March 01, 2001

Copyright Atsushi Shibuya/MSF

Angola © Atsushi Shibuya/MSF 2001

Bearing witness to injustice and abuse has been a fundamental component of the mission of Doctors Without Borders/Médecins Sans Frontières (MSF) since the organization's founding in 1971. But how do we decide when and how to raise our voices?

"Whenever MSF field volunteers directly witness a humanitarian tragedy, they feel a moral responsibility to tell the outside world what they've seen. This urge to tell others about abuses we witness in the field is what drives all of MSF's advocacy activities," explains Antoine Gerard, MSF USA program director. "Last year, for example, I spent a month working in the Gaza Strip where MSF has set up a mental health project for displaced Palestinians. The suffering I saw there compelled me to take these concerns public by writing up patient testimonies and talking to journalists."

But each time MSF considers speaking out, we face the difficult question of whether our actions could jeopardize the safety of the populations we are seeking to protect, our own staff, or the continuation of the medical programs we are running. At times, MSF has decided that taking a public stand on an issue is so essential, it is worth the risk that we might be forced to stop our work in a particular region or country.

Speaking out can take many forms: a press conference or publication; a small, behind-the-scenes meeting at the local, national or international level; a public presentation of testimony; or a discussion with the local leaders in the region of concern. Sometimes MSF bears witness silently, acting as a deterrent to injustice through its mere presence. Whatever the means, our purpose is to provoke a response from those who have the capacity and the responsibility to address egregious abuses that confront our teams.

In recent months, MSF has raised its collective voice on a number of issues, and in a variety of ways. Following are just a few examples:

ANGOLA: QUESTIONING THE ROLE OF POLICYMAKERS

For more on Angola, be sure to read the MSF special report Angola: Behind the Facade of Normalization.

Despite peace agreements in the mid 1990s, Angola's 25-year civil war between the government and Unita rebels has over the past two years, entered a new, particularly violent phase. As one of the largest aid agencies working in Angola, MSF was and remains deeply concerned with the deteriorating humanitarian situation.

MSF operates projects to meet the emergency health needs of internally displaced persons (IDPs) across most of the accessible areas of Angola.

The Angolan government has failed to implement a countrywide health care program so most health care is supported or delivered by the international humanitarian community. But continued fighting and the use of landmines have severely constrained the ability of MSF and other humanitarian organizations to reach IDP populations.

The international community as well as the Angolan government and the United Nations are promoting a vision of the situation which suggests that peace is just around the corner, that the government is making progress and is demonstrating an increased commitment to human rights and the protection of the civilian population. This is not a reflection of the reality that MSF aid workers in Angola are witnessing.

As a result, the U.S. office of MSF joined its counterparts around the world in a campaign to raise awareness of the humanitarian crisis in Angola among the general public and policymakers beginning by issuing a press release and report entitled Behind the Facade of Normalization. Both were timed to coincide with a U.N. Security Council meeting on Angola in late 2000.

AFGHANISTAN: INSUFFICIENT AID TO REFUGEES

Copyright Stephen van Fleteren


Afghanistan © Stephen van Fleteren/MSF 2001

War and drought have inflicted new wounds on the population of Afghanistan over the past year. In 2000, the Taliban's struggle for control of the north of the country forced 200,000 refugees from their homes, leaving them sick, exhausted, and without health care. MSF volunteers, who operate numerous medical programs throughout Afghanistan, reported outbreaks of cholera, typhoid, hepatitis, and meningitis. At the same time, about 100,000 refugees who had previously found refuge in Iran were being targeted for repatriation to Afghanistan under a joint program run by the Iranian authorities and the U.N. High Commissioner for Refugees (UNHCR).

MSF met with U.N. representatives to express its concerns about conditions for the Afghan population. In Iran, MSF met with local authorities as well as the UNHCR to protest the return of refugees under conditions that did not meet the criteria for voluntary repatriation, according to international law. The refugees were not receiving adequate information about conditions in their home regions (such as famine, drought, and active fighting), and some were misinformed about what kind of aid they would receive upon their return.

More recently, MSF issued an urgent plea for more international assistance as thousands of desperately hungry and cold refugees poured into Herat in western Afghanistan at a time when international aid had fallen far short of the promised amounts for 2000.

ACCESS TO ESSENTIAL MEDICINES: CAMPAIGN ENTERS A SECOND YEAR

For more on the Access Campaign, please visit the campaign website at http://www.accessmed-msf.org/

The beginning of 2001 produced a number of breakthroughs in MSF's Campaign for Access to Essential Medicines.

MSF has long advocated that generic drugs will be critical in driving down the high prices for drugs to treat HIV/AIDS and other infectious diseases. In February 2001, the Indian generic drug maker Cipla offered its anti-retroviral drugs to MSF for $350 per patient per day and to governments for $600 per patient per day. Cipla's offer has triggered an astounding round of price reduction announcements by large pharmaceutical companies as well as a series of U.N. proposals that are positive steps in the fight to make AIDS drugs accessible in developing countries.

In March, however, MSF felt compelled to launch a global Internet petition calling on 39 pharmaceutical companies to abandon a court case against the South African government that would impede access to affordable AIDS drugs in the country with the largest number of people living with HIV/AIDS. Petition signatures will be presented to the companies and governments when the trial resumes in South Africa on April 18.

MSF's Access Campaign also made strides in securing a better treatment for African sleeping sickness, a disease that affects people in 36 countries. The standard treatment for the advanced stage of the disease, a 60-year-old drug called melarsoprol, is extremely toxic and causes lethal side effects in about five percent of cases. For several years, MSF has sought to find a producer for a better drug, eflornithine, that had gone out of production because it was not profitable for the manufacturer. With the recent discovery that eflornithine production was being resumed-because it is useful in removing unwanted facial hair, MSF is in the process of securing an agreement to reduce the price of eflornithine to assure a sustainable supply of this much-needed medicine.