Sophie Delaunay, Executive Director of MSF USA, Discusses Dilemmas of Humanitarian Action

In this interview, Sophie Delaunay, Executive Director of Doctors Without Borders/Médecins Sans Frontières USA (MSF) discusses negotiations humanitarian organizations must conduct in order to gain access to populations in need, drawing on a MSF’s recent book Humanitarian Negotiations Revealed: The MSF Experience. She says that access ultimately depends on the organization’s ability to strike a difficult balance between its principles and the needs of the population. Using the examples of Afghanistan, Mali, and Somalia, Ms. Delaunay says that MSF’s ‘red lines’ vary greatly depending on the context of the country, the types of operations they are conducting there, and the presence of other humanitarian actors.

She also discusses MSF’s position on the use of military intervention on humanitarian grounds, observing that it is ultimately a contradiction in terms. Speaking about Syria, she says that the emphasis should be on demilitarization of health facilities, rather than militarization of aid.

She deconstructs the myth that MSF is detached from international coordination mechanisms in crisis zones, but insists on MSF’s ability to conduct independent operations when coordination creates delays or becomes disconnected from the needs of beneficiaries. Lastly, Ms. Delaunay discusses MSF’s position on public advocacy, or the duty to “speak out and bear witness” to atrocities, which has greatly evolved over the years and continues triggering internal debate.

The interview was conducted by Jérémie Labbé, Senior Policy Analyst, International Peace Institute.

Listen to interview (or download mp3):

Interview Transcript

Jérémie Labbé (JL): I am here with Sophie Delaunay, Executive Director of Doctors Without Borders/Médecins Sans Frontières, MSF USA.

Thank you for joining the Global Observatory today.

MSF has recently published a book in the US called Humanitarian Negotiations Revealed: The MSF Experience. It discusses compromises and negotiations your organization has to contend with in times of crises to access populations in need. Could you tell us more about this book and its main conclusions when it comes to negotiating humanitarian access?

Sophie Delaunay (SD): Thank you Jérémie for inviting me to this conversation.

This book indeed is a reflection on what we usually call humanitarian space. Through a series of examples in countries where MSF has developed operations, like Myanmar, Pakistan, Afghanistan, Somalia, Sri Lanka over the years. The authors of the book try to demonstrate that there’s no such thing as a tangible right to humanitarian space, by virtue of being a true humanitarian actor. And that the space that we gain in the field is actually the product, the result of a negotiation that most of the time involves some compromises. The book looks at how MSF over the past four or five years has conducted these negotiations and has resorted or not to accept these compromises.

JL: This book, which I read with interest tells us, and if I can sum up what you mentioned, that the art of humanitarian negotiations is as you said, about compromising but without surrendering on principles or without crossing the red line, the bottom line. How do you identify this bottom line in practice in the field? Could you illustrate this in light of MSF experience in current volatile contexts such as Afghanistan, Somalia, maybe Mali?

SD: You actually never know where the red line is until you are about to cross this red line, and this is usually what triggers the discussion, the internal debate and what leads to the decision to cross it or not, or to make compromises or not. But generally speaking, the red line would be defined as looking at the balance between the level of compromise that you have to make in terms of risking the lives of our teams, for example, or undermining your humanitarian principles and the benefit the action has for the patients. And this is this balancing act that makes us decide whether or not we want to accept the compromise.

Regarding Afghanistan, Mali, and Somalia, clearly there are in these contexts some possible, or even obvious, red lines but they are very different. In the case of Afghanistan for example, for us, in 2004 when five of our colleagues were assassinated in Badghis province and the fact that we felt there was a total culture of impunity. And the Afghan government even refusing to conduct any investigation was a red line for us, in the sense that we felt we could not guarantee a satisfactory level of security for our teams. So in this specific context the red line was there. Now we have resumed activities in Afghanistan and the red line would certainly be if at some point we felt we were targeted, or we felt the acceptance from the communities was not at a satisfactory level.

Talking about Mali, I would say it’s a little bit different at this stage. Mali used to be a very stable country. We are conducting some malaria activity there, working with the Ministry of Health in developing very innovative protocols. It’s clear that the situation is changing, the geopolitical situation is changing very much. We are looking and trying to analyze what is going on and we don’t know where the red line will be. But we are not operating life-saving activity in Mali and therefore I would say that there might be little inclination to accept a high level of compromise in terms of risk there.

Now talking about Somalia, it’s certainly the most complex context where we work. Where the compromise is both about risk, security, and also about the principles of independence and impartiality and neutrality. In Somalia, I must say that this is the country where we have put the bar higher in terms of accepting compromises. It’s the only country where MSF works where we accept an armed escort. It’s also one of very few places where we conduct remote programs. That is, our staff is national staff, Somali staff who know the area very well and we can hardly send international staff. This being said, there are compromises we don’t make in Somalia. For example, we don’t subcontract our activity. We continue to provide direct medical care to the population. This is something I don’t think the organization is ready to go beyond. Another compromise we are not ready to make in Somalia, and particularly in Al-Shabaab-controlled areas is to pay unreasonable level of taxes. In the month of June for example, we suspended some of our activities because we were asked to pay unacceptable taxes on top of all the aid and all the economy we were actually triggering by our presence.

JL: It is very interesting to hear about those different situations, different contexts that call for different responses on the part of humanitarian organizations and it’s quite clear from what you said that there are some inherent limitations in terms of what some unarmed humanitarian actors can achieve to access populations affected by conflict. Somalia is a case in point, but it’s also quite well illustrated by the situation in Syria for example. What is MSF’s position with regards to calls for imposing humanitarian corridors, notably in Syria? And about the broader debate on military interventions to protect civilians when humanitarian actors cannot achieve much. And notably what is encapsulated in the Responsibility to Protect concept.

SD: The position MSF has today regarding the distinction between military intervention and humanitarian action is different from that of the organization a decade ago. If you remember in 1994, during the Rwanda genocide, we actually called for military intervention. But this is precisely because we did it, we have learned from this experience that today we are quite convinced that there is an intrinsic contradiction between military intervention and humanitarian action. Because it’s almost an oxymoron because humanitarian action is about alleviating suffering and a military intervention always involves at some stage the possibility of violence or even if it’s not violence, some collateral damage. So we believe that although we have no position on the intervention itself, we are not advocating against military intervention, but we think that is not the role of humanitarian actors to call or to engage in military intervention because it does otherwise jeopardize their own mandate and neutralize their initial purpose.

Looking at humanitarian corridors, and more specifically Syria, I think it pertains to the same logic that we think that taking a stance asking for humanitarian corridors would de facto put us on one side of the conflict and it would undermine perception that we are neutral. Therefore we don’t think this is the right solution for the current situation. We are more in favor of what ICRC actually advocated for. That is, propose a pause in the conflict in order to allow humanitarian actors to do their work. What you need in Syria, because what we have experienced so far, although we have very limited access inside Syria, we have been able to support patients who manage to get out of the country. And we have been able to support some networks of medical staff who are operating underground in a clandestine way inside Syria. What we witness is that the health facilities are hugely instrumentalized by the security forces. Therefore what we feel we need now is not a militarization of aid through a humanitarian corridor, it’s a demilitarization of health facilities. That would be more helpful.

JL: I would like now to move to one of the fundamental principles of MSF. You mentioned neutrality of MSF, notably in terms of action. Now, independence is another very important principle for you. It is actually inscribed in your DNA: 90% of your funding comes from private contributions, which gives the organization a unique autonomy of action. The same attachment to independence explains the fact that MSF is one of the few humanitarian NGOs that refused joining the UN-led coordination mechanisms. Could you explain the rationale behind this decision to stay outside of this UN-led coordination mechanism?

SD: Thanks Jérémie for giving me the opportunity to deconstruct a myth. That is that MSF would act in isolation from others and would not participate in coordination mechanisms. That really is not true. Our teams on the ground spend a huge amount of time and effort in collaborating, dialog, and trying to coordinate with other actors. However we believe that coordination should not be an end. It should be a means and too often, especially what we have learned over the years in emergency situations, the coordination mechanism itself is an obstacle to intervene. It slows down the process; it becomes the priority before responding to the needs. So when the cluster is dysfunctional we actually take the liberty and we want to keep this freedom and independence to be able to work outside of this cluster, in order to respond in a faster way and in what we think is a more relevant manner. This being said, we are sitting in most clusters, UN clusters, as observers. We just don’t want to be tied by a certain mapping or assessment that might not be relevant, might not correspond at some point to the reality. I can give you a very concrete example. In October 2008, violence erupted again in the Kivus, in the DRC, and at that time there was a very very organized cluster system and mapping and distribution of roles in areas for each organization. Violence erupted causing a lot of population displacement. It’s been really a struggle for us to move out of the area we had been assigned and to be able to follow the population, but also to mobilize and motivate other organizations to actually go against or adapt their response to what the reality was becoming as opposed to just sticking to a plan that had been coordinated but that was no longer relevant to the situation.

JL: I will give you the occasion to maybe deconstruct another myth that surrounds MSF. MSF was founded 40 years ago in reaction to a strict policy of confidentiality of the International Committee of the Red Cross (ICRC). Or at least this is the way the creation of MSF is perceived. Contrary to the ICRC, MSF claimed a right to “speak out and to bear witness” of atrocities it would observe in the field. Yet as explained in the book we are discussing today, there are a growing number of contexts where MSF decides to remain silent. Could you tell us more about this ambiguous relationship of MSF with public advocacy and temoignage?

SD: Yes, it’s a difficult issue and it’s very controversial internally. It creates a lot of debate and frustration in the organization. Actually, I was surprised myself to realize that MSF was not founded out of this outrage and with a willingness to speak out because I read in one of the chapters in the book that actually in our first charter, in our first year, that followed MSF’s creation, there was a provision of confidentiality. So our doctors were not supposed to speak out about what they saw and bear witness. But you are right; this has changed, especially in the 1980s and 1990s, MSF has largely taken its role as an advocate and as a witness of the crisis where we work.

There has always been a tension between operating in the field and preserving access, being granted access to some populations in need, and speaking out. This tension is increasing more as we operate less in failed states and more in areas that are controlled by very structured and organized governments. So we are facing this pressure even more today. The reason why we are facing this pressure more also is that in the past we would have a team of three colleagues with a few boxes of drugs, spending six months in Afghanistan in the mountains, treating maybe a total of 300 patients. Now 300 patients is what we treat a day. Now we have 200,000 people on HIV treatment. HIV is a life-long treatment. So, we have more to lose than we had 20 years ago. That is for sure. It is because we have been successful in providing medical care, it’s because we have expanded the scale of our operations, and therefore it plays out when deciding to speak out and to risk being expelled from the country. This being said, I think that there is still a very very strong willingness in the organization and there was a debate at our Board of Directors meeting one month ago where we actually wanted to reaffirm. We had the feeling we had been a bit too far in compromising on speaking out. Although medical operations should prevail, we feel that sometimes the necessity, especially if we are the only witness, and if we witness a high level of violence, we feel there is an individual and institutional responsibility to react. So you will see this balancing act and you will never see MSF taking the same position in every situation. I think we will continue to struggle with this tension.

JL: Sophie, thank you very much for being with us today on the Global Observatory and good luck to MSF all around the world.

SD: Thank you Jérémie.