For five decades, Doctors Without Borders/Médecins Sans Frontières (MSF) has responded to a wide range of emergencies—each experience prompting deep reflection and pushing us to evolve. This timeline documents 50 years of bearing witness, through the eyes of the aid workers and photographers who stood with communities in moments of crisis.
A NEW FORM OF HUMANITARIANISM
In 1968, a group of doctors and nurses set out with the International Committee of the Red Cross to help provide emergency medical care to people affected by war and famine in Biafra, Nigeria. But these young doctors find themselves chafing against the “culture of silence” surrounding their work with the Red Cross, which makes it impossible to speak out about the injustices they witnessed. They openly criticize both the Nigerian government and the Red Cross for what they see as complicity in the murder and starvation of civilians.
Other doctors also speak up and begin to lay the foundations for a new and questioning form of humanitarianism. MSF is created in 1971 on the belief that all people have the right to medical care regardless of gender, race, religion, creed, or political affiliation, and that the needs of these people outweigh respect for national boundaries. For the doctors and journalists who come together to start the organization, bearing witness is inseparable from MSF’s medical humanitarian mission.
“December 22, 1971, will thus come to mean the mobilization and determination to topple the barriers and break down all the borders that separate those who seek to save lives and provide care from the victims.” —Tonus, the French medical journal, where MSF’s founding was officially announced.
RESPONDING TO NATURAL DISASTERS IN CENTRAL AMERICA
MSF’s earliest activities are in response to natural disasters. Medical teams are sent to Nicaragua’s capital, Managua, after an earthquake destroys most of the city and kills between 10,000 and 30,000 people in 1972. In 1974, MSF launches a project in Honduras after Hurricane Fifi causes major flooding and kills thousands of people.
ORGANIZING REFUGEE CAMPS IN SOUTHEAST ASIA
To assist Cambodian and Vietnamese people fleeing oppressive regimes in their countries, MSF sets up its first large-scale medical program for refugees in Thailand. In February 1980, MSF works with other organizations to carry out the “March for Survival,“ a symbolic protest at the Cambodia-Thailand border calling for international aid to be distributed in Cambodia. This action gives powerful expression to MSF’s commitment to témoignage, or witnessing.
"We are here to demand protection for these civilians; these unarmed people.” —Claude Malhuret, president of MSF, during the March for Survival of Cambodia, 1980.
LEBANON: MSF’S FIRST OPERATIONS IN THE MIDST OF CONFLICT
After war breaks out in Lebanon, MSF launches an emergency medical response to care for people wounded in the fighting. When MSF arrives in Beirut, bombs are dropping, and the city is burning. The team treats patients injured by shrapnel and bullets and suffering from burns and broken bones in extremely challenging conditions, without access to equipment like X-ray machines and ventilators. In order to comply with its principles of neutrality and impartiality, MSF provides aid to people on both sides of the conflict throughout the country.
AFGHANISTAN: CLANDESTINE MEDICAL AID DEEP IN THE MOUNTAINS
Immediately after Soviet troops invade Afghanistan in December 1979, MSF teams are dispatched to the country to provide medical care. Crossing the border from Pakistan in secret with medicines and supplies on horseback, staff travel hundreds of miles setting up small hospitals deep in the mountains. Over 10 years, more than 550 MSF doctors and nurses will rotate through this rough terrain.
“There was nowhere else to go for treatment. Our centers were oases in the midst of deserts of indifference.” —Juliette Fournot, MSF head of mission in Afghanistan, 1982–1989
ETHIOPIA: RESPONDING TO FAMINE AND SPEAKING OUT
At the height of northern Ethiopia's dire famine in August, some 50 people die each day while thousands more desperately await food distribution. Months go by before the government will call the crisis a “famine.“ MSF sends food, medicine, and supplies, in addition to working in therapeutic feeding centers. When the government begins to forcibly displace people and divert humanitarian aid, MSF decides to speak out, resulting in the expulsion of one of the two MSF sections present in the country. MSF continues to care for Ethiopian people who fled to neighboring Sudan.
“If nothing changes, I don’t know what we’re doing here. Without food, medical treatment is meaningless.” —Brigitte Vasset, MSF medical coordinator in Ethiopia, 1984
SOMALIA: HUMANITARIAN AID UNDER DURESS
War in Somalia results in more than 300,000 deaths. As international aid agencies leave Mogadishu because of safety concerns, MSF teams arrive on the scene to open nutritional centers and treat the thousands of children suffering from malnutrition as a result of a months-long famine. After facing numerous kidnappings and repeated security incidents, MSF is forced to leave the country but speaks out against excessive military force and flawed foreign military interventions.
“If humanitarian aid must now come under the systematic control of the military or of governments […], that will be very troubling. I don’t want to lose my humanitarian soul.” —Patrick Vial, MSF head of mission in Somalia, 1993
RWANDA: POWERLESS IN THE FACE OF GENOCIDE
The assassination of Rwanda’s president provides a pretext to unleash a campaign to exterminate people from the Tutsi ethnic group, along with other opponents of the government. From April to July, the slaughter of an estimated 500,000 to one million people is met with general indifference from the international community. MSF watches, powerless, as many Rwandan staff members and patients are massacred. For the first time, we issue a warning and testify before the United Nations, hoping to trigger quick military action to stop the killings. The violence leads to a massive exodus of refugees; MSF cares for them in neighboring Zaire and Tanzania.
“We were saying, ‘They’re killing these people.’ The only decent position was to break completely with humanitarian neutrality and call for military intervention against the perpetrators of the genocide.” —Jean-Hervé Bradol, MSF project coordinator in Rwanda, 1994
SREBRENICA: CALLING FOR ACCOUNTABILITY
For three years, Serbian forces laid siege to the Bosnian enclave of Srebrenica. Food convoys and humanitarian workers were blocked from entering. When Serbian troops capture the town in July, MSF—the only humanitarian organization still working there—is forced to evacuate, with no choice but to leave behind some of its Bosnian staff and patients. After the United Nations peacekeepers abandon Srebrenica, more than 7,000 people are killed and 40,000 people are forcibly removed. MSF calls for an inquiry into the UN troops’ failure to prevent the tragedy.
“We were witnesses, we knew what was going to happen. We did nothing . . . Picking up my camera at least meant facing that responsibility: I don’t want to look away.” —Gilles Peress, Magnum photographer in Srebrenica, 1996
HIV: THE GLOBAL FIGHT FOR ACCESS TO TREATMENT
As HIV/AIDS spreads, MSF teams around the world witness the pandemic’s heavy toll. The astronomically high cost of treatment means people in the hardest-hit countries lack access to antiretroviral drugs (ARVs). MSF first becomes involved in the political and social mobilization around equitable access to these lifesaving medicines in South Africa. The campaign and its slogan—“lives before profits“—goes global and eventually helps lead to the production of generic ARVs and dramatically lower prices.
“Why do we want to introduce antiretrovirals? Because our doctors are treating opportunistic diseases, because these patients keep coming back, coming back, coming back—and because we’ll end up sending them all to the cemetery.” —Maryline Mulemba, MSF head of mission in Malawi, 2001
KOSOVO: NO HUMANITARIAN WARS
As the Milosevic regime continues to operate in former Yugoslavia, Serb forces conduct a campaign of terror and violence, forcibly deporting ethnic Albanians from Kosovo. MSF provides medical care to the persecuted. In March 1999, when NATO intervenes— justifying its bombing as a “humanitarian war“—MSF cares for people in refugee camps across the region while continuing to call for the protection of civilians who remain in Kosovo.
“If you wanted to know what was going on in Kosovo, given that there was no one left to provide information, you had to listen to the people who were leaving. As we listened to them, we became convinced that a crime was being committed.” —Thierry Durand, MSF operations director, 1999
THE NOBEL PEACE PRIZE IS AWARDED TO DISSENTING HUMANITARIANS
MSF is awarded the Nobel Peace Prize, which is accepted by James Orbinski, president of MSF’s International Council. In his speech, Orbinski denounces the abuses and indiscriminate bombing of the Chechen village of Grozny by Russian forces, destruction that MSF teams are actively witnessing.
“We are not sure that words can always save lives, but we know that silence can certainly kill.” —James Orbinski, president of the MSF International Council, Nobel Peace Prize speech, 1999
DARFUR: SUPPORTING DISPLACED PEOPLE IN CRISIS
Fighting between Sudanese government forces and rebel groups escalates into war, with the Janjaweed militia—backed by the government—attacking and looting villages. Thousands of people are killed and more than one million flee. MSF responds immediately with more than 2,000 staff to provide medical and nutritional care to displaced people in the Darfur region and to refugees in neighboring Chad, where teams are already engaged in other projects.
“At one point, everyone was aware of these atrocities. Thanks to the press, people could no longer say that I was lying when I would tell people in Khartoum about what was happening in Darfur.” —Jamal Abdalmula, MSF referring physician in Sudan, 2020
NIGER: FACING FAMINE AND A NUTRITIONAL REVOLUTION
Niger is hit by a severe food crisis, resulting in unprecedented rates of malnutrition. In response, MSF teams use Plumpy’Nut, a peanut-based ready-to-use therapeutic food, on a large scale for the first time. It proves revolutionary, with excellent recovery rates. This treatment becomes a national protocol in August.
“Sometimes I would cry when I saw all these little children who would show up in a terrible state, just skin and bones . . . My experience as a pediatrician hadn’t prepared me to confront the deaths of so many of them.” —July Menschink, MSF doctor in Niger, 2005
HAITI: MULTIPLE EMERGENCIES
In January, Haiti is struck by a devastating magnitude 7.0 earthquake. MSF—already active on the island for several years—begins treating the wounded within hours of the disaster. Teams also work to rebuild medical facilities and restore access to safe water. In subsequent months, the emergency response shifts to containing a massive cholera epidemic. MSF opens more than 50 cholera treatment centers, launches a widespread public awareness campaign, and treats more than 350,000 people in 10 months—the organization’s largest operation to date.
“I didn’t leave the hospital for the first five days. Gradually, Haiti will no longer appear on the front page of our newspapers every day, but the needs of this community, of the people who’ve lost everything, won’t be met for months and, perhaps, years.” —Paul McMaster, MSF surgeon in Haiti, 2010
SYRIA: SUPPORTING UNDERGROUND MEDICAL CARE
Against the backdrop of the growing Arab Spring movement, Syrians rise up in mass protests across the country. As the violent suppression of the demonstrations by President Bashar al-Assad’s government spirals into all-out war, even doctors who attempt to care for the wounded are at risk. Networks of medical professionals organize secretly, but they often lack supplies and equipment. MSF operates without official authorization, providing essential medicine and supplies to local health providers before opening three hospitals in northern Syria. A decade later the war rages on, and MSF continues to care for millions of displaced people, both within Syria and in neighboring countries.
“The first thing that struck me was the number of civilians who’d been killed. They weren’t just collateral damage— they’d been targeted by Syrian army snipers.” —Jérôme Sessini, Magnum photographer in Syria, 2012
RESPONDING TO AN UNPRECEDENTED EBOLA OUTBREAK
In March, the largest Ebola outbreak in history is declared in West Africa. MSF responds immediately, setting up treatment centers in Guinea, Liberia, and Sierra Leone— the three worst-affected countries—while criticizing the international community’s inaction. The lack of a vaccine and available treatments results in extremely high mortality rates, with more than 11,300 deaths (including 500 health care workers) before the spread of the virus is contained. At the peak of the epidemic, nearly 4,000 locally hired staff and more than 325 internationally mobile staff are working across MSF’s Ebola projects, admitting a total of 10,376 patients, of which 5,226 are confirmed Ebola cases.
“I cannot stand aside and watch my people die. But I, along with my colleagues here, cannot fight Ebola alone . . . If the international community does not stand up, we will be wiped out.” —Jackson Naimah, MSF medical assistant in Liberia, 2014