Medecins Sans Frontieres - France

What they say about themselves: 'Medecins Sans Frontieres offer assistance to populations in distress, to victims of natural and man made distress, to victims of armed conflict, without discrimination irrespective of race, religion, creed or political affiliation'
What other say about them: 'Because it is not affiliated to any government or UN organisation, MSF has been able to operate in politically precarious situations, and has alerted the world to numerous epidemics and famines that had been kept secret by the respective governments' Laurie Garret (Pulitzer Prize winning journalist)
CVs to: Jean-Marc Chardon, Overseas personnel officer, MSF-France, 8 rue Saint Sabin, Paris 11, France.

Interview with Dr Brigitte Vasset, MSF France

by Killian Forde

If humanitarian organisations were, like armies, to be awarded medals for their work in war zones, two organisations would have trouble trying to stand up under the weight of their accolades; ICRC and MSF. ICRC would be like the experienced General, wise, cautious, self contained, quiet, a bit of a loner, commands respect and attracts envy, whilst MSF-France would be the young special forces Lieutenant, confident, brilliant, brash, experienced beyond its years with an aggressive nature that gets results.

Medecins Sans Frontieres was formed in Paris in late 1971 by two independent groups of doctors - one group back from working for the Red cross in Biafra and the other from caring for flood victims in Bangladesh. Both of these groups had become disillusioned with the limitations of international aid; firstly the shortcomings of adopting a 'neutral' stance which sometimes merely reinforced the status quo of a country and secondly the absolute right of sovereignty. These doctors believed they could play a new dual role in emergencies; provide aid to peoples regardless of borders and have a presence in countries to witness and denounce moral and ethical abuses.

Unlike some other agencies who often hesitate when faced with complex international legal requirements regarding humanitarian intervention, MSF-France has proven itself quick to enter into emergency situations on the basis of public opinion formed by media accounts of massacres, aggression and starvation. Since its formation MSF-France has sometimes stood on its own. It has worked clandestinely in Afghanistan, Iran and Honduras. It was expelled from Ethiopia in 1985 for denouncing the diversion of humanitarian aid and the policy of forced migration by the Mengistu regime. In 1993 they denounced the methods of UNOSOM in Somalia and more recently they were the only international humanitarian agency in Srebrenica when it was overrun by Bosnian Serb troops.

The headquarters of MSF-France are located in Paris. A city famous for its classical architecture. MSF-France's offices are in rue Saint-Sabin and whilst its building has not evoked the same level of debate that M. Eiffel's tower of the last century did, it certainly has its critics. The building, like the organisation it holds is unique. Its all concrete walls, portholes for windows and, at its zenith, a tangle of communication antenna linking it to its international family. Like MSF it stands alone, a maverick within its own field, with a unique strong presence that cannot be ignored.

Inside, Field Exchange is directed to the office of Dr Brigitte Vasset MSF-France's Director of Overseas Operations. An eloquent woman Dr Vasset has a modest and easy manner. A committed humanitarian, she started work with MSF-France in 1979, and has worked full-time with the organisation since 1983.

Dr Vasset believes that in recent interventions the perception of humanitarian organisations has been changing. "We are not perceived as before. In Goma where you had 500 white four wheel drive vehicles, the beneficiaries saw us as aliens, with our walkie talkies, our cars. We are not and can not be part of their world". She contrasts this with Afghanistan in the 1980s where an MSF-France team would go into the country for six months assimilate with the population and "nobody knows you were there," now, she explains "this type of situation no longer exists for example the Taliban know exactly what a humanitarian organisation is and what they can get from you". She recognises that humanitarian organisations are increasingly aware of how they work with local populations and how their role is perceived.

Within the humanitarian community over the years there have been differences in agency approaches towards advocacy. Some agencies believe that speaking out against what they believe to be injustices can harm the beneficiaries that humanitarian organisations are there to assist i.e., the most vulnerable in society. In the new world order since the collapse of the USSR and the subsequent civil wars and genocides in Africa and Europe MSF-France have taken an increasingly pragmatic approach in the name of advocacy. Dr Vasset gives an example of how MSF-France was able to achieve a balance in their role to assist the poor and vulnerable in a country and also to ensure that MSF-France do not help to advance the ambitions of morally and ethically suspect authorities. In Burundi MSF-France has dealt with the dilemma of whether or not to work in the Hutu regroupment camps, by refusing to build any sort of infrastructure in those camps. Through discussions with local authorities it was agreed to allow MSF-France dispensaries to be placed outside the camps and that the beneficiaries are allowed come to them. Dr Vasset adds that in the case of an emergency, in one case a measles epidemic MSF-France decided to go inside the camp to immunise the children".

MSF, although originally a French organisation, has expanded rapidly and is now the worlds largest medical NGO. Apart from France there are now five other independent 'MSF sections'; Belgium, Holland, Spain, Luxembourg, and Switzerland. All of these 'sections' have the mandate and authority to send MSF teams overseas. Additionally there are a further 13 sections, in effect sub-sections, whose role is in fundraising, education and recruitment of health professionals for overseas assignments with any of the Independent sections. These 'sub-sections' are based in UK, USA, Australia, Greece, Hong Kong, and Japan amongst others. Dr Vasset frankly admits that in Goma there were too many MSFs. It was in response to this experience that MSF created an international Emergency Team (ET) . Consisting of medical and technical experts from a variety of nationalities, the ET is designed to co-ordinate tasks at field level. It is currently working in Sierra Leone and Brazzaville. Dr Vasset admits that co-ordination can be problematic amongst the MSF sections but says that there is a move and a willingness to unite all nineteen sections without duplication and so save money.

Like many organisations who rely on volunteers, Dr Vasset admits that recruitment of suitable candidates is getting harder, especially medical doctors, adding that "I would like to see MSF salaries become more competitive but there is a delicate balance between attractive salaries and the need to keep the ethos of voluntary status". Dr Vasset knows that MSF France cannot hope to compete with the salaries within the UN system but hopes that experienced co-ordinators stay on for another few years so they can train new volunteers to be the co-ordinators of the future. MSF-France have a policy that between 20-30% of personnel overseas have no previous overseas experience with any humanitarian organisations.

For MSF-France their modus operandi relies on their ability to be financially independent, and therefore independent from pressure of those with a vested interest. MSF-France in 1995 collected over 43% of its total budget from the public, an incredible statistic considering the huge sums involved. Indeed MSF-France have a strict set of rules in order to ensure that their independence cannot be compromised. The objective is that at least 40% of the budget is from the public and no more than 60% is institutional funding of which not more than one quarter comes from any one funder. MSF-France currently receives only 2% of its funding from the French government and their policy in any year is to limit this to a maximum of 5%. This independence is vital to MSFs identity, an identity which Dr Vasset admits is not always clear to others, "Our problem is that, as we are from France and French speaking we get confused with the French Governments Humanitarian Emergency Aid Teams, but our policies are polar opposites".

Dr Brigitte Vasset wants refugee protection to become a priority; she believes that world-wide refugees are consistently let down. Although philosophical about the future she believes that "Humanitarianism is at the top of a lot of political agendas and in the minds of the media as never before".