Majella Anning begins her series of NGO profiles
by charting the rise and spread of Médecins Sans Frontières
At the Brussels headquarters of Médecins Sans
Frontières, everyone's mind is somewhere else. The rows of clocks on the wall don't give
the time in London or New York, but tell you the hour in Baku, Nairobi and Phnom Penh. At
9:30 a.m. the heads of all departments - operations, medical, logistics, supply,
financial, human resources, and communications - file into the office of the
Director-General of MSF Belgium, Dr. Eric Goemaere. There is no time to lose. They conduct
their daily briefing standing up. "It's quick and dirty," says Dr. Goemaere, who
introduced the standing up rule. "Meetings take longer when you sit down."
It may be morning in Brussels, but in northern
Afghanistan, MSF volunteers are half-way through their day caring for victims of the
recent earthquake. In Kenya, MSF personnel have been up for hours, trying to battle a new
outbreak of cholera.
The morning meeting covers both the mundane and the dangerous aspects of a humanitarian
aid agency. Two MSF workers have been taken hostage in Sierra Leone. While Dr. Goemaere
deals with that crisis, he needs to respond to a demand from the Belgian Finance Ministry
for MSF's volunteers - who receive a modest wage in the field in exchange for long hours
and often dangerous conditions - to pay more tax!
Although Médecins Sans Frontières was founded in France, the biggest operations centre -
from where missions are launched - is now in Brussels. The other two big operations
centres are in Paris and Amsterdam. The organisation has come a long way since it was
formed in 1971 by a group of concerned doctors and journalists as one of the first NGOs to
specialise in emergency medical assistance. It has grown into a large, international NGO
with 19 offices around the world - from Europe to Japan and Australia - running operations
in 80 countries. At any one time, more than 1,100 MSF volunteers are working in the field
alongside local humanitarian aid personnel, with another 15,000 back-up staff around the
globe. In 1996-97, MSF's annual budget was US$251 million.
But for MSF, providing medical assistance isn't enough.
Its mandate goes further, to include what the organisation defines as
"témoignage", the principle of speaking out about breaches of humanitarian
values wherever they're encountered. From its inception, MSF has set out to inform and
sometimes accuse, as well as to treat the medical needs of populations in crisis.
"It's really a fundamental principle for us,"
says Jean-Marie Kindermans, Director of the MSF International Office in Brussels. "We
don't believe we're in the field just to give medical assistance. Sometimes we have to do
more. The International Committee of the Red Cross (ICRC) has a principle of neutrality,
but we are not neutral in the sense that we want to bear witness and sometimes accuse. For
people on the outside, it might not seem much of a difference but for us it's a pretty big
one."
During the war in Bosnia, MSF openly accused the Bosnian
Serbs of massacring civilians. "When we know certain people are responsible for
genocide against civilians, we say it. Information is a way of exerting pressure, to help
people in other ways. When a doctor sees that a child has been beaten, he or she has a
moral responsibility to speak out, to try to stop the abuse," says Kindermans.
In Bosnia, MSF was in a good position to accuse. The
organisation was the last international presence left in the so-called United Nations
"safe haven" of Srebrenica before it fell to the Bosnian Serbs - even the ICRC
had pulled out by then. The subsequent massacre of Muslim civilians continues to shame
Western governments.
But it is clearly a dangerous strategy for a
humanitarian agency often working on the front line to publicly accuse one of the
protagonists, and it can sometimes be counterproductive. For example, MSF France was
expelled from Ethiopia in 1985 after denouncing the misuse of humanitarian aid and the
forced displacement of civilians. But the organisation survives by building up credibility
on the ground.
"You often find that the ICRC and MSF are the last
ones left in a war zone, the last ones to evacuate," says Christopher Stokes, who has
headed missions in Azerbaijan, Hong Kong and Afghanistan. "When you stay behind in
the worst possible conditions, after most other organisations have left, it does help your
credibility with the local authorities and the local people. They recognise you're
committed and are prepared to take risks - that helps a lot afterwards, especially if
you're going to speak out about the situation."
MSF has its critics inside the NGO community, on grounds
both of style and performance. While conceding the superiority of MSF's logistical
infrastructure, some NGOs, who believe they are committed to more long-term aid, question
the validity of "jumping in and jumping out" - that is, flying in an outside
emergency medical team for only short periods.
"While there's always a need for emergency aid, the notion of flying in with external
people who don't know the local terrain can sometimes pose more problems than it
solves," said a representative of one British aid organisation.
There's also some concern, expressed privately, about
MSF effectively "stealing the media limelight" - while other NGOs, who work as
hard, receive less attention. Leaving aside the humanitarian motives of non-governmental
aid organisations, it's a competitive world, and having your name and logo on the
television screen certainly helps with fund-raising. But undoubtedly, MSF is among the
most effective humanitarian aid organisations when it comes to dealing with the media.
That same talent for using the media wins high praise
from United Nations officials in Geneva, who claim that MSF effectively drove the
international campaign to highlight atrocities reportedly committed by Laurent Kabila's
forces in Zaire. While MSF was not alone in expressing outrage at what Kabila's supporters
were doing to Hutu refugees, UN officials say the quality of MSF's work won them
credibility with the media, and that their outspoken campaign effectively forced the UN to
open an investigation into the allegations against Kabila's forces.
Jean-Marie Kindermans says the organisation is careful
to confine any statements to its own experiences on the ground.
"We always link our message to what we're doing.
We're not Amnesty International or Human Rights Watch. For example in Afghanistan, there
is a huge problem with the status of women under the Taliban regime," he says.
"But we don't speak about the issue as a whole, what we denounce is women's lack of
access to health care, and the fact that the women of Afghanistan are not getting access
to medical training, which will create problems in the future for the local provision of
health care."
There is of course a fundamental reason why MSF has the
freedom to speak out - 49% of its annual funding comes from private sources, individual
donors and public donations. The rest comes from governments and institutions, such as the
European Community Humanitarian Office (ECHO) which provides 21%, the office of the United
Nations High Commissioner for Refugees (UNHCR) which accounts for 4%. This percentage of
private, untied funding is high compared to most other non-governmental humanitarian aid
agencies. It makes it easier for MSF to run its own agenda. When fighting broke out in
Chechnya in 1994, none of the big international donors wanted to get involved, according
to Dr. Mario Goethais, Director of MSF's Operations Department in Brussels. The conflict
was seen as an internal Russian affair.
"It's at that moment you need your independence to
intervene - by using your public money. Of course, after about a month, when people became
aware of what was happening, the big international organisations went in. But we were able
to get in immediately," he says.
As soon as word is received of a major catastrophe or
conflict, an emergency meeting is convened - no matter what time of the day or night - of
all the relevant departmental heads and desk officers. Aid supplies can be loaded within
12 hours from MSF's warehouse near Brussels airport and will normally reach any
destination in the world within 48 hours. Emergency medical supplies worth US$1 million
are permanently held at the warehouse. As a specialist medical agency, MSF has led the way
in designing medical kits adapted for emergency use in difficult and remote locations.
MSF's rapid growth in the 1980s, when branches were opened outside France, has forced
extensive reorganisation. Before a system of internal co-ordination was introduced, there
were embarrassing occasions when different MSF offices would send staff to the same
disaster zone or conflict without prior consultation, creating needless duplication and
internal tensions.
A fundamental policy dispute between MSF France and MSF
Belgium at one stage ended up in litigation. To the outside world, the
"médecins" may have been "sans frontières", but inside the
burgeoning organisation, the barriers were going up.
"That's all history now," says Dr. Eric
Goemaere. "It's a question of survival. You can't build an international organisation
without rules, if you want to have a real impact in the field. The areas we work in are
too tough to allow small, individual organisations to operate independently, with no-one
really in charge."
MSF France remains the most outspoken member of the MSF
network - which seems appropriate considering French doctors and journalists gave birth to
the original concept. But the organisation recognised that in order to be effective, it
needed a more coherent message, which is why the International Office was established in
Brussels in 1991. Global spending on "advocacy" however, is relatively small -
3% percent of the overall budget. MSF prefers, as much as possible, to allow the people on
the ground to be the ones to speak out - the doctors, nurses and administrative staff who
give up weeks, months or even years at a time to work in the field.
Catherine Bachy, a Belgian nurse, has worked in Zaire
(now the Democratic Republic of Congo), Tibet, Guinea, Lebanon and Kenya. In 1995, she was
in charge of one of the two MSF hospitals at the refugee camp at Goma which housed
hundreds of thousands of Hutu refugees.
"It was staggering, such an enormous human
disaster. The first reaction when I arrived was I simply couldn't believe the numbers of
refugees. But then you start working. You know what you're there to do, and you do
it," she says. (MSF later pulled out of the camp, when it became clear that Hutu
killers responsible for the genocide in Rwanda were using the refugees as their power
base.)
Catherine Bachy's rationale for doing what she does -
under sometimes horrendous conditions - is simple.
"There's a great deal of personal satisfaction. I
can work as a nurse in Belgium, but for the same effort I can achieve so much more in
places like Kenya. Immunisation is an important part of MSF - cholera epidemics are
currently breaking out all over Africa," she says. "With cholera, 50% of those
with the disease will die without treatment. And yet the treatment is simple - no drugs
are required, just rehydration, both orally and intravenously. By treating the
dehydration, that 50% mortality figure goes down to just one per cent. I don't feel it's
normal that some people die because they simply lack the minimum to survive."
But survival is becoming increasingly tricky as well for
volunteers in the field. MSF has noted a marked increase in attacks on aid workers and MSF
supply bases over the past two years. Christopher Stokes was trapped in a bunker in
northern Afghanistan with several other aid workers for nearly a month last year when
fighting and looting reached a peak at Mazar-i-Sharif. "The personal danger is
variable, and it's increasing. The problem is that conflicts are no longer being run by
the big powers, or governments. We're faced with irregular armies who are not well
supplied and often don't receive any pay. Looting is part of their bonus," he says.
"Several times, I've been in a position where I was convinced I would be
killed." In fact, last June, a young doctor on his first mission for MSF in southern
Somalia was gunned down as he left Baidoa hospital after his morning shift. So, are MSF
volunteers brave or are they addicted to danger?
"I don't think brave is the word, but you have to
be committed. I have never been addicted to the hardship and the danger," says
Stokes, who makes his way to speak to the desk officer in charge of Sierra Leone where two
MSF workers were recently kidnapped. After 14 months in Afghanistan, he is pondering
whether to accept a mission in Sierra Leone. He wants to find out more before he makes his
decision. There doesn't seem much doubt about what that decision will be.
(the MSF was awarded the 1999 Nobel Peace
Prize)