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MSF: We Must Address Humanitarian Failings

After Médecins Sans Frontières’ withdrawal from the World Humanitarian Summit, its U.S. executive director, Jason Cone, warns against conferences that blur the line between state and NGO responsibilities and calls for better humanitarian responses on the ground.

Written by Preethi Nallu Published on Read time Approx. 9 minutes
An employee of Doctors Without Borders (Médecins sans Frontières – MSF) walks inside the charred remains of the organization's hospital after it was hit by a U.S. airstrike in Kunduz, Afghanistan. AP/Najim Rahim, File

Last year, a sizeable influx of people flooded into Katanga province,tucked away in a remote part of the Democratic Republic of Congo (DRC). They were not fleeing conflict, but a more pedestrian kind of threat: measles. Although there have been vaccines for the disease since 1963, at least 40,000 people were affected by the outbreak and 500 people died.

International NGO Médecins Sans Frontières (MSF), or Doctors Without Borders, stepped in to help and to document the Katanga outbreak as a “telling example of the challenges for epidemic response” in conflict-riddled regions.

Given MSF’s decades-long focus on delivering effective aid during conflicts and emergencies as a building block for long-term stability, its decision earlier this month to drop out of the World Humanitarian Summit in Istanbul was less surprising than it may have seemed.

Relegating the landmark gathering as a “fig leaf of good intentions” that will do little to meet the immediate needs of the most vulnerable populations, the NGO criticized the international community’s failure to set a concrete agenda in Istanbul. In particular – at a time when its own facilities in conflict zones across the globe have been regularly targeted – MSF cried foul at the vague wording of the summit’s key documents.

“The core questions around humanitarian failings that we’ve seen and documented quite extensively, be it Sudanese refugees flowing into South Sudan or the slow response in Central African Republic, are not at the heart of the agenda,” said Jason Cone, executive director of MSF USA, during a conversation with News Deeply.

“Very noble ideas of ‘doing aid differently’ and ‘ending need’ are good sound bites but they don’t really address the fact that the aid system is struggling to meet the most basic needs of people, let alone end the idea of need entirely,” he said.

Given the nature of MSF’s work as an emergency aid organization, access – including the ability to cross political lines in conflict zones – is at the forefront of the organization’s agenda. In the absence of an explicit acknowledgement of these issues in Istanbul, MSF will continue its engagement with the international humanitarian community outside of the summit grounds and external to the gathering’s remit.

Last year, MSF became a prime quarry in Syria, hit by the warring groups’ squeezing of humanitarian access. At least 63 MSF-supported health facilities were targeted during the year, with 81 medical staff members killed and 12 centers completely destroyed. In February of this year, government airstrikes leveled the al-Quds hospital, an MSF-supported facility in an opposition-held neighborhood of Aleppo, killing upward of 50 civilians.

The broadly worded core principles of the summit, MSF says, will do little to protect doctors and patients in places like Syria, Yemen and Afghanistan.

In this interview with News Deeply, Cone gets to the heart of the challenges in providing effective humanitarian assistance to displaced communities, especially in Syria, and the problems that arise when organizations try to combine humanitarian assistance and broader development into “resilience strategies.”

News Deeply: MSF has been involved with organizing the summit for the past 18 months. That is quite an investment of time and resources. What were the pros and cons that you considered in pulling out?

Jason Cone: The pros and cons are whether our participation is in any way going to influence the outcomes. After two years of engagement in this process, participating in particular meetings, engaging with the U.N. leadership as well as our peers in the NGO community and donor governments and foreign aid agencies, we didn’t necessarily see that the most critical issues were at the heart of the agenda – mainly the real dearth of both qualitative and quantitative assistance for people in places like Syria, Yemen, South Sudan and Afghanistan. We see also that there have been shortcomings in terms of responding to epidemics – not just Ebola, but also measles epidemics and even the yellow fever outbreak that started in Angola and other cases imported into countries in Africa.

News Deeply: Could you comment on the deliberate targeting of doctors who are just doing their jobs, especially in Syria? Is this being explicitly addressed at the summit, given that world leaders will be present?

Jason Cone: Last week, we had the U.N. Security Council unanimously pass the resolution, along with 85 member states, strongly condemning these attacks, calling them for them to be investigated and holding those [perpetrators] accountable. This wasn’t a new law. It was a restatement of existing responsibilities that apply to states and nonstate actors.

So following through on this, we need to move from rhetoric to action. We can’t have the U.N. Security Council passing resolution after resolution that doesn’t actually change things on the ground. We’ve seen some of that happen with Syria, at least, particularly on the targeting aspect, with some impact on the cross-border assistance into the areas that have been besieged. But no one can begin to talk about whether assistance is being manipulated, when you have medical supplies pulled off aid convoys going into these areas. States need to do what they are required to do under the laws and resolutions that have been passed over the decades. This needs to be explicitly addressed.

News Deeply: Did you notice the process derail in the lead-up to the Istanbul summit or do you feel that it failed to evolve?

Jason Cone: MSF has seen that there are some dangers in putting the responsibilities of states and nongovernmental organizations on equal par. Speaking from personal experience over the years of watching various multilateral conferences, I think there’s always a struggle between the accessibility of civil society, if you will, and the role of states.

So this summit, I think, in the very practical sense of it, is an intergovernmental process where essentially half of the states that are members of the U.N. are in attendance. This created a somewhat weird setup that has confused both governments and NGOs trying to take part. Who gets to speak? Who gets which platforms? Do we delineate the responsibilities to states, as the secretary-general himself has said, in upholding basic norms?

We also still see very large gaps between the numbers of actors on the ground – for example in Yemen. I think trying to strike a balance between inclusiveness and the agencies that can get things done on the ground remains a critical question.

I also think there are questions about how local organizations can tap into international funding sources. This is more my opinion than established MSF policy per se, but I think aid agencies or NGOs that have come up in places like West Africa, sub-Saharan Africa and the Middle East should be able to tap into resources to carry out the work, if the work they’re doing is good.

News Deeply: Should this summit better address the issues that internally displaced people face, as internal displacement is the first step, before a person flees the country? Perhaps, if people were better aided while inside Syria, they would not flee in such large numbers?

Jason Cone: Absolutely. We viewed the right to enter Syria to provide assistance in opposition-held areas quite differently to the U.N., a body that reinforces sovereignty rather than deconstructing it. So we viewed that negotiating with the opposition groups and elements who were in control of areas with the gravest needs was humanitarian action in its core sense.

We obviously try to work with the acceptance of governments and not just the groups that have the control of certain geography. But when we’re denied that ability, we’ll try and find other means because we think the primacy of the individual needs of the patients is above the sovereign rights of the states that deny aid.

News Deeply: In what way does the summit agenda skirt a realistic discussion of the critical issues?

Jason Cone: We’re particularly concerned about the kind of convergence of humanitarian assistance and broader development into so-called “resilience strategies” for aid. We’ve been pretty consistent in viewing them as separate. Not that they aren’t both important in and of themselves, but for instance the need to negotiate with different groups to cross front lines and provide assistance in a conflict setting is very different to the kind of development strategies that lead to the building [reconstruction] of the state.

When you have a civil war situation, the state itself is being contested. So as an aid agency, when you become subject to the policies of the national government, it becomes problematic from an independence and impartiality standpoint that MSF and, I think, the International Committee of the Red Cross (ICRC), are seeing. This especially affects accessing populations across multiple front lines in conflicts today.

News Deeply: What are the immediate needs of the displaced that must be addressed?

Jason Cone: These needs are medical care, basic shelter, water, sanitation – and this is not just in areas that are very highly insecure. We see this in places like the Burundian refugee camps in Tanzania, where it’s an arguably stable environment and where aid should be able to reach rather quickly, but doesn’t. We see some problematic issues with policies around refugees. The E.U.–Turkey deal, for instance, is problematic in terms of how it puts asylum seekers, including Syrian refugees, back into a vulnerable situation.

News Deeply: You mention that even in stable situations the basics are not reaching those in need. Why is this happening? Where is the disconnect? Is it because the U.N. and state-led agencies are not grasping what is needed?

Jason Cone: There’s the question of aid effectiveness and what agencies are actually doing in terms of providing concrete assistance on the ground.

MSF is an organization that largely relies on private funding from the general public. We’re a bit removed from public institutional funding that we receive in small amounts. So some agencies will tell you that a lot of it has to do with the funding flows, how the funding is portioned and how aid appeals are financed. If you look at the U.N. appeals, many would say they are largely underfunded.

But I do think there is another key question: when the funding is there, how effective is the response on the ground? And that gets into the fundamentals of deployment of aid and the quality of staff. There’s also has been a sort of subcontracting that occurs between the so-called large international aid agencies and those who actually implement things on the ground. That sort of subsidiary funding also dilutes accountability.

You have agencies like the U.N. refugee agency (UNHCR) that deploy aid, receive aid and are also donors that award funds to different implementing partners. So you also have structural issues in terms of the multimandate roles that humanitarian agencies play.

News Deeply: How does the politicization of aid impact its effectiveness?

Jason Cone: Aid has always been politicized. Dealing with the political environment is the precondition to being able to reach populations. Negotiating with an opposition group or a government that sees “denial of assistance” as part of their war strategy requires us to engage in politics to a certain degree and to create the necessary tension between those groups in order to get access. But it is also a matter of the independence that aid agencies retain around those choices, for instance, the compromises we have to make to reach populations – for example, pushing back through operational and other strategies in a place like Syria, where you’re forced into a situation in the government-controlled areas or opposition-controlled areas.

News Deeply: How will MSF continue to engage with the international humanitarian system?

Jason Cone: We will continue to share our experience on the ground – where we see gaps in the aid response, where the system is failing patients and beneficiaries. We use an evidence-based approach to demonstrating these gaps. But we are also highly engaged with the U.N. system and our peers in the field. We engage in the U.S. with USAID, for example, and our colleagues in Europe, whether it’s DFID [the U.K. government’s Department for International Development] or ECHO [the European Commission’s Humanitarian Aid and Civil Protection Department] at multiple levels: the field level, capital cities and where MSF sections are present, in Geneva and New York. So this [absence at the summit] is not disengagement. It is an attempt to send a strong signal that we feel that this summit has the potential to miss the mark on the core issues on the ground.

News Deeply: You said you’re engaged with the U.N. system. What kind of reforms would you like to see within the U.N., so it can be a more effective partner to engage with?

Jason Cone: It’s not about the engagement. It’s about the substantive impact in the field. We’ve documented countless times very serious lags in response. In Bangui, in the Central African Republic, you had essentially an IDP camp at the airport, and then you had diplomats and others whisking in and out of that country, with incredible deficiency in the amount of assistance provided, even to those populations.

In Yemen, we see the Saudi-backed coalition in many ways has been given effectively carte blanche to bomb, not just hospitals, but also other parts of civilian infrastructure, be it schools, gas stations, things that people need to be able to live. There was – albeit it’s been lifted – a serious blockade of Yemen, both in the sea and air, for many months, depriving the entire population of basic needs that could not be met by humanitarian assistance alone.

We want to see substantive change on the ground. We want to see UNICEF doing better. We want to see UNHCR doing better. We want to see delivery on the ground, rather than just solely saying that there are shortcomings in funding.

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