Perception Project: A Remedy Against Complacency
Like any other actor, humanitarian organizations and aid workers are entangled in a web of multiple perceptions in the societies in which they work, and as participants they influence those societies through their activities, behavior, and discourse. The dynamics of how perceptions fuel social interaction are as old as human societies. What seems more recent is the way everyone today finds a social utility in requalifying their actions as “humanitarian,” from the local charity active at every street corner to army special operations units, not to mention the myriad multi-mandate NGOs promoting social transformation through civil society, elections, and gender equality. Such rhetoric has an effect that is eagerly sought after: it tends to create a “narrative” by which various national, religious, philosophical, or economic interests are presented as helping “humanity” at immediate risk. On the other hand, it’s important to remember that the re-labeling of intentions as “humanitarian” has a long history, and similar practices actually predate the signing of the first Geneva Convention in the nineteenth century.
So if perceptions are always a given and seemingly out of control, why did MSF choose to launch a specific project on them in 2007, selecting field programs to carry out a series of perception studies? And how did the results influence our decision-making?
In 2004, MSF decided to leave Iraq after the bombings of the UN and ICRC in Baghdad. In 2005, five MSF staff members were murdered in Afghanistan and the organization departed. Strategists from both the US administration and Al Qaeda were theorizing that no neutral space was left in the conflict, and that the only choice for all other actors was to be with them or against them. The possibility for medical facilities to be a respected “sanctuary” in conflicts seemed to be behind us. A majority of NGOs either left or deliberately aligned themselves with a side in this sweeping politicization of aid. “Adapt or become irrelevant” was the motto.
Almost at the same time, the International Criminal Court began its first investigations of politicians and military personnel in power. In Darfur, this development created such a backlash against aid workers that several organizations, including two MSF sections, were expelled in 2009.
Internally, MSF was also tackling questions about its modus operandi, forcing the organization towards greater introspection. Though this trend is widespread in the “aid community,” MSF realized that some deeply entrenched habits were limiting its ability to build programs in tense settings: coordinators unconnected with the societies in which they were active; a sense of overconfidence in what MSF represented and what it meant to others; the frequent overlooking of key stakeholders in negotiations; and a tendency to require others to adapt themselves to us rather than the opposite.
To be blunt, aid workers saw themselves in positions of power and MSF was contributing to this trend.
It is not academic interest that triggered MSF-OCG
initiative on perception. It is both a sense of vulnerability and the realization that a fundamental characteristic of humanitarian work, the attention to others, had progressively disappeared from the general modus operandi of the international aid community. A certain form of unilateral power was being exercized in host communities. On the one hand, big donors had succeeded, slowly but surely, in building an aid system based on a cascade of contracts and subcontracts, with funds being directed toward the achievement of general political and military goals. Of equal concern was the fact that a majority of NGOs were choosing to assist powers through the provision of essential packages to populations, rather than prioritize the effective delivery of humanitarian assistance to vulnerable people. At a time when Western powers are actively engaged in most conflicts around the world, either through the “war on terror” (Afghanistan, Pakistan, Iraq, Yemen, Somalia, Philippines) or by backing UN interventions (DRC, Sudan, Ivory Coast), this specific modus can only foster a critical wave of rejection of aid workers, sometimes through violence, more often through harsh intellectual criticism of “humanitarianism” or “aid” as a tool of dominance.
For an organization such as MSF, investigating perceptions in the field implies looking at ourselves in the mirror and questioning what we see. It implies moving away from the comfort zone to expose discrepancies between our own narrative and the realities expressed by external actors in the field. I can only recommend that others do the same.
The first thing we learned is that most ordinary people have little or no idea of who we are and what we do. The range of misconceptions is amazingly broad: from MSF being a Chinese organization to a Muslim confessional charity to a subsidiary of Western states. Our operational choices are frequently misunderstood, especially when we offer medical care for a single pathology (malaria or surgery, for example) and not the wide scope of services expected. The list of miscommunications at a local level is long—too long. The internal language within humanitarian circles—often derived from military tradition or civil security—affects perceptions of our action. MSF jargon is full of such terms: “operations,” “interventions,” “missions . . . ” maybe too bellicose a tone to speak about what is primarily a medical action in man-made or natural disaster zones.
National staff are perhaps even more important than international staff in shaping relations with the immediate environment. For example, the behavior of crowd controllers or of educated, upper-class management brought from the capital to a traditional social setting often has more effect than anticipated, and deserves close attention.
Almost everywhere, the quality of care provided to individual patients determines perception by populations, and is extremely well appreciated. The immediate effect we have on their acute health problems plays an immense role in the respect expressed towards MSF, in a context of aid where many promises are made but are often not kept.
Much more than the modus operandi itself (direct action or partnership, international or national staff, coordination), the effectiveness of the assistance makes the difference. Using standard level drugs when most are sub-standard, taking care of severe medical cases when most offer only primary health, being present in case of emergencies, avoiding stock ruptures and interruptions of service due to absences, and following up with patients regularly until they are cured are all components that elicit immense respect for the organization that provides them.
The indicators used in the aid system and its multiple "logframes" miss most of these qualitative aspects by focusing exclusively on the volume of the input or activity. But for HIV, it is not the number of patients initiated on ARVs that counts; it is how many are still alive and stabilized a few years later. And for health care in Afghanistan, it is not how many health posts or centers are open in the country (the theoretical coverage of health services) that counts, but whether they are effectively accessible and used by the population when they need care. People feel deceived if announcements are not followed by action, or if what is delivered does not reflect the budgets alotted.
Also, while MSF is often well-perceived by those benefitting from its projects, there is a worrying divide between those beneficiaries and the local administrative or intellectual elites. Of all findings, it is this one I find most serious in terms of consequences. In a growing number of societies, critics see humanitarian action as a costly, archaic form of unilateral charity, weakening national states or civil society actors. They are urging us to be more associated, to be part of a relationship of equals. They want to work with us, not necessarily under us. On one hand, the eagerness to build bridges and cooperate is encouraging, and should serve as a reminder that the “clash of civilizations” is far from being a social reality. But we are criticized because we are perceived as insufficiently inclusive, and failing to strengthen long-term capacities at a local level through greater transfer of knowledge and resources.
Some of these tensions are normal, as assisting neglected vulnerable populations for an immediate result can be seen as going against political priorities or diverting resources from longer-term national institutional objectives. Because international humanitarian assistance often reveals the limitations of local elites’ capacity or willingness to act, it should never be taken for granted that such assistance will be welcomed. The damaged credibility of aid workers among local elites nevertheless has to be strategically and practically addressed by all organizations wishing to remain relevant in the coming years.
Whether by MSF or other organizations, the emphasis on perception at the beginning of the twenty-first century is no coincidence. It is definitely a reflection of something gone wrong in what is usually called the “aid system,” and the need to confront it directly. It also reflects the legitimate aspiration of emerging states and civil societies to organize and mobilize to assist their populations in the best possible way. As a matter of fact, most states and societies are, increasingly, developing autonomous national/regional capacities to reduce reliance on international aid.
Unfortunately, while lamenting environmental constraints, too many aid organizations have forgotten the basics, and neglected the perceptions created by their own choices.
In the end, the lessons learned from these studies and other observations are shamefully obvious, but this in itself says a lot. They should inspire both a greater degree of humbleness in our relation with the environment and a greater sense of responsibility when it comes to delivering what we claim.
• Don’t take for granted familiarity with the organization—it is actually the exception more than the rule, so explain your purpose constantly.
In practice, the perception project has reinforced for MSF the importance of prioritizing high-impact quality projects while encouraging improved networking, emphasizing negotiation with all actors, implementing proactive communication strategies toward societies in which we operate, better integrating national staff in key management and advisory positions, and creating training curricula for our coordinators. It has also reinforced our determination to avoid some of the most disturbing developments in the aid system over the past years: overconfidence in the value of what NGOs represent, becoming part of an organized coordination mechanism under the authority of donors and poorly connected to local realities, subcontracting the security of teams to external companies which then control all contact with the environment, and subcontracting to local organizations without being able to manage the quality of assistance.
Last but not least, the perception project is little by little producing the change to internal culture we were looking for. Our field teams know that the ability to work in any situation is the result of negotiation, but also that respect for our action has to be earned. It cannot be gained from a display of the power that resources provide, nor from the repetition of principles as slogans.