Doctors Without Borders (MSF) has been providing medical care to victims of earthquakes, famines, epidemics, conflicts and other disasters for 50 years. It was born from the ideals of a group of newly qualified French doctors who wanted to be on the scene to help the most needy around the world.
Today, the organization has about 100 operations in nearly 75 countries, from helping displaced persons from the civil war in Yemen to fighting the Ebola virus in Africa and rescuing migrants in the Mediterranean.
But the evolution of the dream of a few dedicated people with little or no resources to worldwide recognition for his humanitarian work – winning a Nobel Peace Prize – has not been without controversy or bitterness.
“From a dream, we created an epic story,” Xavier Emmanuelli, 83, co-founder of Doctors Without Borders, proudly told AFP.
“We wanted to go where people are suffering. Today that may seem trite, then it was revolutionary,” said another founder, Bernard Kouchner.
However, the dream started out of a nightmare.
In 1968, the Biafra War raged between secessionists in southeastern Nigeria and government forces.
Civilians were killed by bombs and famine, as a result of a blockade by the authorities.
In Paris, where students and unions rioted in May of that year, several doctors just from the university responded to a call from the International Committee of the Red Cross (ICRC).
Arriving in Nigeria they would witness the horror and chaos themselves.
“We were not prepared,” Kouchner, one of them and now 81 years old, told AFP.
“The children died en masse because the army blocked all supplies. It was clear to us young doctors that it was our duty as medics to speak out against this situation.”
Contrary to the ICRC’s policy of silence, the doctors decided to denounce the reality of the conflict in Biafra through the media.
Giving care – but also witnessing – gave birth to the modern concept of humanitarian aid.
Doctors Without Borders was founded in December 1971, the name was chosen over an evening of smoking and drinking, Emmanuelli recalls.
The early days were difficult. In effect, without funding, the nascent organization served as a source of doctors for hire by other NGOs.
Although a publicity campaign in 1977 made the name of the NGO more widely known in France, the first missions often ended in harrowing trials.
When Claude Malhuret, a young doctor, enthusiastically left for Thailand in 1975 to help victims who had fled the Khmer Rouge in Cambodia, he quickly became disillusioned.
“It was terrible. We had nothing, you had to make ends meet,” the 71-year-old center-right member of the French upper house of parliament told AFP in an interview at his office.
That applied to finding equipment, setting up camp and even having medicine and food, he said.
The experience shocked everyone, he added, and made it clear that they couldn’t just continue tinkering.
Disagreement Leads to Breakage
For some time now, those who run Doctors Without Borders have bitterly disagreed about the future path.
On the one hand, those who wanted to keep it a small group of friends working in “command” mode; on the other, newer members were out to expand.
The situation came to a head in Vietnam in 1979 when Kouchner, the then president of Doctors Without Borders, mobilized Parisian intellectuals, including the philosopher Jean-Paul Sartre, to charter a boat to pick up refugees fleeing the communist regime. .
That style of activism irritated rivals within the organization who voted against the move, leading some members, including Kouchner, to leave the NGO.
He then founded the campaigning medical organization, Medecins du Monde (Doctors of the World).
But the wounds of that episode still sting four decades later.
“A sad power struggle,” Kouchner, who was France’s foreign minister from 2007 to 2010, said of the incident.
“I was very angry with them.”
But for Emmanuelli, an ex-secretary of state for humanitarian action, Kouchner’s media courtship was not the way forward.
“MSF Kouchner style had become waffle,” he said.
A new chapter began, in which the organization started to become more professional and international branches were set up.
“We needed money to grow. I went to the United States to learn ‘fundraising,'” Malhuret said.
Speak, or not?
With an independence provided by private funding, MSF is not afraid to speak out.
Lawyer Philippe Ryfman, who specializes in the humanitarian field, said MSF had not adhered to the principle of neutrality and respect for state sovereignty, which is upheld by the ICRC.
“They (MSF) do not hesitate to speak out to mobilize public opinion,” he said.
Citing concerns about human rights, Médecins Sans Frontières denounced the abuses perpetrated by communist regimes in Cambodia.
It secretly sent teams to help the Afghans after the Soviet occupation of the country in 1979, where the reputation of the “French doctors” grew internationally.
“We were the only ones who saw the effects of the war,” said Juliette Fournot, who organized MSF missions to Afghanistan until 1989.
Every day the medics had to perform amputations on children and treat farmers for napalm burns.
“Testimonial was very important, Afghans still remember us,” she said.
But in 1985, speaking up in Ethiopia had direct consequences for the work of Doctors Without Borders.
The NGO’s food distribution centers had “become a trap,” Dr Brigitte Vasset said.
“Local authorities abused the camps to register refugees and then force them to move south and depopulate the rebel areas,” she said.
Should the organization speak up or remain silent?
Rony Brauman, one of the doctors, decided to publicly criticize the Ethiopian government: Doctors Without Borders was expelled from the country.
“The aid had become a tool in the hands of a criminal regime for whom we did not want to be an accomplice,” he said.
‘Right of interference’
Doctors Without Borders has spoken out publicly about crises, such as after Saddam Hussein’s regime crushed Iraqi Kurds after the Gulf War.
In 1991, the UN Security Council approved a military operation to help and protect the displaced.
While some at the time welcomed the beginnings of “a right to humanitarian interference,” MSF was concerned about the blurring of the lines between military and aid delivery.
A year later, the controversy continued in Somalia, heading for civil war and famine.
Under UN mandate, US troops and UN peacekeepers were deployed to Mogadishu to ensure the security of food distribution.
In Bosnia in 1992 and two years later in Rwanda, Médecins Sans Frontières called for military interventions to stop the Serb extortions and the Tutsi genocide.
Médecins Sans Frontières doctor Jean-Herve Bradol was quickly struck by the scale of the murders upon his arrival in Kigali in April 1994.
“It all happened very quickly, we saw people disappear and tried to put into words what happened,” he recalls.
“We ended up buying advertising space in (the newspaper) Le Monde to say that we will not stop a genocide involving doctors and that an international military intervention is necessary.
“We had never done that before.”
In 1999, MSF won the Nobel Peace Prize, which allowed it to fund a campaign to broaden access to medicines to treat tropical diseases or AIDS.
Today, within its international structure, it has 25 national branches employing 61,000 people, two-thirds of them locally.
The annual budget is nearly 1.6 billion euros ($1.9 billion), 99 percent of which comes from private donations.
“MSF has become the undisputed number one for medical emergencies in the world,” says Ryfman.
Its decisions don’t always go down well, however, such as when it quickly dropped its appeal to survivors of the 2004 Indian Ocean tsunami because it said the emergency was over.
Its expansion also raises questions, even within its own ranks.
“We have become a big bureaucratic machine with support departments putting pressure on the people in the field to have reports and Excel tables,” said the head of the French section, Mego Terzian, 51.
But while acknowledging that MSF France is no longer in full control of its own decisions, Brigitte Vasset added that “it is a necessary evil because it has given us enormous resources”.
Financial independence is crucial, says writer and physician Jean-Christophe Rufin, pointing out that times and priorities have changed.
Terrorism, migrants, poverty and other emergencies at home are now the most pressing humanitarian challenges, he said.
So what is the future role of MSF, which will hold its general meeting from June 10-13, in a year that also sees it celebrating its 50th birthday?
The milestone comes as practices change, the need for aid continues to grow, while access to those in need is often hindered, and protecting vital personnel amid jihadist attacks.
“More and more countries are able to organize aid on a large scale in the event of a natural disaster,” says Terzian.
“Will MSF continue to be useful? Maybe we’ll evolve into a foundation that supports local organizations.”
In the field, however, the sense of calling is as strong as ever.
Fanny Taudiere, 29, left training straight away and left for famine-ravaged southern Madagascar in March.
“I feel useful here,” said the young doctor from Camp Amboasary.
“It gives meaning, an intensity to life. It’s exciting, there are incredible encounters, every day an adventure, even if some days nothing is easy.”
Becoming a member of Doctors Without Borders was a logical choice for her.
“They go where others don’t, they stay when everyone else leaves. And then they are free to act and speak.”