Médecins Sans Frontières was started in 1971 and now has 18 centres worldwide. Olivier Rowland spoke to its Paris head, Dr Marie-Pierre Allié
Essentially, you recruit volunteers with medical skills and send them for periods abroad?
We offer humanitarian, medical help in crises: helping after a disaster or during a conflict. As conflicts often drag on, we typically end up having a long-term presence. The same goes for disasters like the Haïti earthquake: we help in the aftermath, then, as long as there are people still in danger we stay at their side.
We respond to epidemics, and help prevent them by vaccinating. Aids is one of the major crises and we now have access to treatments that were previously only for first-world nations. We fought to get them for people from poorer countries and then we adapted care programmes; such as using combined forms of treatment that are easier for people to take in difficult situations.
We have about 2,000 "expat" workers who have gone on missions abroad and about 20,000 local people working for us.
MSF is truly international: there are a lot of people from northern countries, but Sudanese or Nigerian doctors also go and work elsewhere.
The number of employees is quite small compared to volunteers
Yes, but everyone receives an allowance. In your first year, you go as a volunteer, and then if you decide to continue, may become permanent. People are interested in what MSF does and say "I’ll make myself available, maybe just the once".
They may volunteer for six months then go back to France, but will often take it up again later. Others decide to work on a project long-term.
What motivates them?
It’s very personal, but wanting to go and give a helping hand elsewhere where the situation is more difficult, is something a lot of people feel, whether it’s young people who’ve just finished their studies or established French doctors. They are attracted by the way we continually try to challenge the status quo. We never just resign ourselves, but keep trying to find better solutions for our patients.
Your founders worked alongside La Croix Rouge. How does your ethos differ from theirs?
The doctors working with La Croix Rouge in Biafra [part of Nigeria seeking independence] found themselves under political pressures.
They wanted an organisation that could act but also alert the world to the situation they found: When they could not help properly because of blockages and misappropriated aid or medicines not getting through.
It’s our duty to talk about it, so politicians and businesspeople can’t say later they didn’t know. We speak out, but always about what we experience on the ground.
In the Democratic Republic of the Congo, Zaire as it was, between 1993 and 2003, Rwandan refugees were being hunted down and massacred and we were trying to help but also draw attention to what was happening.
There were attempts to stop us working effectively or even to manipulate our activities to get refugees together to massacre them. We denounced it very strongly.
We don’t systematically speak out on human rights abuses, other bodies do that, but we do when we are prevented from giving effective help.
Bernard Kouchner, one of the founders, was noted for publicity-seeking activities like hiring a boat for those fleeing Communist Vietnam, but left after being overly interested in stunts
That’s really going back; it’s part of our history and has become a bit mythologised. During our first 10 years, MSF was made up of doctors and nurses who went off here, there and everywhere with no real structure and professionalism.
From 1979, there was a debate as to where we wanted to go with it. For me, the real MSF dates from then. Today we are known for the efficiency of our aid and the high quality testimony when we do speak out.
Was it originally a partnership between doctors and journalists?
We have a communications department, but don’t directly employ journalists. The founders were doctors who worked closely with journalists to help get word out, but it was a different period, media presence wasn’t what it is now. Today the situation in Biafra would be on TV non-stop.
MSF was founded in France. Is France still one of the countries that is most involved?
Our major centres are in Paris, Barcelona, Brussels, Geneva and Amsterdam. Paris is one of the most important. MSF was a French idea and is still strongly rooted here. We are still often called "the French Doctors". It is no longer specifically French, it is for anyone who wants to take action, and to speak out about the action where necessary.
Does Paris have a special focus on Francophone territories?
To an extent: we often work in areas like Chad or Niger; the Brussels one in the Democratic Republic of the Congo, the Spanish one in Latin America. We are non-governmental, not dependent on the base country.
You have been working in Pakistan after the floods, with clinics, diarrhoea treatments etc.
Massive floods leave people homeless and safe drinking water is a major difficulty. Springs are flooded and contaminated. There’s a risk of diarrhoea and the spread of diseases like cholera. You have to be very vigilant.
You have also set up centres to deal with malnutrition
We’ve always been confronted with malnourished children, but treating it was complicated because the child always had to be hospitalised.
A product called Plumpy’nut revolutionised this in the 2000s. It has all the nutritional qualities to treat a malnourished child, in a little sachet and it’s very easy to administer.
If children have no complications but need intensive malnutrition treatment, you can give the sachets to their mum. Now we can treat a lot more children.
What’s the best way to get help?
You can put yourself forward to go abroad: we need all kinds of medical professionals, midwives, nurses, paramedics etc. There are also logistics people and financial or personnel administrators. We need people to build, maintain vehicles, work on drainage, manage stock. Or donate.
Have you been involved for a long time?
I went for the first time in 1990 and I worked in the field for six years in Sudan and South Africa, Iran and Cambodia and then at HQ managing programmes in different countries.
When I studied medicine, I wanted to go abroad and help people, it was in my mind already. I thought I’d go at least once, then you get the bug. You go through very difficult times but at the same time it is very satisfying
as you see results on the people.
One time we arrived in Burundi during intense civil war and despite great tensions we managed to stay and give healthcare as we were seen as apart from it. We created a little humanity in a very difficult situation with massacres and then revenges.
We always know there are risks. We try to understand and minimise them, but you can never eliminate them. It is essential is to work with the population to make sure our work is well-understood, and that we are independent.
We need the drugs first world no longer wants
MSF HAS campaigned for better availability of medicines since the 1990s and Dr Allié said this was because they noticed that medicines their patients needed were going to be withdrawn as they were unprofitable.
She said: "Our patients suffered from these neglected illnesses but those in wealthy nations did not. Some dugs were also inaccessible because of cost, notably Aids ones.
"We couldn’t work without good medicines so we work with the pharmaceutical industry so that they continue to make medicines such as for sleeping sickness [a parasitic illness common in Africa].
"We also push for better medicines for these diseases and also to make Aids anti-retrovirals, easier to afford as they used to be much too expensive.
"There is the question of patents, of course, but we were shocked to find medicines were considered a product just like any other, with the same intellectual property protection as luxuries. We fight on this, but market forces prevail.
"Some people make generics, especially in countries like India or Brazil, and they need to be able to continue doing that and to be able to send them to the countries most at risk of epidemics.
"New restrictions arise every year. Today we have access to the medicines of a decade ago but we need new ones, the most effective, with the fewest side effects. We want them to be produced as cheaply as possible and not just for profits to be put first."
Haiti work will go on for years
DOCTORS and volunteers from MSF were in Haiti before the earthquake in January 2010 and are still there more than a year later.
Dr Allié said they were there because the health system was inadequate, especially for the poorest.
"We had a big presence in the hospitals, specialising in surgery and traumatology [repairing wounds], and also in childbirth.
"When the disaster happened we helped the victims and in the months afterwards worked on the consequences, dealing with the injuries as well as carrying on with curing disease, helping with childbirth etc as life carried on.
"Today, especially in Port au Prince, things are moving on bit by bit, but shelter is a big issue, as many people have no home and are living in very precarious situations. Access to healthcare is difficult and organisations
such as MSF provide a part of it. National structures are being restored bit by bit. It’s a slow job and we will be there for many years.
"The biggest problems come from the huge numbers of injured. It is complex as it means caring for them, surgery, re-education, then getting them back into their daily lives.
"Then there are epidemic risks as people are living in catastrophic conditions.
"There was also psychological trauma. Many lost family members, often without knowing where they were and had to wait many days to be able to extract bodies.
"The state structure was quite weak before the disaster, it’s being put back in place, but it’s hard to know, politically, how things will progress. There is outside help, but Haiti’s institutions must be strong enough to carry the reconstruction."