The French NGO Médecins sans frontières (MSF) is celebrating its 50th anniversary. Fifty years devoted to medical aid to the most disadvantaged, in a constantly changing world. Jean-Guy Vataux, Deputy Director General of MSF France, discusses the highlights of MSF’s history for CNEWS and discusses the new challenges facing the association.
On December 21, 1971, a group of doctors and journalists marked by their experience in Biafra and Pakistan founded Médecins sans frontières. In 50 years, what has changed?
Not much, after all. The main change took place at the end of the 1970s, when two visions of humanitarianism clashed within MSF. The first camp, which won, wanted the organization to professionalize and develop heavy medical means to take care of large populations. The other, who would become Médecins du Monde (MDM), preferred that MSF remain an agile solidarity association, which very quickly projects itself into the field to alert public opinion.
Basically, our mission has always remained the same: to come to the aid of populations in distress, always with care and sometimes with food aid. Since 2003, we have also had a research and development component to find treatments for diseases affecting poor countries, such as sleeping sickness for which there was no effective treatment.
Today’s world seems more uncertain than ever. What are the difficulties you are encountering today?
The world has changed a lot in 50 years. One of the great difficulties of our time is the jihadist groups. We have been dealing with them since the early 2000s. It is complicated to work in the areas where they are present because they wage counter-insurgency wars. It is much easier to gain access to a power that holds a territory and is responsible for a population.
Are you still able to access the population?
When we spot a population in great difficulty, we always try to negotiate access to all the influential parties in the territory in question, whether it is a government or the rebels. We don’t have a blacklist. Unfortunately, many jihadist groups like Daesh do not keep their commitments and attack our staff or the populations we assist.
Last year, an MSF maternity hospital was attacked in Kabul. In June 2021, three MSF employees were killed in Tigray, Ethiopia. Do you happen to no longer intervene in certain areas?
We do not intervene at any cost. We sometimes leave certain territories for security reasons, such as in Syria. There are also governments which make our job extremely complicated. Currently, this is the case of Ethiopia, which is doing nothing to protect our teams, and North Korea, where we can no longer go. Fortunately, these are exceptions.
MSF is deployed in more than 80 countries around the world, some of them very authoritarian. Don’t you fear an instrumentalisation of humanitarian aid?
It is our dread. It is better to abstain than to reinforce the sufferings of the people. The example that struck us the most was the famine in Ethiopia in 1985. We realized that humanitarian aid was used as blackmail by the dictator to deport people to the south of the country. We had to stop our relief activities. It was a courageous decision when Ethiopia was the great global cause of the moment. Today, it is still a concern. Those in power tend to want to favor their political base. Our role is to ensure that it is the most vulnerable who are rescued.
How has the pandemic affected MSF’s activities?
The Covid-19 crisis forces us to make additional efforts to pursue activities that we already had before. Namely, strengthening the protection of patients and MSF staff. We also carry out interventions specifically devoted to Covid such as vaccination in Iran, Lebanon or Yemen and we intervene in hospitals to take care of severe cases. Overall, we had to increase our financial efforts by 10 to 20% because of the health crisis.
MSF has often stood out for its freedom of speech, even if it means deviating from the neutrality traditionally found in the humanitarian landscape. Will you continue to make it your mark?
We are lucky to be 98% funded by private individuals and not to depend on institutional funding, unlike other NGOs. No one will blame us for having criticized such and such a government or such an organization. This facilitates our work and helps give us the freedom of speech that we claim. However, we do not consider ourselves to be the only paragons of freedom of speech.
Is this desire to debate also found internally?
Of course, we don’t stop arguing (laughs).
What is the subject of debate?
In recent years, everything related to discrimination and racism in institutions. Even if we are not the furthest behind on the subject, we are never totally exemplary. For example, if you want to become an operational manager in Paris for MSF France, it is easier if you are French or Italian than if you are Ivorian or Burmese. We try to compensate for the difference by providing special assistance (immigration procedure, family reception) for those who are not from the European community. It’s not just a principled effort, we need these people.
MSF’s operational centers (which run operations, raise funds, recruit staff, etc.) are almost all based in Europe. Is there not an issue of decentralization?
There is indeed an imbalance of power. This is why we have just opened a sixth operational center in West Africa, shared between Abidjan and Dakar. It is only made up of African staff.
MSF is therefore called upon to evolve?
We don’t feel the need to reinvent ourselves. However, MSF continues to evolve because society does. For example, we are going to take measures to better detect and prevent sexual assault suffered by our staff and our patients. We are also sensitive to the climate issue and have made a commitment to reduce our carbon footprint by 50% by 2030.
How do you see the next few years? Where do you think you need to intervene?
All over the world, we see a purchasing power crisis affecting access to health and food. Major nutritional interventions are expected in 2022 and 2023.