Médecins Sans Frontières: Half a Century of Humanitarian Action

The organisation reaches the most inaccessible crises by combining action and denunciation

6 min
wave of displacement to the town of Bouca, (Ouham region), north-eastern Central African Republic (CAR), following clashes between reported anti-balaka elements and ex-Séléka forces last week.

BarcelonaAlbert Viñas is a 62-year-old from Sabadell who has been working as an emergency coordinator for Médecins Sans Frontières (MSF) for two decades. The compilation of the 48 missions in which he has participated is a compendium of the worst humanitarian disasters that the world has suffered since the turn of the century: famine in Kenya, war in Angola, massacres in Darfur, an earthquake in Haiti, the latest jihadist offensive in Mozambique or the current crisis in the Ethiopian region of Tigray. Next week he will travel to South Sudan. He could explain a thousand terrible situations that he has lived in his own skin, but instead would rather tell a positive story: "In 2003, in the Democratic Republic of Congo, there was a little girl who had lost her speech after her parents were killed. I was going from here to there and one day when I was taking her there she said to me muzungu, which means white man, and that's how she started speaking again.

The worldwide pandemic has put global health on the agenda, a concept that the organization has been wielding for many years. And it is in this context that MSF is currently commemorating its 50th anniversary, a milestone that David Noguera, who a few weeks ago ended his term as president of MSF Spain, says has a bitter aftertaste: "We really like what we do, but the best news would be if we could cease to exist... because all the crises in which we work would be avoidable. We have resources so that they don't happen, and if they do, it's because those who have to make the right decisions don't make them".

April 13, 1994. Rwandan refugees on the border between Burundi and Rwanda

This is exactly what is happening with the pandemic. As the WHO denounced just a few days ago, enough vaccines could have been manufactured next quarter to cover the entire adult population of the world, but rich countries are hoarding them to administer third or fourth doses or immunise children, which only prolongs the crisis. "Until patents are released and everyone can be vaccinated, the problem will not be solved. A few days ago a Chadian colleague died of covid who had not been able to get vaccinated, because there are not enough doses even for health workers, who are the main containment barrier in the global south", says Paula Gil, who has taken over the presidency and has become the first nurse to take on the top job at the Spanish branch of the organisation, after last year the statutes that limited the position only to doctors were modified. "It is a source of pride, at a time when nursing is suffering so much," she says.

Noguera admits he still hasn't recovered from the blow they suffered in June, when three of his colleagues were killed in Ethiopia's Tigray region. "I'm still in the process of mourning, anger and frustration, because it's so cruel, so unjust...". And it is not the first time that aid workers pay with their lives for their efforts to assist the most vulnerable in the most difficult moments. On the contrary, the contexts are becoming more and more complicated.

From Biafra to the commitment to speak out

When MSF was founded in 1971, conflicts were being sorted out in the Cold War equation between the two great world powers. Then a group of French doctors and journalists who had worked with the Red Cross's International Committee in the war in Biafra (Nigeria) decided to take a step forward and when they returned to Paris they broke their commitment to confidentiality to denounce to the world what they had seen. It was not enough to save lives: rights violations had to be denounced, public opinion had to be mobilised and aid had to be professionalised. From a cold war scenario we have moved to a multipolar one, where there are no longer local conflicts, because all of them are subject to interferences and crossed interests, players accumulate and the solutions become more complicated.

View of an Ethiopian refugee camp. After Somali forces invaded the region of Jijiga and Harare, several thousand people took refuge in refugee camps on the border with the Ali Sabieh district

Since the "war on terror" launched by the United States at the beginning of the century, the major powers have linked humanitarian aid to political objectives, which has put aid workers in the spotlight.

Since its origins, the organisation has been characterised by a particular way of understanding the medical profession and the need to combine it with a denunciation that points the finger at those responsible for humanitarian disasters. This is why they were expelled from Ethiopia in the 1980s, when they denounced that the big organisations were using humanitarian aid to force migrations. A few years later, in the Balkan war, they discovered that their presence could not prevent indiscriminate killings of civilians, when people went to MSF hospitals not for medical help but for protection. In the Rwandan genocide, 250 members of the organisation died in a military intervention.

The neonatologist in Aleppo

Mercè Rocaspana, a nurse from Sant Cugat who has worked for the organisation for almost twenty years, has witnessed first-hand how things have changed for aid workers in the post 9/11 era. "Everything has become more difficult because humanitarian aid has got mixed with political and military strategies, and now it is very difficult for people to understand that we are neutral and independent of any political power. We make a lot of efforts to have good security protocols but in the end what protects us most is the acceptance of the population we work for. You have to strike a difficult balance between staying out of harm's way but being close enough to the people who are suffering.

Despite having seen the worst humanitarian disasters in Africa, Rocaspana admits that "you never get tough enough". "When I arrived in Syria it seemed to me that in a decade of experience I had never seen a real war," she admits. The weeks she spent in Aleppo, the northern Syrian city that resisted Bashar al-Assad, Russia and Iran's bombardments until the very end, left a mark on her: "The Syrians had a life like ours and we got very emotionally involved. I remember very much one day when we visited a bombed hospital and met a neonatologist who told us that he would not leave as long as there were children left in the area... and it is inevitable to ask yourself what you would do if this happened back at home."

And how does one endure living on the front lines of such tragedy? Noguera shuns the stereotype of the self-sacrificing aid worker. "Is it hard? Yes, but it also burns to get up early every day to go to work in the factory. I do what I do because I have decided to do it voluntarily. We take a big risk, like firefighters or deep-sea fishermen do every day: we are not green berets or martyrs, nor are we better or worse people for doing what we do. For me, having spent twenty years doing what I have done has been a privilege, which has given me another perspective of the world". For Rocaspana, the key is to follow the advice given to her by a veteran colleague when she was just starting out: "You have to enjoy here when you are here and there when you are there; be aware of where you are at any given moment and know how to see the positive things when you are surrounded by so much misfortune". She tries to see in every life saved a colossal victory, because "if you don't have the capacity to see the good things, so much pain ends up getting inside you".

With the flag of independence

Political independence has been one of the great banners of the organisation, which has functioned as a compass in the most difficult places. In 2016, for example, MSF renounced all funding from the EU and its member states in protest against European migration policies and the shameful deal to deport refugees to Turkey. This independence is possible thanks to its seven million members worldwide (86,000 in Catalonia).

Gil starts her mandate with many challenges on the table: the pandemic, increasingly dirty conflicts that hinder humanitarian access to the affected populations, and the impact of climate change, which in some places like Yemen or the Sahel is already causing problems of access to food or water. All this in the context of the growing strength of far-right discourse in Europe that "insults us, degrades people and creates much more insecurity for the populations and the organisation".

MSF supports the Ebola Transit Centre in Bunia. Medical and hygiene staff don PPE to enter the high-risk area of the Ebola Transit Centre in Bunia

But in addition to responding to the new threats of today's world, MSF is also facing internal changes such as a paradigm shift to work "closer to communities rather than just from hospitals that many people can't reach" and to a "less top-down point of view, involving communities in deciding what kind of help they need". This means continuing the decentralization effort and gaining in diversity (MSF's 65,000 workers worldwide are of 170 different nationalities), while continuing to reinforce security measures. At the same time, Gil also has as a priority a zero tolerance policy against sexism, racism or any form of discrimination inside the organisation.