Humanitarian actors and practices

Interview by Helai Hosseini. A first version was published on the website of the MSF France association on 31 July 2020.

In the wake of the Black Lives Matter movement in the United States, voices have risen within MSF denouncing the racist and discriminatory nature of our organization. Equal opportunity, they say, is not offered to all our employees. Founded in France in the early 70s by a handful of doctors and journalists, the organization has grown and become international,  now employing over 46,000 people around the world, nearly 39,000 of whom are recruited locally. How has MSF’s policy towards its personnel evolved down the years? What is currently being done to fight inequalities? Here is Jean Hervé Bradol’s take on the major phases that have marked MSF’s transformation and the ways in which discussions are engaged today.

In our first interview, Marion Péchayre discussed a variety of management-related problems at Médecins Sans Frontières: working in silos, the ever-growing number of management tools for monitoring, the endless validation requests, the vanishing role of the individual in favour of pseudoscientific presentations of events and projects, etc. This interview, conducted by Elba Rahmouni, focuses on solutions to these problems and hypotheses on how to improve our ways of working. Rather than offering set recipes, Marion Péchayre advocates an approach based on “practical wisdom” (a concept from the sociology of professions) and deliberative management that every individual and team can apply in their own way. 

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.

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.

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.

This article discusses the policy of absolute secrecy on abductions adopted by aid organisations. It argues that the information blackout on past and current cases is to a large extent a function of the growing role of private security companies in the aid sector, which promote a ‘pay, don’t say’ policy as a default option, whatever the situation. The article contends that secrecy is as much an impediment to resolving current cases as it is to preventing and managing future ones. It suggests abandoning the policy of strict confidentiality in all circumstances – a policy that is as dangerous as it is easy to apply – in favour of a more nuanced and challenging approach determining how much to publicise ongoing and past cases for each audience, always keeping in mind the interests of current and potential hostages.

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 rehabilitation of international humanitarian law (IHL) has become a priority for those who think that the horrors of contemporary wars are largely due to the blurring of the distinction between civilians and combatants and for those who think that campaigning for the respect of IHL could result in more civilised wars. Similarly, respect for humanitarian principles is still seen by many as the best tool available to protect the safety of aid workers. In this text, I argue that both assumptions are misled. The distinction between civilians and combatants, a cornerstone of IHL, has been blurred in practice since the late nineteenth century. In addition, humanitarian agencies claiming to be ‘principled’ have been victims of attacks as much as others. History and current practice tell us that neither IHL nor humanitarian principles provide safety or can guide our decisions. Accepting their symbolic value, rather than their unrealised potential to protect and solve operational dilemmas, would free humanitarian agencies from endless speculations.

In the summer of 2015, the French section of Médecins Sans Frontières started aid projects for migrant populations in Greece and France. The launch of these operations was the occasion for lively discussions within the association, both in terms of public positioning (how to justify an intervention in a rich country and not get lost in "political" territory?), and in terms of revising our operating methods, knowing that the primary needs of migrants were not primarily medical. Some people then recalled the association's militant practices in the 1990s, which were sometimes considered as abuses. By retracing the history of the French Mission, Michaël Neuman seeks to understand, with regard to the migration issue, the complex articulation between operational constraints, political positioning and militant practices.  

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.

Humanitarian aid organisations carrying out rescues at sea were made into the accomplices of human traffickers. This accusation is as absurd as it is unacceptable. Not only do rescue operations at sea save people from drowning, but they evacuate people in situations of immediate danger in Libya, MSF recalls.

The crude mortality rate (CMR) is one of the most widely used indicators at MSF and the humanitarian sector to evaluate the severity of a health crisis within a given population. It is widely recognized that a CMR equal to or greater than one death per 10,000 persons a day signifies an emergency situation requiring an immediate response. However, the usage of the standard emergency threshold as “1/10,000/day” is very questionable: it goes against the official recommendations endorsed by humanitarian organizations and ignores the worldwide decline in mortality rates over the last 30 years.