MSF is perhaps the most famous of all international relief organizations. It's been around for nearly 50 years and employs 63,000 people from around the world, many of whom leave behind comfortable lives to tend to the sick and wounded in some of the world's most difficult settings. It promotes an image of stoic neutrality in the face of intractable conflict, with its volunteers bearing sober witness — témoignage, in MSF parlance — to the horrors they confront. It is hard not to be moved by the public perception that MSF has cultivated of dashing young physicians spurning well-paying jobs in global capitals to save lives in conflict zones. MSF's tenacity helped it earn a Nobel Peace Prize in 1999 and grow into a $2 billion-a-year behemoth today.
My earliest memories of Doctors Without Borders/Médecins Sans Frontières (MSF) used to be quite mixed. Bright young doctors (often portrayed as overly assertive French women in movies) going to war-torn or disaster areas to provide emergency medical care for victims. Movies featuring them frequently included mercenaries and some resistant doctor who knew best and an ignorant populace that needed saving from rebel mercenaries on the other side. Those were contemporary tropes replacing the self-less nuns running orphanages in the midst of a war. There is probably a little truth in those movie images, but I doubt that they fully show the realities that really are going on.
To be fair, I have no sympathy for young travellers who visit other countries and expect the same safety as they might expect in their backyard. A cousin of mine had first-hand knowledge of this when visiting a "civilized country" like Spain. She had to climb out a vehicle window to avoid being sexually assaulted while she was innocently hitchhiking.
I assume that first-time doctors in the MSF often arrive with an inferior understanding of what they would be facing. An organization like the MSF is important to safe-guard those doctors. I can see the importance of the role of that organization.
In its early days, European clinicians responded to crises around the globe: an earthquake in Nicaragua, a famine in Ethiopia, a refugee crisis in Southeast Asia. But as the organization grew, it set up more, longer-term projects in places with stubborn conflicts like Afghanistan and protracted health crises like the HIV epidemic in sub-Saharan Africa. Those changes demanded more bodies, and more long-term capacity. Relying just on short-term European volunteers didn't make sense anymore.
I think it was a mistake to embrace longer-term projects. It meant employing native employees to run facilities in the long run.
The result of this structure — a common one among global nongovernmental organizations — is a two-tiered system in which a relatively small band of expat professionals, disproportionately from Europe and North America, oversee a caste of lower-paid largely brown and Black support workers in sites spanning the globe.
I dislike the phrasing "largely brown and Black support workers" in comparison to the European and North American staff. Proportionally in the countries being served, there are no native white people. What colours are left? Green and purple people don't exist. That is why the MSF should not be responsible for long-term projects. Instead of focusing on parachuting in qualified personnel into areas where there services are needed, they are being criticised by racists who only see that "white" people are taking advantage of the situation.
In the field, international staffers are sometimes treated like visiting royalty who must be shielded from the depredations of life in the developing world, whereas their locally employed colleagues are expected to simply endure them. International staffers are paid considerably higher salaries — overall, according to the organization's most recent financial report, the average cost of an international staff member in 2020 was nearly six times that of the average local worker.
International staffers also receive a per diem, housing, travel, and in-country transportation, sometimes with a driver. In some projects, international staff members are housed in some of the most exclusive neighborhoods in capital cities, with in-house cooks and cleaners. Several international staffers said they lived better in the field than they ever did at home.
I am not surprised when I see that internationals staffers said "they lived better in the field" than at home. One of the complaints that immigrants to Canada is that their lifestyles decrease. In many cases immigrants leave their homelands where they have houses with housekeepers and end up in apartments and having to do their own housework. Why are internationals brought in? Is it possible that they are better educated and more skilled than the local doctors? If there is no need for them, why are they there.
While all expats receive a base salary benchmarked to the French labor market and determined by their qualifications, some who come from higher-income countries are eligible for additional money. An MSF representative said this was out of recognition that some international staffers on short-term assignments might have long-term financial commitments back home: mortgages, taxes, things like that. Since Switzerland is more expensive than Congo, for instance, a Swiss expatriate would receive more compensation than a Congolese expatriate — even though they're doing the same job, in the same place.
This reinforces my point. If you have access to local doctors or doctors willing to work for less, why not use them instead of more expensive ones. The MSF should not engage in long-term activities. A separate organization should be set up to manage longer term projects.
'Do you know that there is an old lady in Europe who is donating the money that is paying your salary?'
Let me describe a different act of charity. When my son was in cub scouts he had the opportunity to go on a camping weekend. It cost money to attend but I wanted him to have the experience and the memories so I had no hesitation at all. Meanwhile I learned that two other boys in his pack were not going because their mother couldn't afford the expense. I privately when to the leader of the group and paid for their inclusion on the stipulation that no one was told that I had paid for them. Charity also comes attached with an obligation. If you receive charity and know the person that you received it from you become "beholden" to that person. If it is anonymous, you can accept it with no strings attached.
It is entirely possible that there are little old ladies who have donated this money with the expectation that it will be put to use in its original purpose. More likely the money is coming from corporate sponsorship. It would be far better that the money was allocated to an organization run on a different philosophy.
During the world's worst Ebola outbreak, which took place in West Africa from 2014 to 2016, national staffers in Sierra Leone were given approximately $16 a month to spend on medical care, barely enough to cover one simple doctor's visit. They also had access to a small staff clinic that was restricted in what it could provide — no fever or pain medicine, no physical checks — because of the high risk of infection. When national staffers contracted the disease, they were treated in the same clinic where they worked. Meanwhile, international staff members who contracted Ebola were airlifted to better hospitals — a common practice for all expatriates working for international organizations, including USAID and the World Health Organization.
I can understand how international staff were able to leave the country to go to better hospitals because the ones I am aware of returned to their own countries or countries they had the right to visit. Where could natives of Sierra Leone go. Their nations hospitals might not have been able to treat them effectively and I am uncertain of which countries would allow them in on their passports. Those are the realities, but it goes to show that not only is the MSF shouldn't devote themselves to long-term projects, but their ability to safely manage short term emergencies like Ebola outbreaks are questionable as well.