How long has MSF been in the US?
MSF-USA was established in 1990 by the French section.They wanted to have a presence in the US in order to expand their international fundraising, recruitment, and advocacy (chose New York because of its proximity to the UN and media). The US office has since expanded their role in field operations and is now managing programs in Sudan, South Sudan, Chad, and Ethiopia.
Is MSF based in France?
MSF was started by French doctors and its first office was in Paris, but there are now 19 national offices and nine branch offices around the world.
Is there a centralized governing body?
● MSF has an International General Assembly (IGA), which is comprised of two representatives from each MSF partner section as well as two representatives per MSF Association.
● The IGA elects 12 representatives to sit on the International Board (IB). The IB is also comprised of the International President, the Vice President, the International Treasurer, and the Operational Directors. The IB has authority over issues such as resolving conflicts within MSF, opening and closing new entities, and holding sections accountable for implementing a shared vision.
● MSF also has several international committees that see to coordination among sections and sharing of information with regard to policy, management, communications, recruitment, and funding.
What are your biggest challenges?
- Securing predictable and sustainable funding during an uncertain economic climate.
- Maintaining and improving the quality of our programs, especially those that also rely on international funding from large global institutions for such things as drugs, vaccines, and emergency food aid.
- Having the necessary reserves to allow us to respond to new emergencies as they occur.
- Securing experienced and committed field staff and retaining them, especially those who can work as coordinators.
- Finding qualified medical staff that can work on a range of medical issues including emergency surgery and rehabilitation, maternal and pediatric care, tropical diseases, chronic care, and mental health.
- Security—We work in areas of conflict where many actors are often involved. We need to constantly reinforce our neutrality to all parties in order to keep our teams safe. In the past 10 years, there has been a blurring of humanitarian aid and military interventions, where humanitarian aid workers have been directly targeted making it more difficult for us to work in certain high risk areas.
- Balancing speaking out with gaining access to populations; gaining access to people cut off from assistance in armed conflicts due to insecurity, government bureaucracies, and other blockages is not always easy to negotiate.
- Access to appropriate medications, vaccines, and therapeutic foods to treat malnutrition. Policies, pricing, and politics can pose barriers for procuring vital medical supplies. Outdated diagnostics and treatments make medical assistance in resource challenged settings difficult and expensive. Improved research and development for neglected diseases would not only help us save more lives, but would allow us to treat patients with a better and more efficient use of our resources.
Where are your headquarters?
● MSF has no real "headquarters." Although the organization was established in France, it has grown into an international association with 19 independent sections worldwide.
● Five of those 19 sections are the Operational Centers or "OCs," the offices that directly manage all of our field programs or "operations." The OCs are in Paris, Geneva, Brussels, Amsterdam, and Barcelona. The remaining sections partner with the OCs and support their program operations, communications, recruitment, and fundraising. For example, the US, Japan, and Australia offices are in direct partnership with the OC in Paris.
Do you just do emergencies?
● MSF’s specificity is medical humanitarian aid to people in the acute phase of a crisis.
● MSF considers certain diseases medical emergencies—HIV/AIDS, TB, as well as malnutrition.
Do you partner with other organizations in the field?
● MSF occasionally partners with other organizations when there is a component or activity that another organization can fulfill that will benefit the program and its recipients.
● Even when MSF works independently, we still coordinate our activities and information with other agencies in a region to avoid duplication, and we share security information as well.
● Whenever possible, MSF often works closely with a country’s Ministry of Health (MoH) as negotiations and written agreements are necessary to open hospitals and health centers, as well as to gain access to many areas. MSF also works within MoH structures and alongside MoH staff.
● In order to gain acceptance from a community and reinforce our impartiality and neutrality, MSF also works closely with the various parties of a conflict, such as government officials, rebel leaders, and community elders, making clear our medical objectives and our impartiality and independence from any other agenda.
● MSF will also work with other NGOs in order to hand over a project; for example, a community may no longer be experiencing a medical emergency, but they still need access to clean water for extended use. We may hand that project over to another organization that specializes in development (like Oxfam).
Do you train local staff?
● Yes. Training for local and international staff is key to all of our programs.
● Some 90 percent of all MSF staff is from the host country, in fact.
● Most teams comprise a combination of local and international staff at a 15:1 ration.
● Many staff members who have been trained locally often end up becoming part of our international
staff and will be sent on additional assignments in other countries.
Have you had any fatalities in the course of your work?
● Yes, though it’s very rare considering we have some 30,000 people in the field on any given day. The majority are in accidents or due to illness.
● MSF works hard to minimize risk of deliberate targeting by talking to all sides in a conflict, asserting and reasserting our independence and our impartiality, along with our medical ethics.
● Among the most severe incidents were the killing of three aid workers in Somalia in January 2008, and two others in December 2011, and the killing of five field workers in Afghanistan in 2004, which forced us to end operations there for five years. In October 2011, two aid workers were abducted from a refugee camp in Dadaab, Kenya, and held for more than a year and a half inside Somalia, until their release was finally secured in July 2013.
How do you decide to open a project?
● Because of MSF's presence in some 70 countries, our field teams often come across emergencies in vulnerable areas that are close to where we already are. For example, sudden movement and displacement of communities may imply a recent attack or violent conflict (as with Darfur by the sudden flood of refugees into Chad, or the similarly sudden influx of Sudanese refugees into South Sudan in 2012). A sudden rise of children being treated for an infectious disease or malnutrition may suggest that an epidemic or nutritional emergency is impending.
● MSF assesses each situation to determine: Is there an emergency need? Are there other actors (host government or other NGOs) who can meet the need? Is MSF able to respond?
● Emergency needs are assessed in terms of morbidity and mortality rates and access to medical care.
● We do not prioritize one emergency over the other. Every emergency is taken into consideration by the same criteria.
How does MSF decide to close a project?
● When it decides the emergency phase is over.
● When it can successfully hand over responsibilities to the host government or another organization. This can be a difficult decision; the end of the emergency is not always clear, as is/was the case with the AIDS pandemic, other epidemics, and certain ongoing conflicts.
● When it is forced to for security reasons, as was the case in Afghanistan in 2004, where MSF staff members were killed and no credible investigation was made into the incident by the authorities, or in Somalia in 2013, when the circumstances on the ground made it too difficult to operate with any sense of security.
● When it is forced to by government decisions, as happened in the past decade in Darfur and in Niger.
Were you in Haiti during the earthquake? How did you respond?
● Yes, MSF had been working in Haiti since 1991. At the start of 2010, MSF was operating four health structures in Port-au-Prince, providing, among other things, primary and secondary care, trauma and emergency treatment, and surgical and obstetric services. After the earthquake, as MSF rushed to respond to overwhelming medical needs, the number of projects rose to 26 and included hospitals, postoperative care facilities, rehabilitation centers, and general medical centers.
● In 2010, with 3,000 medical personnel on the ground, MSF treated over 360,000 patients, distributed nearly 50,000 tents, and delivered a half million cubic meters of water per day. Of the $138 million raised, $100 million was spent by the end of the year.
● Today MSF now manages five health structures in Haiti addressing medical needs such as maternal care and emergency obstetrics, pediatric care, general surgeries and care for burn victims, and treating cholera.
What are the limitations to MSF expanding programs?
● Management/staff capacity to run complex programs biggest limiting factor
What is the process of the project being opened?
● When a team recognizes a possible emergency, they will send an exploratory team to the area to assess the situation. They do this through observing the population, talking to members of the community, communicating with the Ministries of Health and other NGOs, and collecting medical and epidemiological data. Once it is confirmed as an emergency, the team will report back to their headquarters with their findings and data. The headquarters will then report back to their OC where staffing, financial, and logistical arrangements are immediately made to set up a program.
● This can all happen in a relatively short amount of time (as little as 24 hours). Because MSF does not rely on government or institutional funding, and does not have to answer to any political agenda, programs can be opened and closed without delays and at our discretion.
What is your general reception in the countries where you work?
MSF is often the only medical service provider; therefore, the reception is usually very positive. Staff also stay in continuous contact with local leaders and people of influence in a given area to make clear what MSF intends to do and why, and to address any issues that may arise that could affect the ability of a program to operate effectively.
What is your relationship to the UN and the US government?
MSF is an independent, non-government organization. We will frequently prepare reports, medical surveys, and personal testimonies to present to the UN and the US government as part of our advocacy strategy to “bear witness” and “speak out.” And we do coordinate our activities with the UN to make sure other government and non-government services are also being provided and in order to avoid duplication of services. But we do not take funding from either the US or the UN, we do not partner with them in our field operations, and MSF is not part of the UN “cluster system.”
What measures does MSF take to ensure the safety of its aid workers?
● All workers receive general security training.
● Projects follow an area-specific security plan.
● Security often hinges on transparency—telling all sides of conflict what we are doing and where, and impartiality—serving everyone in need, regardless of what ‘side’ they are on.
● All aid workers get appropriate vaccinations, malaria prophylaxis if needed, and we have contracts to evacuate members if needed.
Where are most of your programs?
● Through 2012, MSF had projects in around 70 countries; the exact number fluctuates depending on when and whether a given program has recently opened or closed.
● 66.4 percent of our programs (also through 2012) were in African countries.
● 55 percent of our programs are in contexts considered “unstable.”
● In 2012, our largest program locations, in terms of resources expended, were DRC, South Sudan, Haiti, and Niger.
Where are the current “hotspots?”
● Where there are ongoing violent conflicts and forced displacement: South Sudan, DRC, CAR, Somalia (though MSF was forced to withdraw from the country in 2013), Afghanistan, Pakistan, and Syria—for example.
● Where nutritional crises occur during the months between harvests (generally between June and October) in areas of West Africa (the Sahel) as well as the eastern Horn of Africa, i.e. Mali, Mauritania, Niger, Nigeria, Burkina Faso, Chad, Sudan, Ethiopia, and Somalia.
● Where epidemics occur: HIV/AIDS, MDR-TB, Cholera, Measles, Meningitis, and neglected diseases like Kala Azar, Chagas, and Sleeping Sickness.
● Where natural disasters have occurred, akin to those that, over the past few years, struck Haiti, Pakistan, Chile, China, Myanmar, Indonesia, Sri Lanka, and Thailand.
Why don’t you do development work?
Development work has a different goal than humanitarian—society, infrastructure, democracy building, and so on. MSF is strictly a medical organization and as such focuses solely on medical matters and issues that prevent people from accessing the medical care they need.
Are you concerned that MSF may be contributing to the development of resistant strains of illness through issuing conventional antibiotics or antiretrovirals to patients that may not know the importance of completing their treatment?
● MSF programs for illnesses such as TB or HIV/AIDS include strong patient education, and MSF encourages decentralized treatment programs and community antiretroviral groups (CAGs) that can help enable better adherence.
● Programs (in South Africa, for example) have better adherence rates to treatment than in the US.
Aren’t you putting yourself at risk by working with some of these diseases?
● Yes, but all aid workers are informed of the risks during their recruitment process.
● All staff are given appropriate vaccinations, comprehensive health insurance, and are trained in emergency protocols.
Do you provide abortions or work with family planning issues?
MSF does not take a position on abortion or family planning; however we do provide emergency medical aid to people according to their individual needs. That often includes abortion, contraception, sex education in HIV/AIDS prevention programs, as well as prophylactic treatments for victims of sexual violence. Our teams often see women and girls who need medical attention due to injuries suffered during unsafe illegal abortions in places where the practice is illegal or taboo.
Does MSF do prevention?
● Yes. For all diseases we treat, to the extent possible we also have active prevention programs.
● Examples: Nutritional supplements to prevent severe acute malnutrition, vaccinations campaigns against meningitis and measles, distribution of mosquito netting to prevent malaria, early treatment of HIV/AIDs to reduce transmissions as well as PMTCT (prevention of mother to child transmission of HIV), condoms, and prophylaxis treatment for victims of sexual violence.
Does MSF take drug donations? Where does MSF get its drugs?
No, MSF buys from a variety of manufacturers and supplies its own projects. For example, the majority of our HIV/AIDs drugs are purchased from generic producers in India.
How else do you advocate for patients?
While MSF as a whole continues to speak out about situations where political, military, or other concerns are causing or enabling medical emergencies, MSF’s Access Campaign advocated on behalf of patients when it comes to making lifesaving medications and vaccinations more widely available and affordable, particularly in developing countries. This means speaking out against restrictive trade agreements and commercial regulations, trying to use medical data gathered by MSF teams in the field to influence international medical debates, and more generally trying to ensure that people, not profits, are the focus of the conversation around access to medicines.
MSF was also a founding partner of the Drugs for Neglected Diseases initiative (DNDi), an organization that brings together academics, researchers, and medical humanitarian groups to develop new drugs that can fill the vacuums left by pharmaceutical companies and governments when it comes to certain diseases.
How many patients do you see?
In 2012, MSF teams working in some 70 countries around the world provided more than 8.3 million outpatient consultations, admitted more than 472,000 patients for inpatient care, performed more than 784,000 antenatal consultations, and helped deliver more than 185,000 babies. Teams also cared for more 310,000 people living with HIV/AIDS and more than 347,000 malnourished children; vaccinated more than 690,000 people in response to measles outbreaks and some 496,000 in response to meningitis outbreaks; performed some 432,000 routine vaccinations for children and more than 78,000 surgeries; and treated more than 1.6 million cases of malaria, more than 57,000 cases of cholera, nearly 31,000 for TB, and more than 10,000 victims of sexual violence. Staff carried out more than 191,000 mental health consultations as well, while also distributing more than 197 million liters of water and 61,000 relief kits.
What are the major areas MSF projects address?
MSF programs around the world address a host of different medical issues and challenges. Many offer general inpatient and/or outpatient care. Depending on the location, staff may also provide maternal and pediatric care, mental health care, surgery, physiotherapy, vaccinations, and treatment for malnutrition and diseases such as HIV/AIDS, tuberculosis (and drug-resistant tuberculosis), malaria, cholera, measles, and meningitis. MSF also responds to disease outbreaks and epidemics—in some cases offering water and sanitation services as well—and to instances of widespread movements of internally displaced people (i.e., people moving within the borders of their native land) and refugees (i.e., displaced people who cross a border into another country). Furthermore, MSF looks to provide care and advocate for patients suffering from neglected tropical diseases (NTDs) such as sleeping sickness, kala azar, and Chagas disease.
Are there any other entities MSF does not take money from?
Though it means forgoing a potential revenue stream, we do not take funds from extractive companies (i.e. oil and gas), arms manufacturers, tobacco and alcohol companies, and, as mentioned pharmaceutical companies.
Do you accept funding from the Gates Foundation?
MSF is one of the few major global health actors not receiving Gates funding. The Gates Foundation and MSF share many common objectives in working to address urgent global health needs in developing countries, and to ensure that appropriate vaccines, drugs, diagnostics, and other lifesaving interventions are developed and delivered to populations in need. MSF is strategically engaged with the Gates Foundation on a number of levels, ranging from high level meetings to ongoing and frequent technical and working group consultations on issues of concern to both organizations. Our medical and operational priorities of MSF do at times differ, and sometimes conflict, with the work of the Gates Foundation and the major initiatives they support. In cases where we feel the needs of our patients are not adequately addressed or prioritized, MSF does not hesitate to voice its concerns. At this time, MSF believes that our strategic engagement with the Gates Foundation, as well as our ability to voice criticism or concerns on specific issues over which the Foundation has enormous influence, is strengthened by our financial independence from the Foundation.
Do you accept restricted funds?
● We try to encourage people who want to support us to keep their gifts unrestricted so we have the flexibility to respond where needs are the most critical. Having a steady stream of unrestricted funds also allows us to respond to new emergencies without any obstacles or delays.
● We will accept restricted funds for areas or issues that people have strong personal feelings about, provided we can use them in that particular area.
● We have some focus areas where we know we will always need funds—donors intent on contributing to a specific program or initiative can inquire about those areas.
Do you take money from drug companies?
No. To do so would be a clear conflict of interest.
How much of your funding goes directly to your programs? What are your other costs?
● In the US in 2012, more than 86 percent of our funds went to programs. 13 percent went to fundraising costs, and one percent went to administration and management.
● Internationally, 82 percent of all funds went to programs.
● MSF’s US office has dedicated more than 85 percent of revenue towards programs for the past 17 years in a row.
Is there anything I can do for MSF besides giving donations or going to the field?
● Host a house party
● Help us spread the word to your friends and/or foundations you think would be interested in our work
● Organize a fundraiser
● Make a multi-year commitment.
● Find out if your company offers a matching gifts program and/or help us organize an office presentation.
● Follow MSF on social media and share news and updates with your contacts.
● Volunteer with the organization in its New York office or view employment opportunities here
What is your annual budget (international and US)?
● In the US, in 2012, it was nearly $190 million.
● Internationally, in 2012, it was roughly $1.28 billion.
Where does MSF get its money?
● Internationally, 89 percent of MSF’s income comes from private sources More than 4.6 million individual donors and private foundations worldwide made this possible.
● Around 9 percent of funds globally come from public institutional agencies ECHO, the governments of Belgium, Canada, Denmark, Germany, Ireland, Luxembourg, Spain, Sweden, Switzerland, and the UK.
● In the US, 100 percent of our funding comes from private sources. In 2012, 92.1 percent of it came from individuals, 4.6 percent from professional and family foundations, and 3.3 percent from corporations. In the US, we do not accept any US government funding.
Why doesn’t MSF do more fundraisers? Isn’t there a lot of untapped potential out there that could enable you to grow into a bigger organization?
● The cost to raise a single dollar is high for big fundraisers. They often work better for organizations that have higher fundraising overheads.
● We have many donors that initiate fundraisers for us.
● MSF is concerned with improving the quality of our operations and our ability to respond to emergencies, rather than growing into a larger organization.
Why don’t you take money from the US government?
● The US government is often involved in many crises to which MSF responds. It is important that we remain independent from these—and indeed any—government agendas or political positioning in order to be perceived as neutral, lest we hurt MSF’s ability to operate a program and/or secure the safety of our staff.
● Government programs such as USAID and PEPFAR often have strings attached and political agendas that could thwart our ability to deliver appropriate medical aid.
● Programs like USAID also have strict treasury requirements that we cannot always adhere to (such as turning over personal information about our international staff members).
Do aid workers get paid?
Yes. International staff receive a nominal monthly stipend that increases with accumulated MSF experience and with level of responsibility. Locally hired staff members get paid wages that are within the legal requirements of their country and are also competitive with other government and NGO's in the area. They also receive medical and other benefits.
How do you recruit aid workers?
We recruit aid workers through our website, through advertising in medical and nonmedical publications, and through public events. Candidates must meet qualifications and must apply on our website. Candidates will then go through a series of interviews and orientations before being sent out to the field. Field assignments are based on need and skill set.
How many aid workers do you have? Are they all medical?
● About 30,000 at any one time; 90 percent of them are national staff, people hired locally in a given project location.
● About 35 percent are nonmedical—logisticians, administrators, water/sanitation.