Interview with Ulrike von Pilar

Body:

Independent consultant for the policy and practice of humanitarian action, previously Executive Director of MSF in Germany

Interview by Lena Zimmer

This year MSF celebrates its 40th anniversary. How has MSF come of age during these years?

First of all there is the growth of the organization, today around 30 000 people work for MSF worldwide. Nobody would have imagined that in the beginning. The original motivation was to create a new kind of humanitarian action; the founders thought there were primarily two things that were needed:

Firstly, they saw a need for a well-prepared, adapted medical organization intervening in large-scale emergencies in poor countries, which did not exist at that time. What existed, however, was a system of traditional colonial medicine, and a kind of development medicine, which originated between the wars. And then there was the Red Cross, of course, but it was not focusing on developing modern medical techniques and technologies that would be appropriate to address large-scale humanitarian suffering. What was needed, thus, was an adapted medical answer to large-scale humanitarian crises.

Secondly, there was the experience in Biafra in the late 1960s. They felt that the sense of neutrality was tricking. The French doctors, who worked under the ICRC flag at that time, were convinced that they had witnessed a large scale massacre of the Biafrian population, organized by the Nigerian government: an attempted genocide. They found it unacceptable to work in silence as the ICRC requested: they felt they had become accomplices to murder. The problem was that they just thought they had properly analyzed the political situation, but in fact they were mistaken. The then leader of Biafra, Colonel Ojukwu (who just died a few months ago) had to a large extent instrumentalised the famine that had erupted largely due to Nigerian sanctions; he was co- responsible for the suffering and used it to mobilize international aid and political support in the West. It was only many years later that people realized that the founding-myth of MSF was based on false premises. This early dilemma we have seen again and again in the last decades. Humanitarian aid has continuously been instrumentalised for political calculus; other examples were Cambodia and Ethiopia. Famine, we learned, is never a natural disaster; also the East African famine of 2011 is not just a drought, it is rooted in conflict, corruption and politics, it is in fact a symptom of conflict and crisis.

The question remains: How do humanitarians have to position themselves? Instrumentalisation of suffering and aid is not a new phenomenon - already Lenin used aid for political purposes. The great challenge is really: How can we avoid feeding the butchers while attempting to feed the victims? There is no easy way: recently MSF launched a book on humanitarian negotiations – it is about dirty compromises that sometimes have to be done in negotiating humanitarian space. It is really a sobering deconstruction of a certain myth of purity that is commonly associated with the notion of humanitarian space, and humanitarian access.

MFS has really been learning the painful way. During its first 20 years MSF was not really neutral, but has been taking sides more than it does today – for example in Ethiopia, and in regard to the Khmer Rouge and the Vietnamese in Cambodia - in defending human rights in face of totalitarian regimes. MSF worked in refugee camps populated with people who were fleeing communist regimes. Ironically, radical left-wing organizations accused MSF for siding with the CIA. It was true, however, that many of the founders of MSF had a background in the left students-movements and were frustrated with the leftist movement. Suddenly they saw themselves confronted with the refugees from communist-countries, and thought it therefore right to defend a liberal rights-based democratic agenda.. After 1989, however, they were increasingly confronted with their own governments that directly engaged in 3rd world conflicts while before they were engaged only indirectly, through proxy wars (with the exception of the soviet invasion in Afghanistan). The radical change started with Somalia and Iraq in the beginning of the 1990s, where our own governments became a party to the conflict, engaging with military power. Somalia was a particularly difficult situation, with Germany, Belgium, and the US involved. And then there was the experience of the military interventions on humanitarian grounds, so called ‘humanitarian wars’, which took place in Bosnia – but not in Rwanda, where it would have been necessary -, and in Kosovo. All this brought the western humanitarian organization in a very difficult situation.

The consequence was to become more neutral, and an adversary to the western governments, who had not invaded Rwanda, because of the experience in Somalia, and who did no intervention in Srebrenica - despite the peacekeeping mission on the ground, and who launched a disastrous humanitarian war in Kosovo.

MSF, which had been created to break the silence, was suddenly seen by many people in Muslim countries as being part of a western agenda – a trend that intensified ever since. After 9/11 it has become very difficult not to buy into the western security agenda. So it has become almost impossible for western humanitarian organizations to be seen as neutral in the local people’s eyes. The ICRC is maybe the one organization that has continuously upheld its principles. Both MSF and the ICRC have probably influenced each other. Today, MSF and the ICRC are very close to each other, particularly also in their political analysis – it is only their public positioning, which still often differs. Today, sometimes the ICRC is even more outspoken than MSF. The political contexts have radically changed: before there was the Cold War, today there is a complex military dynamic. It has become more and more difficult to carve out and protect a space for independent humanitarian action..

Another aspect in which great changes have taken place within MSF is the development in the field of medical approaches, methods and technology. As mentioned, MSF always pursued the objective to develop and apply high quality methods that are easy to handle and adapted to the necessities that often come with the work in field-contexts, like a lack of electricity, and difficult hygienic conditions.

Being a humanitarian worker is a heroic narrative, and an ideal of many young people. At the same time a life committed to fieldwork is very extreme, and demands great personal sacrifices. You just have described MSF, a humanitarian organization coming of age – what do you observe when you see individual humanitarians growing up? Is humanitarian field-work a career that can be pursued throughout an entire professional life, or is the humanitarian dream rather just an episode suited to the young-aged adventurer?

Life in the field has changed, in the beginning MSF staff were all young volunteers who would go out for a couple of months; only few of them stayed on to do this kind of work for longer. Today we see a mixture of volunteers - young and old – doing short missions, who quickly learn the techniques, go on mission 2-3 times, and then go back to a more peaceful life at home and pursue their career. MSF encourages this kind of volunteerism very much; every year we are aiming at having 30% first missions among the staff we are sending out. We do this to avoid routine, frustration, to keep the passion and excite new ideas. I believe that there is still a strong volunteer spirit in the organization. But still, people join us for 9 months or 1 year, not just for holidays, this is not possible, except sometimes for experienced surgeons that we fly in into emergencies for a couple of weeks. Normally, the volunteers have to commit for 9 month.

I believe MSF needs this volunteer spirit; it maintains our sense of protest against inacceptable suffering. This is important, because sometimes we tend to accept something unacceptable merely out of routine – for example the HIV/Aids challenge, which we acknowledged very late. For some time, we did not even treat our own staff although it was possible in our countries! We could have realized that we have to react on this at least two years earlier. With Sexual and Gender Based Violence (SGBV) and Tuberculosis (TB) it is the same story. In the 80s and 90s we mainly worked in refugee camps, nowadays we treat patience in the middle of conflict setting. Things within MSF change with the new people that come in – we need this constant change to adapt. MSF still pays very low salaries. The flipside of the coin is, however, that we lose experienced people to other organizations. But still, we constantly gain and also keep people who like MSF for its competence and courage as well as for our culture of debate and self-criticism.

One of our problems, however, is to find qualified leaders – Heads of Mission, for example. We need experienced and well qualified people in these positions, as the challenges have grown, tough security rules are necessary, and there are a great number of actors that we have to coordinate with. The job has become quite demanding. The projects have increased in size, often there are thousands of staff to be managed in one country-program. We are aware that we need excellent managers, but still, we would not hire professional managers who are not committed humanitarians in the first place. Now, we do not have enough qualified people, especially medical, for the higher level positions. Career was not a term that was used in the vocabulary of MSF initially, but it is becoming one now – although still in a different sense compared to many others. We need competence and professionalism, but also a strong humanitarian commitment to put our patients first.

=============================

The two attachments below are: