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- French physician
The French NGO Médecins Sans Frontières, has been providing medical assistance in disaster zones for half a century, and currently operates in over than 70 countries. Has the organisation grown too large?
Médecins Sans Frontières (MSF), or Doctors Without Borders, founded by 11 doctors and two journalists on 22 December 1971, has evolved from a small group of friends working without resources, to a globally-recognised network providing medical care to victims of natural disasters, famines, conflicts and other disasters around the world, with about 100 operations in nearly 75 countries.
With its expansion, it has gained the ability to raise the alert about disasters unfolding. But some say it has grown too large and has lost the ability to react quickly.
Doctors on the ground
MSF was founded as a merger of the Groupe d'intervention médicale et chirurgicale en urgence (Emergency medical and surgical intervention group), made up of French doctors who had worked in south-eastern Nigeria during the 1968 Biafra war and wanted to promote victims’ rights, and the Secours médical français (French medical relief), founded by Raymond Borel, the editor of a French medical journal, who wanted to recruit doctors to provide aid to victims of natural disasters, after the 1970 Bhola cyclone.
The two groups merged to form Médecins sans Frontières, whose first mission was to be on the ground helping those most in need.
MSF's first mission was in Nicaragua in 1972 following an earthquake that destroyed most of the capital and killed tens of thousands of people. MSF set up its first long-term medical relief mission in Honduras in 1974, after Hurricane Fifi caused major flooding and killed thousands of people.
Over the years, MSF developed the field of humanitarian medicine.
“The Red Cross and other humanitarian organisations had doctors, but MSF developed the idea that an organisation could exist with that specific goal, with the development of techniques and methods of intervention,” Rony Brauman, the first permanent doctor hired by MSF in 1979, who served as the organisation’s president from 1982-1994, told RFI.
From the start the group had disagreements over what it should become. On the one hand were those who wanted to keep it a small group; others wanted to expand.
The situation came to a head in 1979 when Bernard Kouchner, one of the founding members who was serving as the organisation’s president, joined a call by Paris intellectuals including philosopher Jean-Paul Sartre, and organised the charter of a boat to pick up refugees fleeing the Vietnamese communist regime.
Some said courting of the media was not the way forward and that the organisation should remain politically neutral. Some members left the group, including Kouchner, went on to set up the campaigning medical organisation, Medecins du Monde
Over the years, MSF has not remained silent. As it raised money from private sources, it became financially independent, and it could speak out about atrocities it felt could be prevented.
In 1985, Brauman decided to publicly criticise the Ethiopian government for using MSF’s food distribution centres to register refugees and force them to move south, to depopulate rebel areas.
"MSF came up against the government of the country it was working in... to protest against methods that used humanitarian aid to worsen the situation of the victims of the famine,” Brauman told RFI.
MSF was expelled from the country, but speaking out worked, and the government stopped forcibly displacing people.
The organisation has made decisions not to enter situations in which it considers it would be used to prop up policies it disagrees with.
"The issue is whether we’re helping the population more, or those in power,” explains Brauman. “This is behind the philosophy in which sometimes it's better to abstain than to act, which for an action organisation is a bit paradoxical, but fundamental.”
How big is too big?
In 1999, MSF won the Nobel Peace Prize, which allowed it to finance a campaign for wider access to drugs to treat tropical diseases and AIDS.
Today its annual budget is nearly 1.6 billion euros, and it employs 61,000 people, two thirds of who are deployed on the ground.
The growth of the organisation “amplifies the material and logistical means that we have to deploy operational teams on the ground, so it's not just negative. Far from it. I worked on developing the organisation,” says Brauman, who has voiced concerns about growing too large.
"The problem is that organisations have a spontaneous tendency to grow… and to justify their growth by incessant new needs. And in terms of humanitarian aid there is always something more to do. So there is an inflationist dynamic that pushes MSF to grow more,” he told RFI.
The result is well-funded campaigns that can take too long to get going
“MSF will undoubtedly have more means on the ground after a certain time, but will arrive later, or the wrong place or the wrong time.”
The next 50 years?
Looking to the future, countries are increasingly able to organise large-scale relief for natural disasters, so the most pressing humanitarian challenges for groups like MSF come from terrorism, migration and poverty.
How will it evolve? In response to criticism that the organisation is to Europe-focused, Brauman says that could shift.
Fifty years ago, MSF was a small group of French doctors going into conflict zones abroad. Today, half of those working for the organisation on the ground are locals, and there are dozens of nationalities working at the Paris headquarters.
Top directors continue to be European, and for Brauman, that might continue, given that most of its funding continues to come from Europe.
“For a while MSF will remain an organisation dominated by Europe,” he says. “But it will continue to internationalise, which is a considerable force.