Médecins Sans Frontières - Wikipedia

Médecins Sans Frontières - Wikipedia
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Humanitarian medical care organisation
Not to be confused with
Médecins du Monde
Médecins Sans Frontières
Founded
22 December 1971
; 54 years ago
1971-12-22
Founded at
Paris, France
Type
International non-governmental organisation
Focus
Humanitarian aid
Headquarters
Global
Geneva
Centres
Amsterdam (OCA)
Barcelona-Athens (OCBA)
Brussels (OCB)
Paris (OCP)
Geneva (OCG)
West and Central Africa (WaCA)
Region served
Worldwide
International President
Javid Abdelmoneim
CEO
Tirana Hassan
Main organ
International General Assembly
Revenue
€2.36 billion
(2024)
Employees
67,000
Website
www
.msf
.org
Introduction to Médecins Sans Frontières (Doctors Without Borders)
Médecins Sans Frontières
MSF
; pronounced
[medsɛ̃
sɑ̃
fʁɔ̃tjɛʁ]
), French for
Doctors Without Borders
, is a
charity
that provides
humanitarian
medical care.
It is a
non-governmental organisation
(NGO) of French origin known for its projects in conflict zones and in
countries
affected by
endemic diseases
The organisation provides care for
diabetes
drug-resistant infections
HIV/AIDS
hepatitis C
tropical
and
neglected
diseases,
tuberculosis
vaccines
and
COVID-19
. In 2024, the charity was active in more than 75 countries with over 67,000 personnel; mostly local doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers, and administrators.
Private donors provide about 98% of the organisation's funding, giving MSF an annual income of approximately EUR 2.36 billion.
MSF was founded in 1971, in the aftermath of the
Biafran
famine of the
Nigerian Civil War
, by a small group of French doctors and journalists who sought to expand accessibility to
medical care
across national boundaries and irrespective of
race
religion
, creed or political affiliation.
MSF's principles and operational guidelines are highlighted in its Charter,
the Chantilly Principles, and the later La Mancha Agreement.
Governance is addressed in Section 2 of the Rules portion of this final document. MSF has an associative structure where operational decisions are made, independently, by the six operational centres (
Amsterdam
Barcelona
Athens
Brussels
Geneva
Paris
and
West and
Central Africa
– with a headquarter office in
Abidjan
, Ivory Coast). Common policies on core issues are coordinated by the International Council, in which each of the 24 sections (national offices) is represented. The International Council meets in Geneva, Switzerland, where the International Office, which coordinates international activities common to the operational centres, is based.
MSF has
general consultative status with the United Nations Economic and Social Council
. It received the 1999
Nobel Peace Prize
in recognition of its members' continued efforts to provide medical care in acute crises, as well as raising international awareness of potential humanitarian disasters.
James Orbinski
, who was the president of the organisation at the time, accepted the prize on behalf of MSF. Prior to this, MSF also received the 1996
Seoul Peace Prize
Christos Christou
succeeded
Joanne Liu
as international president in June 2019.
History
edit
1967 to 1970 – Biafra
edit
A child with
kwashiorkor
during the
Nigerian Civil War
During the
Nigerian Civil War
of 1967 to 1970, the Nigerian military formed a
blockade
around the nation's newly
independent
south-eastern region,
Biafra
. At this time, France was one of the few major countries supportive of the Biafrans (the United Kingdom, the
Soviet Union
and the United States sided with the Nigerian government), and the conditions within the blockade were unknown to the world. A number of French doctors volunteered with the French
Red Cross
to work in hospitals and feeding centers in besieged Biafra.
One of the co-founders of the organisation was
Bernard Kouchner
, who later had a career in French politics, rising to the position of
Minister for Europe and Foreign Affairs
, which he held 2007–2010.
citation needed
After entering the country, the volunteers, in addition to Biafran
health workers
and hospitals, were subjected to attacks by the
Nigerian Armed Forces
, and witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticised the Nigerian government and the Red Cross for their seemingly complicit behaviour. These doctors concluded that a new aid organisation was needed that would ignore political/religious boundaries and prioritise the welfare of survivors.
Apart from Nigeria, MSF exists in several African countries including Benin, Zambia, Uganda, Kenya, South Africa, Rwanda, Sudan, Sierra Leone, and others.
1971 establishment
edit
The
Groupe d'intervention médicale et chirurgicale en urgence
("Emergency Medical and Surgical Intervention Group") was formed in 1971 by French doctors who had worked in Biafra, to provide aid and to emphasize the importance of survivors' rights. At the same time,
Raymond Borel
, the editor of the French
medical journal
TONUS
, had started a group called
Secours Médical Français
("French Medical Relief") in response to the
1970 Bhola cyclone
, which killed at least 625,000 in
East Pakistan
(now Bangladesh). Borel had intended to recruit doctors to provide aid to survivors of natural disasters. On 22 December 1971, the two groups of colleagues merged to form
Médecins Sans Frontières
(Doctors Without Borders).
10
MSF's first mission was to the Nicaraguan capital,
Managua
, where a
1972 earthquake
had destroyed most of the city and killed between 10,000 and 30,000 people.
11
The organisation, today known for its quick response in an emergency, arrived three days after the Red Cross had set up a relief mission. On 18 and 19 September 1974,
Hurricane Fifi
caused major flooding in Honduras and killed thousands of people (estimates vary), and MSF set up its first long-term medical relief mission.
12
Between 1975 and 1979, after
South Vietnam
had fallen to
North Vietnam
, millions of Cambodians immigrated to Thailand to avoid the
Khmer Rouge
13
In response, MSF set up its first
refugee camp
missions in Thailand.
10
When Vietnam withdrew from Cambodia in 1989, MSF started long-term relief missions to help survivors of
the mass killings
and reconstruct the country's health care system.
14
Although its missions to Thailand to help victims of war in Southeast Asia could arguably be seen as its first wartime mission, MSF saw its first mission to a true war zone, including exposure to hostile fire, in 1976. MSF spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in Lebanon, during the
Lebanese Civil War
, and established a reputation for its neutrality and willingness to work under fire. Throughout the war, MSF helped both
Christian
and
Muslim soldiers
alike, helping whichever group required the most medical aid at the time. In 1984, as the situation in Lebanon deteriorated further and security for aid groups was minimised, MSF withdrew its volunteers.
citation needed
Original founders
edit
Jacques Bérès
Philippe Bernier
Raymond Borel
Jean Cabrol
Marcel Delcourt
Xavier Emmanuelli
Pascal Grellety Bosviel
Gérard Illiouz
Bernard Kouchner
Gérard Pigeon
Vladan Radoman
Max Récamier
Louis Schittly
1970s
edit
Claude Malhuret
was elected as the new president of Médecins Sans Frontières in 1977, and soon after debates began over the future of the organisation. In particular, the concept of
témoignage
("witnessing"), which refers to speaking out about the suffering that one sees as opposed to remaining silent,
15
was being opposed or played down by Malhuret and his supporters. Malhuret thought MSF should avoid criticism of the governments of countries in which they were working, while Kouchner believed that documenting and broadcasting the suffering in a country was the most effective way to solve a problem.
In 1979, after four years of refugee movement from South Vietnam and the surrounding countries by foot and
by boat
, French intellectuals made an appeal in
Le Monde
for "A Boat for Vietnam", a project intended to provide medical aid to the refugees. Although the project did not receive support from the majority of MSF, some, including later Minister
Bernard Kouchner
, chartered a ship called
L'Île de Lumière
("The Island of Light"), and, along with doctors, journalists and photographers, sailed to the
South China Sea
and provided some medical aid to the boat people. The splinter organisation that undertook this,
Médecins du Monde
, later developed the idea of
humanitarian intervention
as a duty, in particular on the part of Western nations such as France.
16
In 2007 MSF clarified that for nearly 30 years MSF and Kouchner have had public disagreements on such issues as the right to intervene and the use of armed force for humanitarian reasons. Kouchner is in favour of the latter, whereas MSF stands up for an impartial humanitarian action, independent from all political, economic and religious powers.
17
1980s
edit
In 1982, Malhuret and
Rony Brauman
(who became the organisation's president in 1982) brought increased financial independence to MSF by introducing fundraising-by-mail to better collect donations. The 1980s also saw the establishment of the other operational sections from MSF-France (1971): MSF-Belgium (1980), MSF-Switzerland (1981), MSF-Holland (1984), and MSF-Spain (1986). MSF-Luxembourg was the first support section, created in 1986. The early 1990s saw the establishment of the majority of the support sections: MSF-Greece (1990), MSF-USA (1990), MSF-Canada (1991), MSF-Japan (1992), MSF-UK (1993), MSF-Italy (1993), MSF-Australia (1994), as well as Germany, Austria, Denmark, Sweden, Norway, and Hong Kong (MSF-UAE was formed later).
10
18
Malhuret and Brauman were instrumental in professionalising MSF. In December 1979, after the
Soviet army had invaded Afghanistan
, field missions were immediately set up to provide medical aid to the
mujahideen
, and in February 1980, MSF publicly denounced the
Khmer Rouge
. During the
1983–1985 famine in Ethiopia
, MSF set up nutrition programmes in the country in 1984, but was expelled in 1985 after denouncing the abuse of international aid and the forced resettlements. MSF's explicit attacks on the Ethiopian government led to other NGOs criticizing their abandonment of their supposed neutrality and contributed to a series of debates in France around humanitarian ethics.
19
20
The group also set up equipment to produce clean
drinking water
for the population of
San Salvador
, capital of El Salvador, after 10 October 1986 earthquake that struck the city.
10
21
1990s
edit
In 1990, MSF first entered Liberia to help civilians and refugees affected by the
Liberian Civil War
22
Constant fighting throughout the 1990s and the
Second Liberian Civil War
have kept MSF volunteers actively providing nutrition, basic health care, and mass vaccinations, and speaking out against attacks on hospitals and feeding stations, especially in
Monrovia
23
Field missions were set up to provide relief to
Kurdish
refugees who had survived the
al-Anfal Campaign
, for which evidence of atrocities was being collected in 1991.
24
1991 also saw the beginning of the
civil war
in
Somalia
, during which MSF set up field missions in 1992 alongside a UN peacekeeping mission. Although the UN-aborted operations by 1993, MSF representatives continued with their relief work, running clinics and hospitals for civilians.
25
MSF first began work in
Srebrenica
(in Bosnia and Herzegovina) as part of a UN convoy in 1993, one year after the
Bosnian War
had begun. The city had become surrounded by the
Bosnian Serb Army
and, containing about 60,000
Bosniaks
, had become an enclave guarded by a
United Nations Protection Force
. MSF was the only organisation providing medical care to the surrounded civilians, and as such, did not denounce the genocide for fear of being expelled from the country (it did, however, denounce the lack of access for other organisations). MSF was forced to leave the area in 1995 when the Bosnian Serb Army captured the town. 40,000
Bosniak
civilian inhabitants were deported, and approximately 7,000 were killed in mass executions.
26
Rwandan genocide
edit
When the
genocide in Rwanda
began in April 1994, some delegates of MSF working in the country were incorporated into the
International Committee of the Red Cross
(ICRC) medical team for protection. Both groups succeeded in keeping all main hospitals in Rwanda's capital
Kigali
operational throughout the main period of the genocide. MSF, together with several other aid organisations, had to leave the country in 1995, although many MSF and ICRC volunteers worked together under the ICRC's rules of engagement, which held that neutrality was of the utmost importance. These events led to a debate within the organisation about the concept of balancing neutrality of humanitarian aid workers against their witnessing role. As a result of its Rwanda mission, the position of MSF with respect to neutrality moved closer to that of the ICRC, a remarkable development in the light of the origin of the organisation.
27
Aerial photograph of a Mihanda,
Zaire
refugee camp
in 1996. Pictured are 500+ tents set up in the
Mitumba Mountains
The ICRC lost 56 and MSF lost almost one hundred of their respective local staff in Rwanda, and MSF-France, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a
French military
intervention stop the genocide. MSF-France introduced the slogan "One cannot stop a genocide with doctors" to the media, and the controversial
Opération Turquoise
followed less than one month later.
10
This intervention directly or indirectly resulted in movements of hundreds of thousands of Rwandan refugees to
Zaire
and Tanzania in what became known as the
Great Lakes refugee crisis
, and subsequent cholera epidemics, starvation and more mass killings in the large groups of civilians. MSF-France returned to the area and provided medical aid to refugees in
Goma
28
At the time of the genocide, competition between the medical efforts of MSF, the ICRC, and other aid groups had reached an all-time high,
29
but the conditions in Rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. The
Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes
was created by the ICRC in 1994 to provide a framework for humanitarian missions and MSF is a signatory of this code.
30
The code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments.
31
MSF has since still found it necessary to condemn the actions of governments, such as in
Chechnya
in 1999,
32
but has not demanded another military intervention since then.
10
2020s
edit
Accusations of racism
edit
More than a thousand staffers accused the charity of white supremacy when they voiced their concerns in a 2020 petition. One staffer from Cameroon detailed her experiences with racism from the group's leaders. Many concerns involved different treatment of expatriate staff from Europe and North America, who are typically white, compared to national staff. In an interview with NPR, the president of the organisation acknowledged Doctors Without Borders was founded in racism and pledged to do better.
33
Snakebite prioritisation in WHO
edit
MSF played an important role for including snakebite as a WHO Category A
Neglected Tropical Disease
(NTD) status in, a WHO resolution and development of global strategy to decrease burden of snakebite.
34
MSF highlighted the scarcity of anti-venom in Africa due to stoppage of manufacturing and brought urgency to the scenario and led media advocacy efforts.
34
Access to medicine campaign
edit
On June 20, 2024, MSF announced closing down its access-to-medicines campaign focused on enabling access to medicines in resource limited settings.
35
MSF plans to replace the campaign with a new effort that will focus on products, like medicines and vaccines, that MSF needs for its own relief efforts.
35
Several advocates have criticized this move including the
Treatment Action Group
36
Activities by location
edit
Countries where MSF had missions in 2015
In 1999, the organisation spoke out about the lack of humanitarian support in Kosovo and Chechnya, having set up field missions to help civilians affected by the respective political situations. Although MSF had worked in the Kosovo region since 1993, the onset of the
Kosovo War
prompted the movement of tens of thousands of refugees, and a decline in suitable living conditions. MSF provided shelter, water and health care to civilians affected by
NATO's strategic bombing campaigns
37
A serious crisis within MSF erupted in connection with the organisation's work in Kosovo when the Greek section of MSF was expelled from the organisation. The Greek MSF section had gained access to Serbia at the cost of accepting Serb government imposed limits on where it could go and what it could see – terms that the rest of the MSF movement had refused.
38
A non-MSF source alleged that the exclusion of the Greek section happened because its members extended aid to both Albanian and Serbian civilians in Pristina during NATO's bombing.
39
The rift was healed only in 2005 with the re-admission of the Greek section to MSF.
A similar situation was found in Chechnya, whose civilian population was largely forced from their homes into unhealthy conditions and subjected to the violence of the
Second Chechen War
40
MSF has been working in Haiti since 1991, but since President
Jean-Bertrand Aristide
was forced from power, the country has seen a large increase in civilian attacks and rape by armed groups. In addition to providing surgical and psychological support in existing hospitals – offering the only free surgery available in
Port-au-Prince
– field missions have been set up to rebuild water and waste management systems and treat survivors of major flooding caused by
Hurricane Jeanne
; patients with HIV/AIDS and malaria, both of which are widespread in the country, also receive better treatment and monitoring.
41
As a result of 12 January
2010 Haiti earthquake
, reports from Haiti indicated that all three of the organisation's hospitals had been severely damaged; one collapsing completely and the other two having to be abandoned.
42
Following the quake, MSF sent about nine planes loaded with medical equipment and a field hospital to help treat the victims. However, the landings of some of the planes had to be delayed due to the massive number of humanitarian and military flights coming in.
43
The
Kashmir conflict
in
North India
resulted in a more recent MSF intervention (the first field mission was set up in 1999) to help civilians displaced by fighting in
Jammu and Kashmir
, as well as in
Manipur
. Psychological support is a major target of missions, but teams have also set up programmes to treat tuberculosis, HIV/AIDS and malaria.
44
Mental health support has been of significant importance for MSF in much of southern Asia since the
2004 Indian Ocean earthquake
45
MSF went through a long process of self-examination and discussion in 2005–2006. Many issues were debated, including the treatment of "nationals" as well as "fair employment" and self-criticism.
46
MSF issued a statement for safe abortion following
Dobbs v. Jackson Women's Health Organization
47
Sub-Saharan Africa
edit
Further information:
AIDS in Africa
An MSF outpost in
Darfur
(2005)
MSF has been active in a large number of African countries for decades, sometimes serving as the sole provider of health care, food, and water. Although MSF has consistently attempted to increase media coverage of the situation in Africa to increase international support, long-term field missions are still necessary. Treating and educating the public about
HIV/AIDS
in
sub-Saharan Africa
, which sees the most deaths and cases of the disease in the world,
48
is a major task for volunteers. Of the 14.6 million people in need of anti-retroviral treatment the WHO estimated that only 5.25 million people were receiving it in developing countries, and MSF continues to urge governments and companies to increase research and development into HIV/AIDS treatments to decrease cost and increase availability.
49
Sierra Leone
edit
In the late 1990s, MSF missions were set up to treat tuberculosis and
anaemia
in residents of the
Aral Sea
area, and look after civilians affected by drug-resistant disease, famine, and epidemics of cholera and AIDS.
50
They vaccinated 3 million Nigerians against
meningitis
during an epidemic in 1996
51
and denounced the
Taliban's neglect of health care for women
in 1997.
52
Arguably, the most significant country in which MSF set up field missions in the late 1990s was Sierra Leone, which was involved in a
civil war
at the time. In 1998, volunteers began assisting in surgeries in
Freetown
to help with an increasing number of
amputees
, and collecting statistics on civilians (men, women and children) being attacked by large groups of men claiming to represent
ECOMOG
. The groups of men were travelling between villages and systematically chopping off one or both of each resident's arms, raping women, gunning down families, razing houses, and forcing survivors to leave the area.
53
Long-term projects following the end of the civil war included psychological support and
phantom limb
pain management.
54
Sudan
edit
Since 1979, MSF has been providing medical humanitarian assistance in
Sudan
, a nation plagued by starvation and the
civil war
, prevalent malnutrition and one of the highest maternal mortality rates in the world. In March 2009, it is reported that MSF has employed 4,590 field staff in Sudan
55
tackling issues such as armed conflicts, epidemic diseases, health care and social exclusion. MSF's continued presence and work in
Sudan
is one of the organisation's largest interventions. MSF provides a range of health care services including nutritional support, reproductive healthcare, kala-azar treatment, counselling services and surgery to the people living in
Sudan
56
Common diseases prevalent in
Sudan
include
tuberculosis
kala-azar
also known as
visceral leishmaniasis
meningitis
measles
cholera
, and
malaria
Kala-azar in Sudan
edit
Kala-azar
, also known as
visceral leishmaniasis
, has been one of the major health problems in
Sudan
. After the Comprehensive Peace Agreement between North and
Southern Sudan
on 9 January 2005, the increase in stability within the region helped further efforts in healthcare delivery. Médicins Sans Frontières tested a combination of
sodium stibogluconate
and
paromomycin
, which would reduce treatment duration (from 30 to 17 days) and cost in 2008.
57
In March 2010, MSF set up its first kala-azar treatment centre in Eastern Sudan, providing free treatment for this otherwise deadly disease. If left untreated, there is a fatality rate of 99% within 1–4 months of infection.
58
Since the treatment centre was set up, MSF has cured more than 27,000 kala-azar patients with a success rate of approximately 90–95%.
59
There are plans to open an additional kala-azar treatment centre in
Malakal
, Southern Sudan, to cope with the overwhelming number of patients that are seeking treatment. MSF has been providing necessary medical supplies to hospitals and training Sudanese health professionals to help them deal with kala-azar.
60
MSF, Sudanese Ministry of Health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of kala-azar.
61
Research on its cures and vaccines are currently being conducted.
61
In December 2010, South Sudan was hit with the worst outbreak of kala-azar in eight years.
55
The number of patients seeking treatment increased eight-fold as compared to the year before.
55
Health care infrastructure in Sudan
edit
Sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between
North Sudan
and
South Sudan
55
MSF medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations.
55
The situation of poor infrastructure in the South was aggravated by the civil war and resulted in the worsening of the region's appalling health indicators. An estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth.
55
Malnutrition
and disease outbreaks are perennial concerns as well. In 2011, MSF clinic in
Jonglei State
, South Sudan, was looted and attacked by raiders.
62
Hundreds, including women and children were killed. Valuable items including medical equipment and drugs were lost during the raid and parts of the MSF facilities were destroyed in a fire.
62
The incident had serious repercussions as MSF is the only primary health care provider in this part of Jonglei State.
62
Democratic Republic of the Congo
edit
Although active in the Congo region of Africa since 1985, the
First
and
Second Congo War
brought increased violence and instability to the area. MSF has had to evacuate its teams from areas such as around
Bunia
, in the
Ituri district
due to extreme violence,
63
but continues to work in other areas to provide food to tens of thousands of displaced civilians, as well as treat survivors of mass rapes and widespread fighting.
64
The treatment and possible vaccination against diseases such as
cholera
measles
polio
Marburg fever
sleeping sickness
65
HIV/AIDS
, and
bubonic plague
is also important to prevent or slow down epidemics.
66
Uganda
edit
MSF has been active in Uganda since 1980, and provided relief to civilians during the country's guerrilla war during the
Second Obote Period
. However, the formation of the
Lord's Resistance Army
saw the beginning of a long campaign of violence in northern Uganda and southern Sudan. Civilians were subjected to mass killings and rapes, torture, and abductions of children, who would later serve as sex slaves or
child soldiers
. Faced with more than 1.5 million people displaced from their homes, MSF set up relief programmes in
internally displaced person
(IDP) camps to provide clean water, food and sanitation. Diseases such as
tuberculosis
, measles, polio, cholera,
ebola
, and HIV/AIDS occur in epidemics in the country, and volunteers provide vaccinations (in the cases of measles and polio) and/or treatment to the residents. Mental health is also an important aspect of medical treatment for MSF teams in Uganda since most people refuse to leave the IDP camps for constant fear of being attacked.
67
68
Ivory Coast
edit
MSF first camp set up a field mission in Côte d'Ivoire in 1990, but ongoing violence and the
2002 division
of the country by rebel groups and the government led to several massacres, and MSF teams have even begun to suspect that an ethnic cleansing is occurring.
69
Mass measles vaccinations,
70
tuberculosis treatment and the re-opening of hospitals closed by fighting are projects run by MSF, which is the only group providing aid in much of the country.
69
MSF has strongly promoted the use of
contraception
in Africa.
West African Ebola outbreak
edit
MSF staff member adjusts Dr. Joel Montgomery, Team Lead for CDC's Ebola Response Team in Liberia, goggles before Montgomery enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on 17 August.
During the Ebola outbreak in West Africa in 2014, MSF met serious medical demands largely on its own, after the organisation's early warnings were largely ignored.
71
Burundi
edit
MSF-Burundi has aided in attending to casualties suffered in the
2019 Burundi landslides
72
Asia
edit
Sri Lanka
edit
MSF is involved in Sri Lanka, where a
26-year civil war
ended in 2009 and MSF has adapted its activities there to continue its mission. For example, it helps with physical therapy for patients with spinal cord injuries.
73
It conducts counseling sessions, and has set up an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries".
74
Cambodia
edit
MSF first provided medical help to civilians and refugees who have escaped to camps along the Thai-Cambodian border in 1979. Due to long decades of war, a proper
health care
system in the country was severely lacking.
In 1999, Cambodia was hit with a malaria epidemic. The situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. Counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic.
75
This has prompted efforts by MSF to set up and fund a malaria outreach project and utilise Village Malaria Workers.
76
MSF also introduced a switching of first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally.
77
Cambodia is one of the hardest hit HIV/AIDS countries in Southeast Asia. In 2001, MSF started introducing antiretroviral (ARV) therapy to AIDS patients for free. This therapy prolongs the patients' lives and is a long-term treatment.
78
In 2002, MSF established chronic diseases clinics with the Cambodian Ministry of Health in various provinces to integrate HIV/AIDS treatment, alongside hypertension, diabetes, and arthritis which have high prevalence rate. This aims to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic in contrast to a HIV/AIDS specialised treatment centre.
79
MSF also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people.
80
MSF introduced a community-based tuberculosis programme in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. In partnership with local health authorities and other NGOs, MSF encouraged decentralized clinics and rendered localized treatments to more rural areas from 2006.
81
Since 2007, MSF has extended general health care, counselling, HIV/AIDS and TB treatment to prisons in Phnom Penh via mobile clinics.
82
However, poor sanitation and lack of health care still prevails in most Cambodian prisons as they remain as some of the world's most crowded prisons.
83
In 2007, MSF worked with the Cambodian Ministry of Health to provide psychosocial and technical support in offering pediatric HIV/AIDS treatment to affected children.
84
MSF also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007,
85
which had more than 40,000 people hospitalized, killing 407 people, primarily children.
86
In 2010, Southern and Eastern provinces of Cambodia were hit with a cholera epidemic and MSF responded by providing medical support that were adapted for usage in the country.
87
Cambodia is one of 22 countries listed by WHO as having a high burden of tuberculosis. WHO estimates that 64% of all Cambodians carry the tuberculosis mycobacterium. Hence, MSF has since shifted its focus away from HIV/AIDS to tuberculosis, handing over most HIV-related programs to local health authorities.
88
Middle East and North Africa
edit
Libya
edit
The
2011 Libyan civil war
prompted efforts by MSF to set up a hospital and mental health services to help locals affected by the conflict. The fighting created a backlog of patients that needed surgery. With parts of the country slowly returning to livable, MSF started working with local health personnel to address the needs. The need for psychological counseling increased and MSF set up mental health services to address the fears and stress of people living in tents without water and electricity. As of late 2016, MSF was the only International Aid organisation with actual presence in the country.
MSF was ordered in November 2025 to leave Libya without any apparent explanation.
89
Search and Rescue in the Mediterranean Sea
edit
MSF is providing Maritime
Search and rescue
(SAR) services on the Mediterranean Sea to save the lives of migrants attempting to cross with unseaworthy boats. The Mission started in 2015 after the EU ended its major SAR
operation Mare Nostrum
, severely diminishing much needed SAR capacities in the Mediterranean.
90
Throughout the mission MSF has operated its own vessels like the
Bourbon Argos
(2015–2016),
Dignity 1
(2015–2016) and
VOS Prudence
(2016–2017). MSF has also provided medical teams to support other NGOs and their ships like the
MOAS
Phoenix
(2015) or the
Aquarius
(2017–2018) and
Ocean Viking
(2019–2020) with
SOS Méditerranée
91
and
Mediterranea Saving Humans
. In August 2017 MSF decided to suspend the activities of the
VOS Prudence
protesting restrictions and threats by the Libyan "Coast Guard".
92
In December 2018 MSF and SOS Méditerranée were forced to end operations of the
Aquarius
, at that date the last remaining vessel supported by MSF. This came after attacks by EU states that stripped the vessel of its registration and produced criminal accusations against MSF. Up to then 80,000 people had been rescued or assisted since the beginning of the mission.
93
Operations resumed with
Ocean Viking
in July 2019, but the ship was seized in Sicily in July 2020.
94
In May 2021, MSF returned to refugee rescue operations in the Mediterranean with a new vessel, the
Geo Barents
95
94
Within a month this resulted in the rescue of some 400 people.
96
In December 2024 MSF announced the suspension of further operations of the vessel. During the 2023 and 2024, due to bureaucratic blockages by the Italian government, it had spent some 160 days in port.
97
98
99
In November 2025, the 20m-long vessel
Oyvon
began in service as a replacement for the larger
Geo Barents
, with a crew of 10 MSF activists under the German flag.
100
Yemen
edit
See also:
Airstrikes on hospitals in Yemen
MSF is involved in trying to help with the humanitarian crisis caused by the
Yemeni Civil War
. The organisation operates eleven hospitals and health centres in Yemen and provides support to another 18 hospitals or health centres.
101
According to MSF, since October 2015, four of its hospitals and one ambulance have been destroyed by Saudi-led coalition airstrikes.
102
In August 2016, an airstrike on Abs hospital killed 19 people, including one MSF staff member, and wounded 24.
101
Europe
edit
The Netherlands
edit
In August and September 2022, MSF provided medical care to asylum seekers staying outside the overcrowded migration centre in
Ter Apel
, the Netherlands.
103
Italy
edit
MSF has been active in Italy since 1999, providing comprehensive assistance – including humanitarian, medical, psychological, and socio-health support – to migrants, asylum seekers, and refugees across the country. Over the years, its efforts have spanned various initiatives, from aiding migrant arrivals to operating within reception centers and informal settlements in different regions of Italy.
104
105
As of Spring 2024, MSF is involved in projects across three key locations in Italy.
106
In
Calabria
, it delivers medical and psychological aid during migrant arrivals and ensures ongoing care within the region's reception centers. In
Ventimiglia
, situated on the Italo-French border, MSF operates a mobile clinic specifically catering to migrants passing through the area. Meanwhile, in
Palermo
, in collaboration with local health authorities, MSF has launched a program to support foreign individuals who have survived torture and other deliberate acts of violence.
107
108
Moreover, MSF Italy possesses the capability to provide psychological first aid to individuals who have undergone particularly traumatic experiences during their
Mediterranean Sea
crossings.
104
Organisation of activities
edit
Before a field mission is established in a country, an MSF team visits the area to determine the nature of the humanitarian emergency, the level of safety in the area and what type of aid is needed (this is called an "exploratory mission").
Medical aid is the main objective of most missions, although some missions help in such areas as
water purification
and nutrition.
109
Field mission team
edit
MSF logistician in
Nigeria
showing plans
A field mission team usually consists of a small number of coordinators to head each component of a field mission, and a "head of mission". The head of mission usually has the most experience in humanitarian situations of the members of the team, and it is their job to deal with the media, national governments and other humanitarian organisations. The head of mission does not necessarily have a medical background.
Medical volunteers include physicians, surgeons, nurses, and various other specialists. In addition to operating the medical and nutrition components of the field mission, these volunteers are sometimes in charge of a group of local medical staff and provide training for them.
Medical component
edit
Doctors from MSF and the American
CDC
put on protective gear before entering an
Ebola
treatment ward in
Liberia
, August 2014.
Vaccination campaigns are a major part of the medical care provided during MSF missions. Diseases such as
diphtheria
measles
meningitis
tetanus
pertussis
yellow fever
polio
, and
cholera
, all of which are uncommon in developed countries, may be prevented with
vaccination
. Some of these diseases, such as cholera and measles, spread rapidly in large populations living in close proximity, such as in a refugee camp, and people must be immunised by the hundreds or thousands in a short period of time.
110
For example, in
Beira, Mozambique
, in 2004, an experimental cholera vaccine was received twice by approximately 50,000 residents in about one month.
111
An equally important part of the medical care provided during MSF missions is AIDS treatment (with
antiretroviral drugs
), AIDS testing, and education. MSF is the only source of treatment for many countries in Africa, whose citizens make up the majority of people with HIV and AIDS worldwide.
48
Because antiretroviral drugs (ARVs) are not readily available, MSF usually provides treatment for
opportunistic infections
and educates the public on how to slow transmission of the disease.
112
In most countries, MSF increases the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff.
113
When the local staff is overwhelmed, MSF may open new specialised clinics for treatment of an endemic disease or surgery for victims of war. International staff start these clinics but MSF strives to increase the local staff's ability to run the clinics themselves through training and supervision.
114
In some countries, like Nicaragua, MSF provides public education to increase awareness of reproductive health care and
venereal disease
115
Since most of the areas that require field missions have been affected by a natural disaster, civil war, or endemic disease, the residents usually require psychological support as well. Although the presence of an MSF medical team may decrease stress somewhat among survivors, often a team of
psychologists
or
psychiatrists
help people who have depression, survivors of
domestic violence
and those with
substance use disorder
. The doctors may also train local mental health staff.
116
Such cases include
Palestinian refugee camps
, where long-term displacement and geopolitical circumstances have left many residents without long-term purpose or clear strategies for action. Humanitarian actors, like Médecins Sans Frontières, have sometimes responded by proferring coping skills to residents as a humanitarian aim and outcome. In the late 2000s, Médecins Sans Frontières launched a mental health program in
Bourj el-Barajneh
camp in Lebanon, providing sexual and reproductive health services, mental health support, and health promotion activities.
117
118
Nutrition
edit
Often in situations where an MSF mission is set up, there is moderate or severe
malnutrition
as a result of war, drought, or government economic mismanagement. Intentional starvation is also sometimes used during a war as a weapon, and MSF, in addition to providing food, brings awareness to the situation and insists on foreign government intervention. Infectious diseases and
diarrhoea
, both of which cause weight loss and weakening of a person's body (especially in children), must be treated with medication and proper nutrition to prevent further infections and weight loss. A combination of the above situations, as when a civil war is fought during times of drought and infectious disease outbreaks, can create famine.
119
An MSF health worker examines a malnourished child in
Ethiopia
, July 2011.
In emergency situations where there is a lack of nutritious food, but not to the level of a true famine,
protein-energy malnutrition
is most common among young children.
Marasmus
, a form of calorie deficiency, is the most common form of childhood malnutrition and is characterised by severe wasting and often fatal weakening of the immune system.
Kwashiorkor
, a form of calorie and protein deficiency, is a more serious type of malnutrition in young children, and can negatively affect
physical
and
mental development
. Both types of malnutrition can make opportunistic infections fatal.
120
In these situations, MSF sets up
Therapeutic Feeding Centres
for monitoring the children and any other malnourished individuals.
A Therapeutic Feeding Centre (or Therapeutic Feeding Programme) is designed to treat severe malnutrition through the gradual introduction of a special diet intended to promote weight gain after the individual has been treated for other health problems. The treatment programme is split between two phases:
121
Phase 1 lasts for 24 hours and involves basic health care and several small meals of low energy/protein food spaced over the day.
Phase 2 involves monitoring of the patient and several small meals of high energy/protein food spaced over each day until the individual's weight approaches normal.
MSF uses foods designed specifically for treatment of severe malnutrition. During phase 1, a type of therapeutic milk called
F-75
is fed to patients. F-75 is a relatively low energy, low fat/protein milk powder that must be mixed with water and given to patients to prepare their bodies for phase 2.
122
During phase 2, therapeutic milk called
F-100
, which is higher in energy/fat/protein content than F-75, is given to patients, usually along with a peanut butter mixture called
Plumpy'nut
. F-100 and Plumpy'nut are designed to quickly provide large amounts of nutrients so that patients can be treated efficiently.
123
124
Other special food fed to populations in danger of starvation includes
enriched flour
and
porridge
, as well as a high protein biscuit called
BP5
. BP5 is a popular food for treating populations because it can be distributed easily and sent home with individuals, or it can be crushed and mixed with therapeutic milk for specific treatments.
125
Dehydration
, sometimes due to
diarrhoea
or cholera, may also be present in a population, and MSF set up rehydration centres to combat this. A special solution called
Oral Rehydration Solution
(ORS), which contains
glucose
and
electrolytes
, is given to patients to
replace fluids lost
Antibiotics
are also sometimes given to individuals with diarrhoea if it is known that they have cholera or
dysentery
126
Water and sanitation
edit
Clean water is essential for
hygiene
, for consumption and for feeding programmes (for mixing with powdered therapeutic milk or porridge), as well as for preventing the spread of
water-borne disease
127
As such, MSF water engineers and volunteers must create a source of clean water. This is usually achieved by modifying an existing
water well
, by digging a new well and/or starting a water treatment project to obtain clean water for a population. Water treatment in these situations may consist of storage sedimentation,
filtration
and/or
chlorination
depending on available resources.
128
Sanitation is an essential part of field missions, and it may include education of local medical staff in proper
sterilisation
techniques,
sewage treatment
projects, proper
waste disposal
, and education of the population in personal hygiene. Proper wastewater treatment and water sanitation are the best way to prevent the spread of serious water-borne diseases, such as cholera.
129
Simple wastewater treatment systems can be set up by volunteers to protect drinking water from contamination.
130
Garbage disposal could include pits for normal waste and incineration for
medical waste
131
However, the most important subject in sanitation is the education of the local population, so that proper waste and water treatment can continue once MSF has left the area.
Statistics
edit
In order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, data on a number of factors are collected during each field mission. The rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres.
132
Various types of
mortality rates
are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries.
133
By compiling data on the frequency of diseases in hospitals, MSF can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs. For example, the "Meningitis Belt" (sub-Saharan Africa, which sees the most cases of meningitis in the world) has been "mapped" and the meningitis season occurs between December and June. Shifts in the location of the Belt and the timing of the season can be predicted using cumulative data over many years.
134
In addition to epidemiological surveys, MSF also uses population
surveys
to determine the rates of violence in various regions. By estimating the scopes of
massacres
, and determining the rate of kidnappings, rapes, and killings, psychosocial programmes can be implemented to lower the
suicide rate
and increase the sense of security in a population.
135
Large-scale forced migrations
, excessive civilian casualties and massacres can be quantified using surveys, and MSF can use the results to put pressure on governments to provide help, or even expose genocide.
136
MSF conducted the first comprehensive mortality survey in
Darfur
in 2004.
137
However, there may be ethical problems in collecting these statistics.
138
139
Innovation and use of technology
edit
In 2014 MSF partnered with satellite operator
SES
, other NGOs Archemed, Fondation Follereau, Friendship Luxembourg and
German Doctors
, and the
Luxembourg
government in the pilot phase of
SATMED
, a project to use
satellite broadband
technology to bring
eHealth
and
telemedicine
to isolated areas of developing countries. SATMED was first deployed in Sierra Leone in support of the fight against Ebola.
140
Governance and structure
edit
List of international presidents:
141
1991–1992
Rony Brauman
1992 Reginald Moreels
1992–1994
Rony Brauman
1994–1995 Jacques De Milliano
1995–1996 Doris Schopper
1996–1997 Philippe Biberson
1997–1998 Doris Schopper
1998–2000
James Orbinski
2000–2003
Morten Rostrup
2004–2006
Rowan Gillies
2006–2010
Christophe Fournier
2010–2013
Unni Karunakara
2013–2019
Joanne Liu
2019–2025
Christos Christou
2025–Present
Javid Abdelmoneim
In addition to the Geneva global headquarters and five regional operational centers, as of 2025 MSF had national offices as follows:
142
MSF Australia
MSF Austria
MSF Beijing
MSF Belgium
MSF Brazil
MSF Canada
MSF Chile
MSF Colombia
MSF Czech Republic
MSF Denmark
MSF Eastern Africa
MSF Finland
MSF France
MSF Germany
MSF Greece
MSF Holland
MSF Hong Kong
MSF Ireland
MSF Italy
MSF Japan
MSF Lat (Spanish Speaking South America)
MSF Lebanon
MSF Luxembourg
MSF Mexico
MSF New Zealand
MSF Norway
MSF Poland
MSF Singapore
MSF South Africa
MSF South Asia - India
MSF South Asia - Sri Lanka
MSF South Korea
MSF Spain
MSF Sweden
MSF Switzerland
MSF Taiwan
MSF UAE
MSF United Kingdom
MSF Uruguay
MSF United States
MSF West and Central Africa
In-house organisations
edit
Epicentre
edit
In 1986, MSF created Epicentre, an in-house research organisation, to support its activities. Epicentre conducts training, publishes scientific papers and develops new techniques for MSF. It performs epidemiological research, conducts clinical vaccine trials during outbreaks MSF is responding to, experiments on vaccine stability, and analysis of vaccine deployment strategy.
143
Campaign for Access to Essential Medicines
edit
Main article:
Campaign for Access to Essential Medicines
The Campaign for Access to Essential Medicines was initiated in 1999 to increase access to
essential medicines
in developing countries. "Essential medicines" are those drugs that are needed in sufficient supply to treat a disease common to a population.
144
However, most diseases common to populations in developing countries are no longer common to populations in developed countries; therefore,
pharmaceutical companies
find that producing these drugs is no longer profitable and may raise the price per treatment, decrease development of the drug (and new treatments) or even stop production of the drug. MSF often lacks effective drugs during field missions, and started the campaign to put pressure on governments and pharmaceutical companies to increase funding for essential medicines.
In 2006, MSF tried to use its influence to urge the drug maker
Novartis
to drop its case against India's patent law that prevents Novartis from patenting its drugs in
India
. A few years earlier, Novartis also sued
South Africa
to prevent it from importing cheaper
AIDS
drugs.
145
On 1 April 2013, it was announced that the Indian court invalidated Novartis's patent on
imatinib
(Gleevec). This decision makes the drug available via generics on the Indian market at a considerably lower price.
146
In March 2017,
Els Torreele
who had been leading the campaign from 1999 to 2003 returned to MSF as the executive director of the Access Campaign. For the following three years she led a global analysis and advocacy team whose goal was to guarantee that appropriate medicines, vaccines and diagnostics are developed, available, affordable and adapted to people's needs.
147
As of 2022, the most critical subjects of the campaign were rising antimicrobial resistance and outbreaks of epidemic diseases such as Ebola and COVID. Still, a lot of vaccines, diagnostics and medicines were inaccessible for people in need.
148
Security risks to staff
edit
MSF staff are sometimes attacked or kidnapped. In some countries, humanitarian-aid organisations are viewed as helping the enemy. If an aid mission is perceived to be exclusively set up for victims on one side of the conflict, it may come under attack. However, the
war on terrorism
has generated attitudes among some groups in US-occupied countries that non-governmental aid organisations such as MSF are allied with or even work for the
Coalition forces
. Insecurity in cities in Afghanistan and Iraq rose significantly following United States operations, and MSF has declared that providing aid in these countries was too dangerous.
149
The organisation was forced to evacuate its teams from Afghanistan on 28 July 2004,
150
after five staff (Afghans Fasil Ahmad and Besmillah, Belgian Hélène de Beir, Norwegian
Egil Tynæs
, and Dutchman Willem Kwint) were killed on 2 June in an ambush by unidentified militia near
Khair Khāna
in
Badghis Province
151
In June 2007, Elsa Serfass, a staff member with MSF-France, was killed
152
in the Central African Republic and in January 2008, two expatriate staff (Damien Lehalle and Victor Okumu) and a national staff member (Mohammed Bidhaan Ali) were killed in an organised attack
153
in Somalia resulting in the closing of the project.
Arrests and abductions in politically unstable regions can also occur for volunteers, and in some cases, MSF field missions can be expelled entirely from a country.
Arjan Erkel
, Head of Mission in
Dagestan
in the
North Caucasus
, was kidnapped and held hostage in an unknown location by unknown abductors from 12 August 2002 until 11 April 2004. Paul Foreman, head of MSF-Holland, was arrested in Sudan in May 2005 for refusing to divulge documents used in compiling a report on rapes carried out by the pro-government
Janjaweed
militias (see
Darfur conflict
). Foreman cited the privacy of the women involved, and MSF alleged that the Sudanese government had arrested him because it disliked the bad publicity generated by the report.
154
Incidents
edit
See also:
Kunduz hospital airstrike
Below is a partial list of notable incidents of direct violence against MSF staff or facilities, in chronological order:
14 August 2013: MSF announced that it was closing all of its programmes in Somalia due to attacks on its staff by
Al-Shabaab
militants and perceived indifference or
inurement
to this by the governmental authorities and wider society.
155
3 October 2015: Fourteen staff and 28 others died when an MSF hospital
was bombed
by
American forces
during the
Battle of Kunduz
156
On 7 October 2015, US President
Barack Obama
issued an apology.
157
Doctors Without Borders was not satisfied by Obama's apology.
158
27 October 2015: An MSF hospital in
Sa'dah
, Yemen,
was bombed
by the
Saudi Arabia–led military coalition
159
28 November 2015: An MSF-supported hospital was barrel-bombed by a Syrian Air Force helicopter, killing seven and wounding forty-seven people near Homs,
Syria
160
10 January 2016: An MSF-supported hospital in Sa'dah was bombed by the
Saudi Arabia
-led military coalition, killing six people.
161
15 February 2016: Two MSF-supported hospitals in
Idlib District
and
Aleppo
, Syria, were
bombed
, killing at least 20 and injuring dozens of patients and medical personnel.
162
163
Both Russia and the United States denied responsibility or being in the area at the time.
164
28 April 2016: An MSF hospital in Aleppo was bombed, killing 50, including six staff and patients.
165
12 May 2020: an MSF-supported hospital in
Dasht-e-Barchi
Kabul
, Afghanistan, was attacked by an unknown assailant. The attack left 24 people dead and at least 20 more injured.
166
25 June 2021: Three MSF employees were reported killed in
Tigray, Ethiopia
167
18 November 2023: An evacuation convoy of MSF vehicles was attacked in
Gaza, Palestine
during the
Gaza war
, resulting in deaths of two family members of MSF workers with one being a volunteer supporting MSF at
Al-Shifa Hospital
. MSF reported "MSF considers that all elements point to the responsibility of the
Israel Defense Forces
for this attack".
168
Awards
edit
1999 Nobel Peace Prize
edit
James Orbinski
speaking about MSF in 2015
The then president of MSF,
James Orbinski
, gave the Nobel Peace Prize speech on behalf of the organisation. In the opening, he discusses the conditions of the victims of the
Rwandan genocide
and focuses on one of his woman patients:
169
There were hundreds of women, children and men brought to the hospital that day, so many that we had to lay them out on the street and even operate on some of them there. The gutters around the hospital ran red with blood. The woman had not just been attacked with a machete, but her entire body rationally and systematically mutilated. Her ears had been cut off. And her face had been so carefully disfigured that a pattern was obvious in the slashes. She was one among many—living an inhuman and simply indescribable suffering. We could do little more for her at the moment than stop the bleeding with a few necessary sutures. We were completely overwhelmed, and she knew that there were so many others. She said to me in the clearest voice I have ever heard, 'Allez, allez...ummera, ummerasha'—'Go, go...my friend, find and let live your courage.'
— James Orbinski, Nobel acceptance speech for MSF
Orbinski affirmed the organisation's commitment to publicising the issues MSF encountered, stating
170
Silence has long been confused with neutrality, and has been presented as a necessary condition for humanitarian action. From its beginning, MSF was created in opposition to this assumption. We are not sure that words can always save lives, but we know that silence can certainly kill.
— James Orbinski
Other awards
edit
2015
Lasker–Bloomberg Public Service Award
, from the
New York
based
Lasker Foundation
171
2016
Hamdan Award for Volunteers in Humanitarian Medical Services, from Hamdan Medical Award.
172
Other recognition
edit
MSF's "Bracelet of Life", the
Middle Upper Arm Circumference
(MUAC) measuring band, was included in
Pirouette:
Turning Points in Design
, a 2025 exhibition at the
Museum of Modern Art
featuring "widely recognized design icons [...] highlighting pivotal moments in design history."
173
174
175
176
The museum also added MUAC to its
Architecture and Design collection
177
Namesakes
edit
A number of other unrelated non-governmental organisations have adopted names ending in "
Sans Frontières
" or "Without Borders", inspired by
Médecins Sans Frontières
, for example:
Engineers Without Borders
Avocats Sans Frontières
('Lawyers Without Borders'),
Reporters sans frontières
('Reporters Without Borders'),
Payasos Sin Fronteras
('Clowns Without Borders'),
Bibliothèques Sans Frontières
('Libraries Without Borders'), and
Homeopaths Without Borders
The French game show
Jeux Sans Frontières
('Games Without Borders') is older than MSF, being first broadcast in Europe in 1965.
The 2010 video game
Metal Gear Solid: Peace Walker
used Militaires Sans Frontières (MSF) as the player's main base.
Ethical concerns and criticism
edit
See also:
Sexual exploitation and abuse in humanitarian response
Structural racism
, and
Development porn
Questions about the ethical treatment of MSF staff, clients and communities by MSF as a result of some of its policies and practices have arisen, with issues being canvassed by employees, others in the development sector, and the media.
178
MSF has maintained separate employment conditions and pay for its "national staff" (those employed locally for field missions) and its "international staff" (those deployed from regional or national units to field missions in other countries). The international staff tend to hold the senior posts on a mission, with the national staff most often reporting to the senior staff who have come from elsewhere. There are ongoing complaints from national staff that they are treated less favourably, employed on more dangerous tasks, paid considerably less, and are without access to benefits of housing, health care, and other advantages afforded incoming expatriate staff. MSF stated in 2020 that this policy would be reviewed with the intent to eliminate differential treatment. These practices, amongst other concerns, were the catalyst for a 2020 statement by 1,000 of its current and former employees outlining their concerns regarding the organisation's perceived structural racism. Included in the collective staff statement was testimony of personal experiences of racism within MSF, both in the form of adverse treatment in the workplace, and what is perceived as a white supremacist and colonial mindset expressed in the formation and implementation of programmes.
178
179
180
While MSF hires ninety percent of its staff for missions "in-country", the organisation continues to have a preponderance of Europeans in its higher management. Despite the percentage of its international programme coordinators originating from the
Global South
rising from 24 percent to 46 percent over the decade 2012−2022, the international president Christos Christou acknowledged that the highest echelons of MSF were still dominated by those from the Global North. With its headquarters and five operational units located in western Europe, MSF's policies and operations were characterised in the 2020 MSF-staff statement as "Eurocentric".
178
In 2018, there were revelations of
sexual misconduct
by MSF employees, including
sexual harassment
and abuse of patients, local community members or other MSF staff. Nineteen people were fired as a result of MSF's investigations of complaints. The complaints ranged from sexual harassment by MSF colleagues; exploitation of local (and possibly underage or solely "
survival sex
")
sex workers
by field staff, against MSF policy; and disparaging attitudes and remarks from staff regarding the supposed sexual availability of patients or community members, or an expressed intent to barter medical treatment for sex. Nearly all the resulting dismissals related to inter-staff sexual misconduct.
181
182
183
184
185
Another controversy involved images taken without informed consent of vulnerable patients, some of whom were minors without adult guardians. Some images were criticised as exploitative and objectifying. They included a photograph of a mother mourning the death of her baby, with the boy's body visible; child rape survivors and sexual and domestic abuse survivors, with details of their experiences included. Intended to increase awareness of dire conditions prevailing in places where MSF works and the need for their programmes, the images were used on MSF and community websites and in print publications. Licensing of the images were available for sale to image databases. The ethics of exposing devastated or victimised individuals, sometimes with partially identifying information was questioned. Following the criticism, MSF decided to cease use of the images. The removal of the images was in turn also criticised.
186
MSF's funding model has come under scrutiny after
BlackRock
donated $500,000 towards its COVID-19 crisis fund, leading to calls of hypocrisy from staff and other humanitarian organisations.
187
188
189
Decline of medical aid during the Hong Kong protests
edit
On 17 November 2019, Darren Mann, a medical doctor who provided first aid to protesters, wrote in
The Lancet
about the arrest of medics during the
2019 Hong Kong Polytechnic University campus conflict
and that police had issued warnings about the potential use of
live ammunition
190
191
Mann called on the
Red Cross
and Médecins Sans Frontières (MSF) to intervene.
190
191
The Red Cross agreed to send personnel into the
Hong Kong Polytechnic University
campus, while MSF issued a statement on 18 November, claiming that "medical resources and rescue capabilities provided by various sectors of Hong Kong society are sufficient" and declined to offer medical aid.
190
Their statement reportedly triggered online backlash, leading to a wave of donation suspensions.
192
193
194
Multiple celebrities, including
Wong He
Gregory Wong
, and
Gloria Yip
, also responded by cutting their donations.
195
On 19 November,
Hong Kong Inmedia
reported that MSF's hotline could "never get through" and their headquarters was crowded with people intending to cancel their donations.
196
MSF reportedly attempted to reject these suspensions, although they denied such rumors.
190
197
Also on 19 November, MSF sent a four-member team into the university campus to "assess the situation".
198
Apple Daily
columnist
Lee Bat-fong
zh
criticized that MSF only reacted after the widespread donation suspensions, describing their actions as "rushing to the university to patch things up";
199
while pundit
Donald Yu
zh
wrote that, "given Hong Kong's status as the second-largest fundraiser globally for MSF, it was surprising that even in such an advanced society, there was
doublespeak
. It calls into question whether MSF's claims of aid to Africa were exaggerated".
200
The controversy resulted in a 28.2% decrease in the number of donors and a 16.8% drop in donation amounts in the region during 2020.
201
In February 2020, MSF issued a statement to "sincerely apologise for the confusion between what [they] said and what [they] did in PolyU" and they reinstated their voluntary medical work carried out during the
2019–2020 Hong Kong protests
202
Suspension of operation in Gaza
edit
In December 2025, the Israeli government announced it would revoke the licenses of MSF and more than 30 other humanitarian organisations operating in the
Gaza Strip
effectively preventing them from continuing their activities during the ongoing
Gaza war
The Israeli
Ministry of Diaspora Affairs and Combating Antisemitism
stated that the MSF and other organizations had failed to comply with
new registration requirements
, including providing information about staff, funding sources, and operational structures.
203
204
As of early 2026, MSF has stated that around 15 of its staff members have been killed since October 2023.
205
As of January–February 2026, Israel confirmed it would enforce the deregistration of 37 non-governmental organizations, including MSF, requiring them to cease operations and depart by early March 2026.
206
207
On February 11, 2026, MSF published a project update explaining their partial suspension of medical operations at Nasser Hospital in Khan Yunis. This included staff and patients at the facility reporting "armed men, some of them masked," and suspected the movement of weapons within the compound.
208
Citing these security breaches and a loss of control over the hospital's neutrality, MSF suspended all non-critical medical operations at the facility as of January 20, 2026.
208
209
Selected non-fiction works about MSF
edit
Bortolotti, Dan (2006).
Hope in Hell
: Inside the World of Doctors Without Borders
. Firefly Books.
ISBN
978-1-55407-634-5
Brown, Damien (2013).
Band-aid for a broken leg: Being a doctor with no borders (and other ways to stay single)
. Sydney: Allen & Unwin.
ISBN
978-1-74331-556-9
A doctor's memoir of his first MSF posting on the medical frontlines in Angola, Mozambique, and South Sudan
The Photographer: Into War-torn Afghanistan with Doctors Without Borders
, graphic 'novel' (a memoir in graphic-novel format) by Guibert, Emmanuel (2009); photography and narration by
Didier Lefèvre
; colourist: Frédéric Lemercier. New York: First Second Books.
ISBN
978-1596433755
Living in Emergency: Stories of Doctors Without Borders
, 2008 documentary film by
Mark N. Hopkins
that tells the story of four MSF volunteer doctors confronting the challenges of medical work in war-torn areas of Liberia and Congo
Six Months in Sudan
2009 memoir by doctor
James Maskalyk
An Imperfect Offering
, 2008 memoir by former MSF president
James Orbinski
Triage: Dr. James Orbinski's Humanitarian Dilemma
, 2007 documentary
See also
edit
Switzerland portal
Medicine portal
Attacks on humanitarian workers
References
edit
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Hope in Hell: Inside the World of Doctors Without Borders
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ISBN
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Bortolotti, above, puts the death toll at 10,000. An estimate of 15,000 to 30,000, warning of an inevitable dysentery epidemic, comes from:
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Christopher Stokes (4 October 2015).
"Death toll rises"
(Press release). Médecins Sans Frontières.
Shear, Michael D.; Sengupta, Somini (7 October 2015).
"Obama Issues Rare Apology Over Bombing of Doctors Without Borders Hospital in Afghanistan"
The New York Times
ISSN
0362-4331
. Retrieved
1 October
2019
Kheel, Rebecca (8 October 2015).
"Doctors Without Borders not mollified by Obama apology"
The Hill
. Retrieved
2 October
2019
"Airstrikes hit Médecins Sans Frontières hospital in Yemen"
The Guardian
. 27 October 2015.
"Syria: Barrel bombing of MSF-supported hospital kills seven"
. Msf.org.uk. December 2015
. Retrieved
6 July
2016
"MSF-supported hospital bombed in Yemen: death toll rises to six"
msf.org
. 17 January 2016.
"Syrian war: Suspected Russian air strikes destroy two hospitals – despite so-called Syria 'ceasefire'
The Independent
. 15 February 2016.
"MSF-supported hospital bombed by Russian Air Force in Northern Syria"
The Guardian
. 15 February 2016.
"U.S. and Russia both deny bombing Syrian clinic"
CBS News
Associated Press
. 16 February 2016
. Retrieved
6 July
2016
Kareem Shaheen in Beirut; Ian Black (28 April 2016).
"Airstrike on MSF-backed Aleppo hospital kills patients and doctors"
The Guardian
. Retrieved
6 July
2016
"Kabul Hospital Attack: 'They came to kill the mothers'
Médecins Sans Frontières
. 15 May 2020.
"Three MSF employees killed in Ethiopia's Tigray, aid agency says"
Reuters
. 25 June 2021
. Retrieved
26 June
2021
"MSF convoy attacked in Gaza: all elements point to the responsibility of the Israeli army"
Doctors Without Borders / Médecins Sans Frontières (MSF ..
. 1 December 2023
. Retrieved
22 February
2024
Abrams, Irwin (2001).
The Nobel Peace Prize and the laureates: An illustrated biographical history, 1901–2001
. Nantucket, Massachusetts: Science History Publications. pp.
351–
352.
"The Nobel Peace Prize speech"
. MSF. 1999
. Retrieved
7 October
2013
"2015 Lasker Prize for MSF (in Spanish)"
. Jornada.unam.mx. 8 September 2015. Archived from
the original
on 22 April 2016
. Retrieved
6 July
2016
"Médicins Sans Frontières – Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences – HMA"
Hamdan Award
"MoMA exhibit features MSF's "bracelet of life" for malnutrition diagnosis"
Doctors Without Borders - USA
. Retrieved
12 May
2025
"NASA Worm as Art, Museum of Modern Art Opens Exhibition Featuring NASA Worm"
NASA
. 23 January 2025
. Retrieved
12 May
2025
Pirouette: Turning Points in Design
"SAFE: Design Takes On Risk"
Museum of Modern Art
. Retrieved
12 May
2025
"Médecins Sans Frontières (Doctors Without Borders). Middle Upper Arm Circumference (MUAC) measuring device. 1994"
Museum of Modern Art
. Retrieved
12 May
2025
"Feelings running high at 'Eurocentric' MSF"
The New Humanitarian
. 24 June 2020
. Retrieved
11 December
2022
Campbell, Sean; Kardas-Nelson, Mara.
"Doctors Without Borders saves lives every day. Some insiders say it is also a racist workplace where nonwhite workers get worse pay, less security, and inferior medical care"
Business Insider
. Archived from
the original
on 5 December 2022
. Retrieved
12 December
2022
McVeigh, Karen (10 July 2020).
"Médecins Sans Frontières is 'institutionally racist', say 1,000 insiders"
The Guardian
. Retrieved
11 December
2022
Arie, Sophie (25 June 2018).
"Médecins Sans Frontières is focus of new sex scandal in charity sector"
The BMJ
361
k2788.
doi
10.1136/bmj.k2788
ISSN
0959-8138
PMID
29941460
S2CID
49407281
"MSF dealt with 24 cases of sex abuse in 2017"
DW News
. Deutsche Welle. 14 February 2018
. Retrieved
11 December
2022
"Doctors Without Borders fired 19 people for sexual abuse last year"
Reuters
. 14 February 2018
. Retrieved
11 December
2022
Adams, Anna (20 June 2018).
"Medecins Sans Frontieres staff 'used local prostitutes'
BBC News
. Retrieved
11 December
2022
"MSF apologises after BBC reports 'widespread' sexual misconduct issues"
civilsociety.co.uk
. Retrieved
11 December
2022
Batty, David (26 May 2022).
"Médecins Sans Frontières apologises for using images of child rape survivor"
The Guardian
. Retrieved
11 December
2022
"BlackRock's COVID-19 Response"
BlackRock
. Retrieved
11 December
2022
"Mission impossible: humanitarianism is neutral or it is nothing"
Médecins Sans Frontières (MSF) International
. Retrieved
11 December
2022
Ullah, Areeb (17 September 2020).
'Gut punch': MSF staff wounded by decision to accept Blackrock donation"
Middle East Eye
. Retrieved
11 December
2022
林齊晧; 葉家均 (23 November 2019).
"重磅廣播／背棄人道救援？香港無國界醫生的「沉默缺席爭議」"
United Daily News
(in Chinese)
. Retrieved
22 March
2026
"Arrest of medics 'unheard of in civilised countries'
RTHK
. 22 November 2019. Archived from
the original
on 13 December 2019
. Retrieved
22 March
2026
鍾錦隆 (19 November 2019).
"無國界醫生拒對香港伸援手 網友砲轟不再捐款"
Radio Taiwan International
(in Chinese)
. Retrieved
22 March
2026
李慧妍; 梁煥敏 (19 November 2019).
"【11.19理大】無國界醫生昨不介入救援捱轟 今派員入校了解情況"
HK01
(in Chinese)
. Retrieved
22 March
2026
"香港人反抗》「無國界醫生」拒伸援手 網友怒：不再捐款"
Liberty Times
(in Chinese). 19 November 2019
. Retrieved
22 March
2026
"【恥與為伍】藝人群起與無國界醫生割席 王宗堯：香港人唔會再捐錢畀你"
Apple Daily
(in Chinese). 19 November 2019. Archived from
the original
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. Retrieved
22 March
2026
"無國界醫生拒介入捱轟 停月捐熱線被打爆、多人親身填表"
Hong Kong Inmedia
(in Chinese). 19 November 2019
. Retrieved
22 March
2026
"【修例風波】網傳阻止取消定期捐款 無國界醫生澄清：並無其事"
Sing Tao Daily
(in Chinese). 19 November 2019
. Retrieved
22 March
2026
張子清 (19 November 2019).
"無國界醫生拒絕救援遭到批評 今派4人進理大評估"
Radio Taiwan International
(in Chinese)
. Retrieved
22 March
2026
Lee, Bat-fong (20 November 2019).
"隔牆有耳：網民cut捐款　無國界醫生即蒲頭 - 李八方"
Apple Daily
(in Chinese)
. Retrieved
22 March
2026
Yu, Donald (29 November 2019).
"【有限創意】對抗偽善"
Apple Daily
(in Chinese)
. Retrieved
22 March
2026
"不滿「無國界」遲去理大　4.7萬人停捐助"
Apple Daily
(in Chinese). 19 December 2020
. Retrieved
22 March
2026
"MSF's response to the Hong Kong situation"
Médecins Sans Frontières
. 10 February 2020
. Retrieved
22 March
2026
"Israel says it will bar aid groups, including Doctors Without Borders, from Gaza"
NPR
. 30 December 2025
. Retrieved
31 December
2025
"Israel says it will halt operations of several humanitarian organizations in Gaza"
NBC News
. 30 December 2025
. Retrieved
31 December
2025
"Remembering our colleagues killed in Gaza"
msf.org
. 5 October 2025
. Retrieved
3 January
2026
"Israel says it 'will enforce' ban on 37 NGOs in Gaza"
euronews
. 1 January 2026
. Retrieved
5 February
2026
"International aid groups grapple with what Israel's ban will mean for their work in Gaza"
AP News
. 4 January 2026
. Retrieved
5 February
2026
"Addressing frequently asked questions and allegations about MSF work in Gaza Palestine | MSF"
www.msf.org
. Retrieved
13 February
2026
"Doctors Without Borders Admits Gaza Hospital Used by Militants, Halts Operations"
Algemeiner
. Retrieved
13 February
2026
Further reading
edit
Bortolotti, D. (2004).
"Hope in Hell: Inside the World of Doctors Without Borders"
Firefly Books
97
(11). Buffalo, N.Y.:
1575–
1577.
ISBN
978-1-55297-865-8
PMC
2594913
Katz IT, Wright AA (2004). "Collateral Damage – Médecins sans Frontières Leaves Afghanistan and Iraq".
The New England Journal of Medicine
351
(25):
2571–
2573.
doi
10.1056/NEJMp048296
PMID
15602015
(registration required)
McCall M, Salama P (1 September 1999).
"Selection, training, and support of relief workers: an occupational health issue"
British Medical Journal
318
(7176):
113–
116.
doi
10.1136/bmj.318.7176.113
PMC
1114577
PMID
9880288
Weber, Oliver
(1995).
French Doctors
. Robert Laffont.
Weber, Oliver
(2002).
Humanitaires
. Félin.
Zwi, A.B. (2004).
"How Should the Health Community Respond to Violent Political Conflict?"
PLOS Medicine
(1) e14.
doi
10.1371/journal.pmed.0010014
PMC
523835
PMID
15526042
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