Dear Friends,

It is a great pleasure to write to you as the new executive director of the U.S. office of Doctors Without Borders/Médecins Sans Frontières (MSF). Since I first met an MSF team assisting refugees on the arid border between Kenya and Somalia in 1992, I have embraced the particular blend of medical professionalism and passionate humanitarian engagement that drives this organization. After many years in the field, I am excited to join the effort to make MSF's work and values resonate in the United States—an undertaking that has already seen much success over the past decade.

This issue of Alert addresses a fundamental component of MSF's mission. Speaking out goes to the core of MSF's identity as an organization. Our primary concern is to ensure the survival and restore the autonomy of persons who find themselves in extremely difficult circumstances. Often, medical help is not enough: doctors, vaccines, and medicines are no match against indiscriminate bombing raids, forced displacement, or targeted persecution. At times, humanitarian aid can even be turned against the population it seeks to assist. In these situations, words can be potent allies, especially when they describe real-life experiences that challenge a suffocating silence or the convenient official version of unacceptable events.

When we speak out, our purpose is to provoke a response from those who have the capacity and the responsibility to address the egregious abuses our field teams witness in the exercise of their medical action. Often our targets are the authorities holding sway over oppressed population groups—states and rebels alike. However, the notion of collective responsibility for our global community is increasingly taking hold. International organizations such as the United Nations as well as individual nations, particularly Western industrialized countries, also have political responsibilities and obligations under international law to which they should be held accountable.

Certainly, our aim when speaking out is to achieve results. We may seek to raise awareness generally about a neglected issue, or actually to reverse an unbearable situation. The responsibility to take action is however largely out of our hands: try as we might, the desired outcome is never guaranteed. Sometimes our efforts do bear fruit. Launched nearly two years ago, MSF's Access to Essential Medicines Campaign is beginning to yield tangible gains. The case we have been making about the disparity between wealthy and poor countries as to the availability and affordability of needed drugs has been echoed by other organizations and put serious pressure on politicians and drug companies. It is now vital to build on this momentum to achieve real breakthroughs in the availability of medicine for poor patients and to stimulate research and development for neglected diseases.

It is, however, more difficult to directly trigger a positive response when calling to improve the protection of victims of conflict. When the bombing of Chechen civilians persists despite the graphic descriptions of untold suffering documented by our medical teams; when the displaced populations of Angola continue to be abused and aid manipulated despite clear evidence made public in a recent MSF report, it is difficult not to feel a sense of powerlessness and question the usefulness of speaking out. This feeling is even more pronounced in cases where making our voice heard entails significant risks, particularly for the security of our field teams who must deal with the very authorities who have committed the abuses we denounce. Yet risks can be minimized, if not avoided, and bearing witness publicly is at times an ethical imperative, irrespective of whether anyone cares to listen.

It is also important to realize that public denunciation—the most strident method of speaking out—is the exception rather than the rule. Most of our outspokenness is an inseparable part of our everyday humanitarian action, and does not get much media attention. Face-to-face dialogue is the main tool we use to persuade, and often to exert pressure. This type of advocacy is perhaps less glamorous than press conferences, yet it is often effective as it directly confronts authorities with their own responsibilities. When, in 1996, I saw our field team in Liberia manage to persuade a warring faction not to attack a hospital and kill patients, it was a small victory, but one made possible by assertiveness in defending fundamental humanitarian values in the face of those bent on violating them.

While speaking out is an exercise fraught with dilemma and uncertainty, I hope this issue of Alert will make a compelling case for why it forms such an essential part of MSF's mission and identity, from Afghanistan to Angola.