BMJ No 7120 Volume 315
News Saturday 29 November 1997
Médecins Sans Frontières faces new challenges
The international president of Médecins Sans Frontières, Doris Schopper, tells Hilary Bower that she wants her organisation to have a louder voice in humanitarian issues. She hopes to do this without losing the spontaneity, individual commitment, and creativity of MSF
Non-governmental health organisations (NGOs) have burgeoned in recent years and none more so than Médecins Sans Frontières (MSF). From a single French branch with a handful of people in 1971, MSF now has branches in 19 countries and sends 2400 people on operations each year to work with 15,000 local staff.
But the challenges that Doris Schopper, the organisation's international president, foresees are not restricted to questions of size and logistics. Along with those running other NGOs, she faces the pressing task of redefining the role of voluntary organisations in a rapidly changing political and social environment.
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One of the most frightening changes is the increasing climate of insecurity in which volunteers work. This loss of respect for the neutrality of humanitarian work is due partly to the disappearance of the division between East and West blocs and the waves of internal wars in recent years, and partly to the increasing need for voluntary workers to speak out over human rights abuses. She also points her finger squarely at governments whose underlying economic interests undermine their duty to uphold the provisions of the Geneva convention. "The situation in Zaire and what is happening with the commission of inquiry is a perfect example of the lack of real willingness to uphold human rights. If there were, the European Union and the Americans would say, 'we will give no aid money as long as you do not let this commission do its work.' But they don't say this, because they have economic interests. Trying to create a secure environment not only for NGOs but for the local people we are working with, and the populations we are trying to help, is a big problem for us all. It's very important that we give a clear signal to whichever groups put humanitarian agencies in an insecure situation that we are not split, that we are all together in our response." |  | |
| Doris Schopper knows voluntary organisations need to change |
Intertwined with the security factor, she says, are the increasing problems of getting access to populations that need help. She points to situations such as Rwanda, where 200,000 people died in refugee camps because aid organisations were denied access.
But it is not only politics that prompts questioning of future directions. The shape of the health crises facing NGOs is also changing.
In her current role as public health adviser to the canton of Geneva, Ms Schopper has also been a driving force in developing AIDS control programmes in Africa. "We are seeing a whole lot of problems that nobody ever thought about in the 1970s. There are new epidemics such as AIDS, re-emerging epidemics like tuberculosis and meningitis that can now spring up with a vengeance at any time due to the high mobility in the world. There is also the huge issue of rapid urbanisation and urban slums, which 10 to 15 years ago were simply not there."
Another factor is that despite the World Health Organisation's Health for All campaign it is becoming increasingly clear that some governments will not be able to provide health care for their population.
As a result, NGOs are having to redefine what an emergency is. "What we are talking about is helping populations in danger - and there is a whole spectrum from emergency intervention and war time situations to helping people get over the conflict and to reconstruct functioning health services. There are also the chronic crisis situations, such as urban slums. For this a medium term approach is needed which tries to help people set up services that can then continue beyond an MSF presence."
Resources must be focused
While such individual operations remain the driving force of MSF's international branches, Ms Schopper is also adamant that the organisation should focus its resources and experience on some international health issues that other groups are not taking on. "A lot of things have been done separately. Now we really need to pull together our experience and ask what are the main areas in which we want to be able to intervene really strongly."
An example of this is MSF's decision to throw its weight behind the growing problem of access to drugs in developing countries.
In a recent case, intensive lobbying and negotiations with manufacturers stopped a plan to cease production of the antibiotic chloramphenicol - a drug vital for treating meningitis in developing countries but not used in developed countries.
MSF has also intervened to protect access and reasonable pricing when drugs commonly used in the developing world are suddenly discovered to have a new use in developed countries. "Issues like this are central to our everyday activities but do not make the headlines at all. You can't get care to people if you don't first of all have access to drugs and then have access to drugs which are of good quality and are a reasonable price."
Elected as international president for the second time in three years, Ms Schopper has the backing of the independent branches of MSF in her drive to give the organisation a louder voice on humanitarian issues. The challenge is to do this without losing the spontaneity, individual commitment, and creativity that has built the organisation.
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