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16th January 2012

On the front line

Khalil Secker talks to Marc Dubois, head of MSF UK, an independent humanitarian medical aid organisation founded in 1971.

Médecins Sans Frontières (Doctors Without Borders) deliver emergency medical care to 2 million patients a year in 65 countries across the world affected by war, famine, earthquakes and epidemics and their brave volunteers face life-threatening dangers every day. This week I spoke to Marc Dubois, head of MSF, UK. Marc was in Manchester giving a lecture to medical students on poverty and humanitarian aid and I caught him for a chat just beforehand. We discussed the situation in Egypt, the barriers to humanitarian workers in a post-9/11 world and a near-death experience he had working in the field.

How did you come to work for MSF?

When I got out of university I joined the US Peace Corps. They sent me to work out in the bush in Burkina Faso in West Africa and I really got into that life. I then studied law with a focus on international human rights and humanitarian law. One of my friends from law school was working at MSF said, “Why don’t you apply here?” The next thing I knew I was managing a primary healthcare project in a displaced persons camps in Khartoum.

I did more field missions in Sudan and Angola. Then I got a headquarters job working in humanitarian affairs – the side of witnessing and advocacy. Largely based on the fact that I have a big mouth and a good critical eye I rose up the ranks. MSF is a place where we do like to engage in passionate discussion…or arguments!

Then here in the UK they were looking for somebody. For humanitarian action, London really is the place to be. It’s got the big organisations like Oxfam and Save the Children; it’s got the British Government, which is a very, very important actor in the whole policies around development. It’s got think tanks and universities and tropical medical centres and all this stuff. And they wanted somebody who could communicate right in the middle of all of that and I was lucky enough to get the job.

You say there are quite a few arguments and debates within MSF, would you say it’s a democratically run organisation?

It’s an interesting mix. There is a very democratic approach and a lot of discussion on how to deal with some of the realities we are facing at the moment. There are no simple solutions to how you improve your operations in Somalia right now for example, with the Al-Shabaab militia on the one hand and warlords on the other hand. It’s making it very, very difficult for MSF to get anywhere near patients at a time that’s absolutely critical given the levels of malnutrition. So we’re an organisation that encourages a lot around the discussion aspect. I remember being on my very first mission and having an argument with the general director. You don’t see that in a lot of organisations.

On the other hand, an organisation has to be able to move fast and take some very serious decisions. There is also an operational hierarchy that is militaristic in its approach, and it is able to say in a matter of minutes that we have to evacuate that team or we have to close that project. And you need both, because really, to be an emergency organisation you can’t be talking about everything all the time, so its both.

What is the scariest thing you’ve had to experience working for MSF?

The scariest thing? Aside from the bureaucratic weight of the annual planning process every year you mean? Well, the brutal Angolan civil war was going on when I was over there. The situation was absolutely critical. People were in rags, starving to death. It was just desperate. We were travelling along these roads that hadn’t been driven down in years. It’s spooky in that way. You’re driving through a town with streetlights and little shop fronts but it’s all covered in vines. No ones lived there in 25 years.

But the real thing is the landmines – there were more landmines than people in Angola at the time. The military who’d told us where to go had assured us that the road was safe, but further down the road it looked like one of those old safari movies where there’s just the two tracks of dirt with tall grass in the middle. So you know no ones driving down these roads. You really think there might be some live explosives and you’re thinking ‘Should we turn around?’ but then you think on the other side ‘We’re not going out here to address conjunctivitis, we’re talking about levels of malnutrition that are killing huge numbers of people.’ That was the scariest thing for me.

What experience whilst working with MSF has been the worst or most difficult to deal with?

The worst thing is just the people, but they’re also the best thing. There was one day we brought back a couple of kids in the car who didn’t make the journey… Then somebody says, “That was my fifth child, I’ve lost every other one.” It was a horrible situation and it’s not something humans are very well equipped to deal with…as you can see [his eyes tear up briefly]. It does weigh on you and it should weigh on you. If people were able to go to the places where we worked and not be disturbed – and I mean fundamentally disturbed – then I’m not sure if they belong in the organisation, because we have to be driven by human compassion. (PULL-OUT)

What has been your most rewarding experience working for MSF?

Again, it’s the people. What you see everywhere we go is just the incredible grace and generosity that people show their neighbours and friends in a refugee camp when they have nothing themselves. The woman whose sister dies of HIV/AIDS and she’s got four kids already, but she takes on another four. You see that and it’s uplifting to realise that of course MSF saves some lives. But actually, it’s the people in these countries who save their own lives and save their neighbours lives long before MSF gets there.

What is the evolving role of MSF in the 21st century? That is, modern challenges that didn’t exist ten or twenty years ago?

One of the main challenges is just the challenge of access, especially since 9/11. There’s been a huge polarisation between East and West and between Muslim and non-Muslim. Countries are standing up and saying, “We want to control our territory, because we don’t want the West interfering in it.” I mean, what is humanitarian action in a world where governments are talking about humanitarian wars? Where they’re justifying military intervention on the basis of humanitarianism? That word, that label ‘humanitarianism’ has taken on new meanings, a meaning that we aren’t necessarily in agreement with.

And what does that mean when we come across as a Western organisation, not a global organisation? It’s a real liability and we are struggling in Pakistan, Iraq, Afghanistan, Somalia, Sudan – these are all places where we should be much busier, and we aren’t. And the reason is often politics. The politics of the world that views us as a dangerous threat. Recently the Al-Shabaab militia has expelled all of the aid agencies inside Somalia in the area where the crisis is at its sharpest – except for MSF, the Red Cross and an Italian agency. It’s a huge challenge maintaining that level of independence that you’re able to gain access, but even there the access isn’t enough.

There’s also the challenge of urbanisation, how that changes disease profiles and how that changes the way we operate. Because all of a sudden you’re in an urban centre where there might be five million people who would all like access to high quality free medical care. What do you do to cut the flow? We aren’t the world’s medical provider. And it’s easier when you’re out there in a refugee camp with 80,000 people in the middle of a desert where you have a population you can deal with because it’s fixed.

What do you think about the emerging role of global health policy around the world today?

The very fact that global health is an issue, that people talk about ‘world health’, that governments see their level of health as something that is discussed in high levels. It’s really quite a shift. There are also new actors out there who are changing global health. For example, sure the World Health Organisation (the medical branch of the UN) is important, but the budget of the Bill and Melinda Gates Foundation is bigger.

What is the current humanitarian situation in Egypt?

One of the things about what people call ‘The Arab Spring’, whether it was Tunisia, Libya, Egypt or Bahrain is that the medical systems there are relatively good. The level of training of the doctors and the capacity of the hospitals to deal with the wounded are far more able to cope than what we find in Congo, Darfur and Somalia.

So Egypt is a political crisis that hasn’t produced the same scale of humanitarian crisis. There’s no such thing as a humanitarian crisis just coming out of nowhere, even a Haiti earthquake has a huge political dimension. The reason why a natural event like an earthquake becomes a disaster is the intersection of that earthquake with an incredibly impoverished population of people living in very precarious circumstances. The same level of earthquake here in London wouldn’t produce nearly as much death and destruction. Egypt is a case where the heavy part is the political crisis and the humanitarian situation is serious, but it’s as bad for instance as Somalia.

What do you think about the cancellation of the next round of grants by the Global Fund to fight AIDS, tuberculosis and malaria?

The questions we ask like, “Is there enough funding for the malnutrition situation in Somalia?” or “Can we provide malaria treatment to children?” are almost absurd questions in a world where in the blink of an eye, several trillion dollars is spent to bailout banks.

The Global Fund is very important and it’s had a huge impact on our own ability to deliver medical care to people. We don’t have infinite funding. We have about 120,000 people at the moment on HIV medication and if the price of that is twice as much then you halve the number of people who are getting it. These are the horrible choices we have to make. The global fund is absolutely vital in its ability to provide the necessary funding to governments and other healthcare providers to be able to deal with some of these diseases. It’s a fairly simple equation – if the Global Fund is cut then a lot of people will be without medical care.

Some final thoughts on what you think about health in the developing world more generally?

I think its too easy, especially for us NGO’s, to paint a picture of a poor impoverished world that can’t do anything and we simply need to go down there and give them money. If you actually look at these countries what you find is that by and large there’s a lot of wealth around. Governments need to make decisions that owns up to their responsibility as governments to provide things like healthcare and education for their people. There are often quite substantial resources that are often not put into healthcare, so there needs to be a real quantum shift in that. That’s not our responsibility – we should be out of business! It’s that simple.

Are there any educational opportunities in particular that you would encourage students pursuing a career in global health to get involved in?

You can’t understand global health I think until you understand foreign culture. Certain area studies are useful such as Africa studies, or just languages. I mean we are desperate for French speakers right now in the organisation. That’s the kind of stuff I’d encourage people to be getting involved with.

What do you think about global health education in universities at the moment, especially with regard to the growing number of global health degrees emerging around the country?

Fifteen years ago, there were maybe a hundred students around the world studying for a Masters degree in humanitarian action. Now there’s thousands. There are people writing reports about how 18th century Ottoman migrations can find a new parallel in the movement of the Zaghawa group from Chad into Sudan. We don’t really need that stuff. We need people out there with muck in their boots. At the same time though, humanitarian action is extremely complex. It’s about positioning a neutral, independent and impartial actor in a very dynamic and a very politicised, often violent environment. And that requires people to have a certain level of understanding.

Khalil Secker

Khalil Secker

Former reporter for The Mancunion, now Campaigns Manager.

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