian personnel, which should lead to a publication on the subject – to do a critical analysis of the current alarmist discourse while exploring the impact of the professionalization and bureaucratization of the humanitarian security sector. Along those same lines, a reflection on humanitarian principles based on a comparison between MSF and the ICRC has been published. Though traditionally focused on conflict contexts, the CRASH has focused increasingly on medical issues resulting in the 2009 publication of Innovations médicales en situations humanitaires, whose aim was to recount and analyze the introduction of new medical practices in humanitarian situations, and to understand how to create processes of change and ensure that those receiving care benefit from them (English version: Medical Innovations in Humanitarian Situations). A “Que sais-je” on humanitarian medicine was published that same year (English version available online). Those publications used case studies and historical research to try to shed light on contemporary practices. The CRASH also initiated a series of publications on MSF’s public positions (www.speakingout.msf.org), now coordinated by the organization’s international office, which describes the actions and the decision-making processes during crises that have led MSF to speak out publicly. More recently, the CRASH has been looking closely at the limitations of some mass immunization campaigns, the soundness of the campaign to eradicate polio, and the security risks faced by medical staff in Yemen.
Not all research efforts result in books. Some are presented at symposiums, or in “Cahiers,” or in articles. But all of them, like “Is Humanitarian Water Safe to Drink?”, aim to compare practitioners’ experience against the knowledge of anthropologists, economists, scientists, military people and industry people.
 

2) Advice

Intended to improve practices, the CRASH advises MSF leaders on issues of operational and public positioning. As such, we intervene at the request of the association’s president or directors on issues related to our interventions, on current events, or on matters related to the organization of the institution.

To be legitimate, the advice must be based on concrete knowledge of the challenges and practices, and draw on critical tools and relevant knowledge from the social sciences. By combining field practices with the study of political, historical, geographical, medical and anthropological knowledge, and by bringing these to bear on issues facing the association, we are able to offer the most useful responses. What public position should we take in the Central African Republic, when our teams urge us to call for military reinforcements to protect persecuted Muslims? How much leeway do we have for negotiating with Jihadist groups in Syria? What are our options for treating patients and protecting healthcare staff in the Ebola epidemic? How does the association give account of its activities in a pertinent, useful way? These are a few of the questions we have been asked to look at in recent months.
 

3) Training, participation in public forums, and dissemination

The CRASH’s work is only meaningful if it contributes to reflection not just by the association – the French section that hosts it – but also by the MSF international movement and the aid world in general. It is by participating in operational and association discussions, by taking part in internal training courses – or even putting them together – that we share our research and reflections and try to foster a culture of debate. We also maintain relationships with equivalent structures at other MSF sections, such as the UREPH in Geneva or Epicentre, the MSF satellite responsible for epidemiological training and research. We also lead university training courses – in particular, at the Institut d’Etudes Politiques and the University of Manchester.

In addition, the CRASH has a policy of actively sharing, disseminating its work on its website, in the social media, and by participating in – and even organizing – symposia and workshops. These efforts are not limited to the French-speaking world. Most of our publications are translated into English, and Humanitarian Negotiations Revealed has also been translated into Arabic, Japanese, Italian and Spanish. We also try to promote the distribution of our books by putting them online for free. In this way we hope to reach not just academics, but also practitioners and aid colleagues elsewhere in the world.
 

Limitations and difficulties of internal criticism and debate

The CRASH’s work is the result of the culture of debate fostered within MSF by its successive leaders, and of the associative nature of the organization. Such debate should be possible not just internally, but externally as well. We can attest to the fact that public exposure of internal differences stimulates discussion and ultimately the production of quality analyses. The CRASH, whose collective method of working relies on group discussion and collective review of the research, is composed of individuals whose analyses and opinions often differ. Such differences also exist in the MSF movement as a whole, as was seen during recent discussions on the performance of the aid system.

This culture of debate does not always go smoothly; expressing a different viewpoint in an operational debate often causes tension, and there can be strong temptation within the institution to see the CRASH as merely a guard dog or inspector for the finished work, content to intervene after the fact, without having any part in the implementation of difficult operations. The tensions, which are legitimate, do exist, in particular due to the differing time frames of CRASH and operations activities. Several CRASH member contributions – published or not – have been forcefully disputed by association management, including viewpoints expressed on the mass immunization policy and on the management of abductions. This was also the case when several CRASH members wanted to make public the UN’s responsibility for Haiti’s 2010 cholera outbreak, and ran into very strong opposition from the majority of operational and medical managers both in the field and at Paris headquarters. Arguing that disclosing certain information or analyses would endanger the teams or hurt the institution’s reputation sometimes makes any debate impossible.

Is the CRASH being used, against its will, as the administration’s critical alibi? The question arises. In fact, CRASH opinions and recommendations are not always taken into consideration. Its members are just advisors; it is the leaders who set the course. This requires, above all, that CRASH members carefully protect their autonomy; in this case, serving the social mission does not mean blindly serving those charged with implementing it.