50 years of Doctors Without Borders

Over the past five decades, Medecins Sans Frontieres (MSF), or Doctors Without Borders, has been providing medical care to millions of refugees, along with survivors of natural disasters, epidemics and genocide in crisis regions and conflict zones all over the world.

Hundreds of thousands of doctors, nurses and logistics experts, many local, have set up field hospitals, carried out operations, vaccinated countless numbers of people and provided medical supplies to those in dire need. In recognition of its humanitarian work worldwide, the group was awarded the Nobel Prize in 1999.

Breaking from neutrality

"It all started in the late 1960s," said Ulrike von Pilar, co-founder of the German branch of MSF.

At the time, the oil-rich province of Biafra wanted to secede from Nigeria. French doctors working for the International Red Cross witnessed thousands of severely malnourished people in the war-torn region, and suspected that a genocide was taking place. As Red Cross workers, they were sworn to neutrality — but they refused to comply. 

Medecins Sans Frontieres was born, founded by some of those volunteer doctors. "The most important principles were: to save human lives worldwide, whatever it takes, and to bear witness to crimes against human life," said von Pilar. 

Even though it was later determined that a genocide had not taken place in Biafra, denouncing injustice would quickly become an essential element of the new group's agenda.

Caught in the crossfire

The Ethiopian famine of 1984 was another major challenge for the group. Thanks to worldwide reporting and the highly publicized Live Aid concerts, large amounts of aid money flowed into the country.

But Ethiopia's dictator, Mengistu Haile Mariam, used famine relief funds to forcibly resettle hundreds of thousands of villagers into the inhospitable south of the country, where tens of thousands of these people later died.

"Because no one else took note of these crimes, MSF France denounced them in a dramatic press conference," said von Pilar. "Although it was clear that it would then have to leave the country, and its patients as well."

Time and time again, Doctors Without Borders has been confronted with a fundamental ethical dilemma: to either save lives with the consent of the rulers of those countries, or denounce crimes committed by those same rulers and risk having to abandon their patients.

In 1994, when the world seemed to be ignoring the genocide against Rwanda's Tutsi minority by the majority Hutus, MSF called for military intervention — to no avail.

Beyond political minefields, members of the organization have been literally caught in the crossfire on a number of occasions. On October 3, 2015, an MSF hospital in Kunduz, Afghanistan, was reduced to rubble in an airstrike that the United States later called a mistake.

 Staff members have also been the victims of attacks and abduction as well.

Aiding refugees also brings the group into conflicts with authorities. MSF workers in Greece, for example, are caring for refugees who have crossed the Mediterranean in boats that are barely seaworthy.

"We try to reach the refugees before the coast guard does," said Daniela Steuermann, a German nurse with MSF.

Crucial HIV campaign in South Africa

The group also aims to get much-needed medical supplies to the poorest of the world's poor. 

Mpumi Mantangana is a veteran MSF nurse in Khayelitsha, South Africa, a very poor district of Cape Town. She's also a veteran in the fight for HIV drugs for AIDS patients, and remembers how bad it was back in the late 1990s when terminally ill AIDS patients were heavily stigmatized by society.

"Unfortunately, our government denied that there was an HIV problem in South Africa. President Thabo Mbeki even said publicly that he had never seen an HIV-positive person," she said.

At the time, more than 4 million South Africans were already infected with HIV, and thousands were dying every day. When the first antiretroviral drugs hit the market, they were unaffordable for many — costing up to €10,000 ($11,300) per person per year.

"In May 2001, MSF started providing the drugs to carefully selected HIV patients," Mantangana recalled. "In the beginning, it was a very small program, because these drugs were still extremely expensive."

This changed, however, after the group bought cheap generic versions of the drug from the Brazilian government — and later smuggled these into South Africa. They had to be kept hidden from the authorities during police raids.

"When [Nelson] Mandela came to Khayelitsha in December 2002, we handed him one of our T-shirts saying 'HIV positive.' To our surprise, Mandela immediately put it on. And he revealed that he had lost his eldest son to AIDS," she said.

This gesture by Mandela, the former president and father of the nation, increased pressure on the government. Shortly thereafter, all South Africans were granted the right to free antiretroviral therapies.

MSF accused of paternalism, racism

Today, Doctors Without Borders has around 45,000 employees and is active in more than 70 countries. Its annual budget — around €1.6 billion ($1.8 billion) — comes largely from donations. In particularly vulnerable countries, like Haiti and South Sudan, MSF is even acting in the place of national health care providers.

But the organization has not been free from criticism.

Margaret Ngunang, a social worker from Cameroon who worked for MSF in Juba, South Sudan, in 2018 and now lives in New York, talked about what she sees as the arrogance of "white demigods in white" and the group's subtly racist attitude. 

"When we entered the MSF office in Juba, the deputy director of the program sat there at her desk and ignored us for minutes. Clearly, she did so because she thought we were South Sudanese," said Ngunang. She added that she repeatedly experienced microaggressions on the part of European and American staff.

In the United States, a thousand former employees published an open letter demanding an end to what they see as paternalism and racism within the organization.

And in 2018, investigators also found out that MSF employees in Africa were frequenting local prostitutes. Although the incidents were rigorously investigated and those involved were fired, the damage to the organization's reputation remains.

These days, according to MSF insiders, the group is involved in intense discussion on how to eliminate structural racism when it comes to emergency aid cooperation.

Efforts are being made to reduce inequality between local and international staff and to employ more non-white staff internationally. Strategic decisions are also to be shifted more from Europe to the Global South.

Fifty years after the group's founding, there is still much more to do — both internally, and globally.

This story was originally written in German