Rhiannon Dominy-PergentileC0367386

PSC 224 International ConflictResearch Paper – Médecins Sans Frontièrs

Mona BrashMarch 20, 2014

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Médecins Sans Frontièrs (MSF) began in 1971 when a group

of French doctors and journalists returned shocked and

empowered from the Nigerian civil war and famine crises in the

region of Biafra. The goal of the non-profit organization is

to be unlike any other NGO by being completely neutral,

unbiased, and fighting to provide quality health care to those

in need. With over 23 associations around the worldi, MSF has

strong member teams in North America under the name Doctors

Without Borders. With its spread, MSF has treated well over a

hundred million patients, recording 8.3 million patient

consultations in 2011 alone.ii Offices all over the world and

an international team of 30,000+ staff and volunteers have

empowered the organization to wholeheartedly fight for those

in need of quality medical care. This commitment has resulted

in MSF often criticizing lacklustre humanitarian action, and

thus is “frequently a thorn in the side of the aid

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establishment” and international communityiii. Though not a

conflict resolution organization, Médecins Sans Frontièrs uses

their invaluable medical aid, logistical observationsiv, and

international recommendations to bring awareness to conflictsv

and catastrophes that may be lost in the current affairs of

politicsvi. The aim of the organization is first and foremost

to attend to those in dire need of medical aid, and MSF will

use all their resources to go further and bring the

international community into the region to enact further

changes.

French doctors and journalists founded the independent

medical humanitarian organization Médecins Sans Frontièrs in

1971 after delivering aid during famine and war to the region

of Biafra caused by the Nigerian Civil War.vii MSF provides

global quality medical aid, humanitarian action and bears

witness and addresses injustices in an unbiased manner –

serving the interests of the global community. The goal of the

organization is to respond to any public health emergencies,

victims of natural or man-made disasters, and to those

suffering as a result of armed conflict, regardless of race,

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religion or political convictionsviii. Five main principles

guide MSF as health professionals and staff members fight for

the lives of those affected: medical ethics, independence,

impartiality and neutrality, bearing witness and

accountabilityix. In short, this results in unbiased

international aid, financial and political independence from

states, complete neutrality to situations and individuals, and

a strong commitment to justice and quality of life to be

enjoyed by everyone. Médecins Sans Frontièrs fights for the

right of everyone to receive quality medical care, and will

continue to do so regardless of government interference. The

organization only rarely removes operatives from the region

when the safety of staff and patients is violently

threatenedx.

In the decade after its founding, health care specialists

were dispatched to provide aid across the world, and currently

the organization is active in over 70 countries. In the 1970s,

MSF staff were present in response to the Nicaraguan

earthquake, the hurricane in Honduras, for refugees of

Cambodia, Thailand, Ethiopia and Sudan, and provided

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substantial assistance in the first active war zone of

Lebanonxi. However, dissent caused a split between founding

members of Médecins Sans Frontièrs in 1979. The result was a

new organization (Doctors of the World) that believed that

isolated, “guerrilla” doctors and staffing was the best tactic

in the global theatre. The remaining MSF staff created a

structured organization that was better suited to provide

extensive quality medical services in crisesxii. Geneva houses

the headquarters of MSFxiii with a basic budget of €280

millionxiv (spent €944 millionxv), 20% of which goes to

management, administration and fundraising with the 30,000

employeesxvi, and 80% being directly allocated for humanitarian

activitiesxvii.

There is a set of procedures that are initiated when the

need arises for Médecins Sans Frontièrs to implement aid. An

immediate and efficient plan of action is compiled and quickly

implemented that is based on the need of the region, and

whether there is sufficient medical infrastructure

availablexviii. Often what begins as a relief program will morph

into a rehabilitation project that could run for many years

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after the initial crisis has been addressed. Examples of past

programs that have been applied internationally include

emergency healthcare and surgery in war zones or natural

catastrophes, extensive vaccination and water sanitation

campaigns, distribution of drugs and medical supplies and

training and implementing health facilitiesxix. In this age of

globalization, the necessity of the phrase “without borders”

has decreased from the original manifestation of MSF in 1971.

It is not as commonly required for doctors to travel for weeks

on mules through back roads to reach refugees and injured in

remote and war torn countries. Need and dire situations faced

by individuals is not as easily shrouded in this age of

technology and while governments may occasionally protest MSF

and their every move, there have only been a handful of

occasions where the organization has been expelledxx. Health

care specialists have been forced to retreat due to the danger

to their lives and the patients, but more often than not they

will return as soon as physically possible. Technology has

made fundraising and funding for Médecins Sans Frontièrs

accessible for everyone, with notification of need being

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expressed within hours of a crisis. With PayPal, fast Internet

connection, and extensive cell phone coverage, the efficiency

and speed with which MSF can be dispatched has exponentially

increased.

With constant news coverage of crises and events playing

out internationally, MSF has been active in the majority of

catastrophes faced by civilians around the world. There were

doctors and other specialists providing aid for the Haitian

earthquake, civilians affected during the Libyan and “Arab

Spring” crises, the Syrian conflictxxi, and ongoing involvement

in South Sudan for over 30 years. Focusing on Sudan, the

Darfur region and South Sudan since 1978, one is able to glean

the full range of effectiveness and efficiency Médecins Sans

Frontièrs truly wields on the international theatre.

In order to understand how MSF functions as an active

transnational organization (to be referred to as NGO) in the

international theatre, one must be familiar with basic

characteristics of the organization. Delving deeper into the

budget, Médecins Sans Frontièrs receives donations from more

than 4.5 million private donors – providing more than 90% of

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their expenditures. This allows MSF to have a high level of

independence and prevents states from attempting to control

the movement and humanitarian aid provided to certain regions

or groups of people. Therefore, the organization controls

itself in a completely neutral and unbiased fashion, seeking

to help those in need in any way possible, not for any

political gain. 90% of the specialists and support staff that

are employed or volunteer are hired locallyxxii and work in

conjunction with a minute detail of international staff. This

awards the team with legitimacy, respect and authority in the

region, as local populations will be more likely to recognize

and trust their actions. Another benefit of having local

employees is evident when representatives speak

internationally on an issue that requires more aid than MSF

alone can supply. They bring not only the need for aid to the

attention of the international community, but also the reality

of violence and/or struggle that needs to be addressed. In

addition to having legitimacy through local representatives,

MSF is actively providing medical research and surveys through

their non-profit association Epicentrexxiii, which provides

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epidemiological support to field teams. Combined, these

elements make Médecins Sans Frontièrs an organization that has

specifically designed itself to be a respectably neutral

expert and implementer of humanitarian medical aid and medical

research.

As evidenced by their ability to work in a region without

official government approval or cooperation (Syria, Sudan,

Myanmar, Liberia etc.) and openly denounce the actions of

countries (USA, Russia, Chad), Médecins Sans Frontièrs has

achieved international legitimacy and authority, resulting in

the support of various governments, international institutions

and NGOs. This level of cooperation is obvious when one

recalls situations in which MSF has made an international plea

of humanitarian help, which brought attention and support to

the extremity of various civil wars (Liberia, Chad, Congo) and

conflicts. While the mission of the organization is not

conflict resolution, MSF attacks an issue from a medical

standpoint. This almost forces the international community to

intervene if for no other reason than to stop injustices

against humanity. While limited, this exertion of experience

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and authority to generate a reaction is a form of soft power

in the international theatre. By appealing to the humanity in

everyone to end suffering, Médecins Sans Frontièrs attempts to

bring about conflict resolution with the tools available.

An example of the full extent to which MSF can provide

aid and awareness is the Sudanese conflicts. The organization

has been providing ongoing humanitarian aid to the region, but

has also been treating the results from violent clashes

between Sudan and South Sudan (pre-2012), and Southern rebels,

tribes, and the government. Médecins Sans Frontièrs has been

active in the region of and surrounding Sudan since 1978,

fulfilling various roles over the decades. The initial

response was to provide refugee programs for Eritreans that

had fled to Sudan. However, this quickly evolved into

providing medical services during the second civil war

(1983-“2002”)xxiv and later in 1998 famine and drought aid

programs were also implemented.xxv Given their continued

involvement with the Sudanese people, Médecins Sans Frontièrs

has experienced a type of soft power influence that has a

“hardliner” aspect. This influence and threat of international

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condemnation was enough to dissuade warring factions from

attacking civilians and medical facilities up until 2012, when

a new internal conflict broke out in South Sudan after

independence 2011.xxvi The most recent manifestation of

conflict in the South Sudanese region is unlike any previous

one as factions are refusing to acknowledge the role and value

of MSF in rural regions – and thus the influence MSF has in

the international theatre,xxvii by completely disregarding the

organization. MSF has two levels of soft power at their

disposal: providing medical assistance to prevent massive

Sudanese death tolls and having access to internationally

active news agencies.xxviii Though not able to resolve the

conflict between the South Sudanese government, rebels and

tribal conflicts, MSF has made global pleas for the

appropriate international organizations to effectively step in

to implement national change. Médecins Sans Frontièrs has gone

from a working relationship with the Sudanese and South

Sudanese governments and providing medical aid, to fearing for

their own lives, the publication of which has garnered a

powerful responsexxix. BBC has been actively publishing

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reports from MSF teams in South Sudan, with topics ranging

from first-hand accounts of staff and civiliansxxx, interviews

about the humanitarian catastrophesxxxi, to recording the

injuries and deaths of staff and patients.xxxii

Médecins Sans Frontièrs often fulfills two roles while in

a conflict region: attempt to provide quality medical

assistance, as well as lobby “other stakeholders to assure

that proper and swift action is taken” in favour of the

civilians.xxxiii As of March 20th, the government and rebel

troops have continued to violently fight despite the

ceasefire, almost disregarding MSF, the UN mission in South

Sudan, and various other NGOs. Health care and medical aid are

not important enough to warrant an enforcement of the

“ceasefire” that is currently in placexxxiv. With no telephones

available to them, the staff use the faulty and scarce

Internet connections to attempt to raise awareness in the

international community. However, they have had very limited

response as this ongoing conflict does not catch the attention

of the Security Council or other major international groups.

With conflicts like those in Libya, Syria and the Ukraine, the

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ongoing civil unrest in the historically rife region of Sudan

and South Sudan does not register as important enough for

peacekeepers or UN task forcesxxxv. Therefore, with renewed

fighting combined with ongoing disease and famine, South Sudan

and surrounding regions are being bombarded with egregious

violations of humanitarian rights. One must wonder if this

civil unrest and guerrilla warfare has the potential to turn

into something far more gruesome with death tolls rising to

hundreds of thousands. Would the international community

recall past civil crises in Africa, and attempt to intercede

with strict peace talks and enforcement before one group

eradicates the other?

Since inauguration by French doctors and journalists in

1971, Médecins Sans Frontièrs has been active in over 70

countries. Staffs fight to save lives from natural disasters

and man-made catastrophes, regardless of race, religion or

creed. A benefit of being almost wholly privately funded is

that MSF is free from political influence – allowing the

organization to have a close relationship with civilians.

Hiring locals to work on aid and relief programs strengthens

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this relationship. Neutrality also grants MSF a high level of

respect in the international community and with news agencies,

which is useful when drawing attention to global injustices of

humanitarian rights and warfare circumstances. While not able

to control and facilitate conflict resolution directly, MSF

teams in the field and the board members in Geneva garner

significant awareness-raising tactics that have brought

humanitarian injustices to the attention of the numerous

international bodies such as the UN, WTO and the EU. These

connections give Médecins Sans Frontièrs a degree of coercive

power, all the while fighting for the safety and health of

those in need.

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Endnotes

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i http://association.msf.org/ii http://www.msf.ca/en/timeline-0iii http://www.msf.org/about-msfiv http://tribune.com.pk/story/677046/medecins-sans-frontieres-pakistani-medic-applies-balm-on-sudans-war/v http://allafrica.com/stories/201403040848.htmlvi https://www.devex.com/news/how-can-the-us-enforce-the-non-ceasefire-in-south-sudan-82939vii http://www.msf.ca/en/who-we-areviii http://www.msf.org/about-msfix http://www.msf.org/msf-charter-and-principlesx http://www.msf.ca/en/timeline-0xi http://www.msf.ca/en/timeline-0xii http://www.msf.ca/en/who-we-arexiii http://association.msf.org/xivhttp://www.msf.org/sites/msf.org/files/msf_financial_report_interactive_2012_final.pdfxv http://www.msf.org/msf-factsheetxvi http://www.msf.org/our-staffxvii http://www.msf.org/our-financesxviii http://www.msf.ca/en/who-we-arexix http://www.msf.ca/en/who-we-arexx http://www.msf.ca/en/timeline-0xxi http://www.msf.ca/en/timeline-0xxii http://www.msf.org/msf-factsheetxxiii http://www.epicentre.msf.org/en/in-briefxxiv http://www.bbc.com/news/world-africa-14019202 xxv http://www.msf.ca/en/south-sudanxxvi http://www.doctorswithoutborders.org/article/msf-responds-evolving-needs-amidst-fighting-south-sudanxxvii http://www.npr.org/2014/02/27/283307927/violence-in-south-sudan-targets-hospitalsxxviii http://www.bbc.com/news/world-africa-19292250xxix http://www.bbc.com/news/world-africa-26357138 http://world.time.com/2014/02/26/hospital-patients-in-south-sudan-shot-dead-in-their-beds/xxx http://www.theguardian.com/world/2014/jan/20/south-sudan-msf-diary-of-crisisxxxi http://www.nytimes.com/2012/07/07/world/africa/refugee-children-dying-at-alarming-rate-in-south-sudan-aid-groups-say.html?ref=africa&_r=0

xxxii http://www.bbc.com/news/world-19293687 http://www.sbs.com.au/news/article/2014/02/26/south-sudan-violence-healthcare-msfxxxiii http://www.msf.org/article/south-sudan-new-refugees-sudan-need-assistancexxxiv http://www.infoplease.com/world/countries/south-sudan.html?pageno=3xxxv http://www.bbc.com/news/world-africa-14069082