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close this bookThe Courier No. 136 - Nov-Dec 1992 - Dossier Humanitarian Aid Country Reports Sao Tomé-Principe-Senegal (European Community, 1992)
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View the documentHumaritarian aid
View the documentCommunity humanitarian aid: some facts and figures
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View the documentHumanitarian assistance: the needs and the response
View the documentHumanitarian assistance turns to democratic interference
View the documentUnited Nations Resolutions
View the documentPriorities for UNHCR Today
View the documentNew challenges for the international community by Nicholas HINTON *
View the documentJournalists and humanitarian emergencies
View the document«Médecins sans Frontières» - Helping hands for the sick and injured
View the documentEurope helps the former Yugoslavia
View the documentSomalia: Millions face starvation
View the documentEmergency humanitarian aid for the Iraqi peoples
View the documentThe 1991 Bangladesh cyclone: the Commission's response
View the documentDrought in Southern Africa

«Médecins sans Frontières» - Helping hands for the sick and injured

Much of the humanitarian work financed by the European Community is carried out by non-governmental organisations with special skills in particular areas. One of these is the international medical organisation known by its French title of Mcins sans Frontis ('Doctors without frontiers'), a private, non-profit-making association originally set up in 1971 to promote health in Third World countries. It started in France but now has national associations in Belgium, Switzerland, the Netherlands, Luxembourg, Spain and Greece.

The Belgian section of MSF at the moment has some 1000 doctors, nurses and para-medical staff of various nationalities working in 29 countries, primarily in Africa but also in Asia, Latin America and Europe. In 1991 it spent some ECU 50 million, of which the European Community provided 58%. The rest of its funds come from some 380 000 private donors in Belgium and, to a much lesser extent, from UN bodies and the Belgian and other governments. Like its sister organisations, MSF-Belgium provides urgent medical treatment and surgery, and organises and gives advice and training on nutrition and health care in cliff cult situations. As its Director-General, Dr Jean-Pierre LUXEN, told The Courier, it specialises in acting fast.

- We respond to need in two ways - first of all with immediate action, by sending out, say, a plane straight away with everything we need on board, or, if we need to collect various items of information ourselves first, by putting someone on the first available flight and then triggering the action within the next 24 hours. Over the years, we have built up a team which looks after the logistics, getting together the medicines and tents and non-medical kits which we sort into kits tailored to the situation in hand, gets a management system moving to get all those things sent off, issues an invitation to tender for planes and collects detailed information.

· Where do you get your equipment and medicines?

- We have enough stocks in Belgium, France and Holland to have what we need ready in 10 minutes. Nothing is left to chance. A cholera kit, for example, will contain drips as well as medicines and shovels and lime and all in the right proportions for the particular situation - we have kits for 1000-bed hospitals, for example. Kits are made up in the light of experience. With some of them, we could look after 10 000 people for three months without any of the medicines running short. It is all tailored to the medical conditions we find on the spot. To replenish supplies later, we have purchasing centres in France and Holland which mean we can make a note of requests, seek out the lowest prices on the European market and make bulk purchases which can then be sent out to the different countries.

· What you have just described must cost a lot, so you must keep fairly strict financial control of it all.

- Emergencies do cost a lot, because it is far more expensive to shift 20 tonnes by plane than by boat, for example, and there is obviously a huge amount of money involved. The funds from the European Community and the public at large are very tightly controlled. With European Community funds, invitations to tender have to be issued for everything, there has to be financial justification for every item of expenditure. There are the conventional controls, of course, but we apply the same approach, only with more flexibility, to the private funds which we get from the general public. And it is all audited, it is all checked by the Court of Auditors and, at that level, a franc is a franc.

· People often complain that NGOs spend too much on running their head offices. Do they say that about you?

- No they don't. We have a rule that no more than 15% may be spent on administration and communication. Look at the past few years, in fact, and you see that the average was 5% for administration and 6% for communication and information - which is really the minimum we could work with, I think.

· And is the European Community still your biggest funder ?

- It most certainly is, for several reasons. First of all, because it has money and, second, the sort of money which is extremely suitable for the situations in which we have to work. There is the emergency aid fund, there is Article 255 of the Lomonvention, on refugees, there is food aid and there are funds for some very specific situations and, undeniably, our criteria are in line with all these. The geographical proximity of the Commission means we can also put our cases properly and so on. However, our policy is to diversify, for the very good reason that, first of all, it is always unhealthy to be dependent on one funder and we could well become dependent on the Commission and, second, with Europe getting more political, it could also start using its money in political ways and we would lose our whole raison d'e if we were just the operational arm of the Commission. That would be a complete failure as far as MSF was concerned.

· The Commission doesn't impose any political conditions as to how you use the money ?

- The funds we get from the Commission come for projects we have put to it, clearly, so there has been no attempt to steer our use of them in 99% of the cases so far.

· The European Community has just set up its humanitarian relief office, ECHO, which is aiming for a real partnership with the NGOs. What would a real partnership with the European Community mean as far as you are concerned ?

- The Commission had two main aims in setting up ECHO, I think. One, to make its operations more visible, and, two, to avoid being seen just as a banker or funder - hence an overhaul of its operating methods. ECHO will certainly mean that the financial instruments available to the NGOs can be harmonised and we can go for a slightly more coherent policy by putting our various plans on the table and assessing the resources available. That is the big advantage, I think. But there is a risk of an enforced partnership. If the sole idea is to force operators to run schemes decided on by the Commission alone, then I think there are a number of organisations which will not be interested. A partnership has to be reciprocal. There has to be something in it for all the parties involved. Secondly, I think the impact Europe's high visibility has on emergency issues needs to be put into context. Europe is known to be an extremely generous donor, extremely efficient in terms of its partners and in the way it operates a fast budget line. The best thing about Europe's visibility too, I think, is the operators, be they French or Belgian or British or Danish, going out through an NGO. These people are what makes Europe's involvement most visible. So there is more to it than stickers. There are people involved, which is why I think that we have to go on reinforcing and supporting the NGOs which are going to be the Commission's leading operators. Supporting them perhaps means helping them build up stocks and offering administrative assistance and so forth - which may mean giving the operators more towards their stock-building and organisational costs - and it may mean being that coordination platform which we are all waiting for.

· Is there anything an NGO can do and a government or a Member State or a UN agency can't?

- Yes, indeed: it can be independent of any State. I think that the reason why MSF was able to step in to help in Afghanistan and Eritrea, in Tigrnd Kurdistan at one stage, was because we are not tied to any particular State. The concept of that duty to intervene has obviously developed, so that nowadays it is true to say that some families in the United Nations or even the Red Cross have gone beyond that sacrosanct link with the State, and are also operating in areas which are not controlled by the State. So it is no longer just the preserve of the NGOs. I do think, on the other hand, that Europe, as an active participant, will come up against problems going into areas not controlled by States.

· Your Charter actually talks about a right to humanitarian assitance. How far does that go ?

- There are no geographical limits, I think. There are no limits when it comes to people's physical and psychological integrity and there are no ideological limits . The problem as we see it would arise if , say , we offered assistance without denouncing the cause of the situation where we were giving help. It would be a pity if we worked in, say , Khmer Rouge areas and couldn't denounce the Khmer Rouge rme. There must be no repetition of the situation the Red Cross was in during World War II, so I think the victims have to be the top priority, but in some situations the cause has to be linked to the effect.

· MSF is strictly neutral and impartial in what it does and it helps people without any discrimination on grounds of race, religion, philosophy or politics - that is what your Charter says. But if you are forced to get armed guards to protect your teams, as is happening in Somalio at the moment, aren't you already politically involved to some extent in that you are bound to be associated with the clans to which these armed guards belong ?

- Somalia is certainly an extreme example of the type of situation which creates the biggest problems for humanitarian operations and all the humanitarian relief agencies involved in them. There are three reasons for this. First, it involves accepting that we have to flood the country with food aid to make sure it gets to the victims, knowing that some of it goes astray. Most humanitarian relief organisations, I think, are aware that for every sack of food which gets through to the hungry, five or ten sacks have to be distributed. Secondly, there is the insecurity in which we work. Somalia is an extreme case of insecurity, I think, along with Yugoslavia and Liberia in 1989. Even in Afghanistan it was easier to get to the victims than in Somalia or Liberia. The third thing is that, in order to get to the victims, we have had to make a pact with the devil and that sort of thing obviously has to be analysed and thought through very carefully in humanitarian organisations. It's the first borderline case we have had and we consciously agreed to fudge a whole set of principles so we could help the victims, although on the understanding that, once things have stabilised, we shall be taking a hard look at those principles to see just how far a humanitarian relief operator can be pushed into sacrificing certain principles at any given time because of the situation in the area affected. That is something which needs to be thought right through to its conclusion, I think.

· Do you perhaps have any suggestions for the UN or any individual countries to make your work in the field easier in situations of this sort?

- Once again I think it may be a question of making pacts with the devil - although less of a devil than the private militias in Somalia. I remember being in Liberia when the situation in Monrovia was very tense and there was an American aircraft carrier off the coast. There were troops on board, but they did not intervene in Liberia and we said to each other sometimes that if only we had just 50 armed guards to look after the hospital and the refugee camp we could have got the work done, and things got so bad that we had to pull out for two or three months. We have reached the stage of asking for UN peace-keeping forces to step in - we did that for Somalia - although it is certainly not the answer in the medium term. It is not the answer because the States which we ask to provide that essential protection must not use it as an excuse for shirking their political or diplomatic responsibilities. Providing humanitarian relief and protecting it must not be the only way States get involved in conflicts where the real responsibility lies with diplomacy and politics. In other words, humanitarian work must not be a cover for the real responsibility.

· In a situation like the one in Somalia, with only one foreign mission, the Egyptian one, on the spot and only you and the Red Cross and no official national authorities at all, MSF teams surely must have unofficial information about what is going on. Are you sometimes asked to perform diplomatic functions or to help the more official authorities?

- Yes, we are, and I think it would be a great temptation to be called mediators. Sometimes, of course, our connections with some groups of resistance fighters mean we can pass on information which is outside the strict bounds of health and sometimes, of course, if we can get certain people to sit round a table together - and why not ? I think that that comes from the closeness of the ties and the contact and the fact that we are there in the field. I think that, without anyone noticing, a kind of informal diplomacy has grown up, through the UN or particular countries, and ultimately we should not be playing at being diplomats like that because we don't have the skills to do so and we could make some very serious mistakes.

· MSF makes a distinction between emergencies and crises, doesn't it ? Can you explain that?

- This also has an important bearing, I think, on the way ECHO and the Commission operate in relation to crises in the future. Emergencies, as far as we are concerned, are situations which crop up fast and which last longer or at any rate stay at a high pitch for some time.

They are things which make the local situation deteriorate in the medium term and destabilise or entirely destroy the structural elements of the country. They leave behind a whole situation which may last for years, either because deterioration prevents the structures from being put back, or because there is a one-off reason to do with the weather or political upheaval preventing the State from rebuilding. Then comes the structural phase when what might be called structuring and development can be undertaken. Take Chad. After 15 years or so of war, there was a period of five years when the State tried to rebuild the country - which is when the limitations of certain types of financing perhaps became apparent. Financing is available without difficulty for emergency operations, either for displaced people or operations run on emergency aid funds, but the instruments are geared to emergencies. So for some years now we have been suggesting a sort of crisis fund to finance rehabilitation. There should be no qualms about talking about rehabilitation for a year or two, or three or four or five if that is what is called for.

· What would MSF do in a period of rehabilitation ?

- We work in the health sector, obviously. We don't claim to do anything else. It's complicated enough as it is. So, just as in cases of strict emergency we go direct to the victims, whatever the potential consequences for the health system, when it comes to rehabilitation, we try to put the different components of the health system back on their feet one by one. A health programme means staff, buildings, supply circuits, vaccination campaigns and so on and all those are things which help us put our patient right during the period of rehabilitation. Then the long-term development phase - which is no longer our affair for the moment - involves helping the State take over its health system. But there are such shortages of everything during rehabilitation that people involved in bringing external assistance must not ask questions, they must just come in with the proper resources anyway.

· Isn't it all too often true, unfortunately, that long-term rehabilitation projects collapse once the expatriates have gone home ?

- Well, that is the whole problem of development projects, and I think it is wrong to be forever wanting to describe a project in terms of a beginning and an end with expatriates coming and expatriates going. There is no point in looking upon expatriates as just assistants. They are there to make sure there is a dialogue and I think that Europe, with all its wealth and its Lomonvention, represents money, of course, but it is also a force which compels all the people involved to get to know each other and take part in a dialogue. I think we should also take another look at the concept of technical assistance and see it more in terms of people transferring technology and engaging in dialogue. Japanese people come to some of our factories sometimes and, while there is no question of getting them to leave at all costs, they are not regarded as helping us. It's an exchange.

· The people who work for you take risks and their pay isn't up to Western standards, is it, so why do they do it ? What is their motiviation ?

- There are several reasons, I think. There are still one or two idealists around, and there are people, doctors especially, who find the work professionally extremely satisfying. A doctor out in the middle of the bush, even in an unstable situation, is a doctor who can still practise real medicine. Thirdly, I think there are people who are looking for a positive adventure and therefore do not feel that they are making a sacrifice, in fact they see the experience as a way of discovering different cultures, different countries and different situations. The fourth reason is that we have built up what the private sector would call a company culture which brings together people who are looking for a particular setting of freedom and tolerance, imbued with the spirit of May '68, in other words an improvement in the world environment from every point of view. It is obviously also a social trend which attracts young people. A couple of years ago, the Nouvel Observateur magazine ran a survey and found young people claiming 'I don't want to be a pilot any more. I want to be a doctor in Mcins sans Frontis', and I think that reflects the concern of a particular generation. It's a trend which has definitely been espoused by some of the youth of today.

Interview by Robert ROWE