Identité de MSF

Chapter 5. MSF Identity

Introduction

Arguments about the identity of the MSF movement are as old as the organisation itself. They often relate to conceptions of MSF’s social mission and how it is embodied in, or achieved through, the individuals who make up the movement. In the early years, tensions emerged along the lines of ‘Paris versus the province’, over the amount of freedom that leaders had to represent MSF publicly, and after accusations that non-French speakers were being excluded (Bradol, 2020; Davey, 2015, pp. 181-214). Since the mid-2000s, debates about organisational structure have been tied up with questions of staff identity and the way that the movement reproduces broader post-colonial inequalities (Redfield, 2015; Fox, 2014; James, 2020). In the words of one contributor to the La Mancha reflections: “MSF always presents itself as an international organization. But how truly international are we?” (Van der Tak, 2005, p. 384)

This chapter examines the persistence and effects of certain tropes in MSF that influence who is understood to embody MSF’s values, and who holds expertise. The first section examines the two-tier system between MSF staff in countries of operation, and how these tropes have justified the exclusion of locally recruited employees from occupying senior decision-making posts. Despite recent policy changes to enable locally recruited staff to occupy coordinator posts, the experience of these new coordinators illustrates how these tropes can still shape who is seen as legitimate and who can hold responsibility in practice. The second section examines training and guidance documents, focusing on induction processes, to provide an illustration of how certain ideas about organisational identity become embedded in MSF’s processes from the onset. In so doing, it suggests that imaginaries about ‘the field’ as a bounded site of intervention ‘elsewhere’ contribute to an exclusionary notion of humanitarian identity. The third section examines how, despite recent attempts at reform, hierarchies remain entrenched in MSF’s associative structures, influencing who can contribute to shaping the organisation’s identity and agenda.

5.1 Trusted to lead?

In countries of operation, certain tropes about who is ‘neutral’ or who holds certain forms of expertise continue to influence who is seen to be legitimate and trusted leaders of MSF operations (James, 2022). While there has been movement to open up additional posts and greater formal authority to locally recruited staff, many locally recruited staff were under the impression that this has not always been done voluntarily, fully, or equitably.

Imaginaries of Neutrality

There is still a degree of distrust surrounding locally recruited staff and their ability to embody MSF’s principles in practice. MSF prefers mixed ‘national’ and ‘international’ teams: the presence of internationally mobile personnel is understood as important for combatting local manipulation, and ‘safeguarding’ the organisation’s real or perceived impartiality, neutrality, and independence (Hofman and Heller Pérache, 2014). One experienced internationally mobile employee described this as central to work in conflict settings:

“It is so important to have this international staff group because in the end it is all about neutrality and then, not about whether we feel ourselves neutral and impartial, but what the perception is […] This group [internationals] – in most settings where we are relevant, settings of conflict – then we need this. It’s part of our being. We need this group. Now if you’re now back to equality it has nothing to do with one is more valuable than the other but, in those settings, there is obviously a totally different role for the international staff than there is for the national staff, who are not necessarily part of the conflict, but part of that setting.”

While proximity to ‘the field’ is a currency of influence among internationally mobile staff to construct their legitimacy, locally recruited staff proximity to ‘the field’ (or being “part of that setting”) to some extent excludes them from being able to fully lay claim to MSF identity. Some staff described how they initially internalised this logic:

“The information that is sold to you, is sold in a way that even though it’s against you, you still support that information because you don’t see the bigger picture. You just believe so much that it’s true unless you really see the other side […] we were all convinced that following the MSF neutrality principle, that as a local you cannot be in a decision-making position […] automatically you just saw all the international employees, this holy person, this pure person, that comes and is purely neutral, follows MSF’s principles.”

This employee, who entered MSF through local recruitment and has since held other types of contracts, argued that the idea that only expats can be neutral is about:

“Keeping that MSF flag, MSF principles, with the only guardians being expats. Being a national, I suffered a lot of times from it, even though I was kind of trying to convince myself: ‘it’s great, I should not suffer that, it’s for good reason.’ But I felt disrespected.”

A locally recruited employee argued that: “It is as if headquarters don’t have confidence in national staff, because of corruption, conflict, poverty, so headquarters don’t give authority to national staff, and keep everything in the hands of international staff.” Another added: “For them [expats], there is no way things would work if there was not an expat or a Westerner in decision-making roles. It’s like they think we are incompetent, thieves.”

International employees also highlighted this distrust:

“There’s almost a suspicion when it comes to national staff. And I hear a lot of dialogue between expat staff that is also, to me, unsettling. Like, ‘Oh you can’t hire national staff in these positions because they would be more open to being influenced by people that are corrupt, or they wouldn’t be able to manage the finances appropriately because of the pressure that comes.’ […] To me it is quite racist to say that because you come from this country, you wouldn’t be able to manage the finances. It’s inferring that you would necessarily misappropriate funding when you wouldn’t assume that about a European coming in.”

The idea that aid workers in the Global South cannot be given leadership in their own country because of concerns about nepotism, mismanagement of funds or neutrality, perpetuates structures of inequality (Peace Direct, 2021, p. 18; James, 2022). Yet, some locally recruited staff were also concerned about corruption or “power abuses” if their colleagues were put in senior decision-making roles: “for technical positions national staff may occupy by them, but for making decision it’s better to give them to international staff.” One locally recruited employee concluded that although corruption exists, MSF risks assuming that corruption is somehow inevitable among local employees: “We must try to look at things on a case-by-case basis.”

Imaginaries of competency and expertise

MSF employees across the organisation highlighted that only certain people in the organisation were assumed to hold expertise. Different employees gave detailed examples of how this manifested in practice in different settings, and the underlying values they believe are in operation. “Expats are experts,” is how one former locally recruited employee summed up the widespread perception.

As many pointed out, this assumption was embedded in the way that MSF operates – the assumed need to bring someone in from elsewhere suggests that existing ‘capacity’ is lacking. Some explained this with reference to the specialised and hierarchical nature of medical care, as in the description by an employee with a public health background:

“My perception is it’s […] less so that MSF is sending doctors to the bedside, so much that they’re sending expertise to crisis areas. So, it’s not saying that Lankien in South Sudan doesn’t have enough doctors. It’s saying: ‘You don’t have the right expertise. So maybe you’ve got doctors but you don’t have doctors who do burns operations or can use ultrasound.’ Or whatever it might be. So, there is something of: ‘Oh we’re coming to provide capacity and hands but also to train and build capacity.’ That’s my perception of what MSF perceives itself to be doing.”

Others pointed to structural inequalities in the settings where MSF works. A senior programme colleague described why top positions in ‘emergency’ contexts are often held by internationally mobile staff:

“The national staff are not ready for it. Most of the internationals, they have expertise, they have higher degrees, they have experience. […] Here, because most of the population are affected because of conflict or whatever, they don’t have that experience because they have been, for example […] excluded from continuing their higher studies at university.”

While there are clearly some settings where access to further education has been limited by recent violent conflict, this generalised interpretation seems to risk reinforcing historically-laden tropes about who holds expertise in the organisation. One locally recruited employee summarised: “it is sometimes perceived that international staff are more intelligent and competent compared to national staff.” This was part of a broader structure, they argued, which meant that international staff “can supervise national staff without proper experience.” Another locally recruited employee said that the “mentality” of MSF is revealed when one asks: “Can national staff supervise international staff?”

Among some locally recruited teams, there was discontent at the fact that when a foreign coordinator leaves the project and is not immediately replaced, their ‘assistant’ rarely fills their position: “What are the assistants accused of? Aren’t they qualified to replace their colleagues?” Instead, OCA sometimes hired people from other organisations to fill senior decision-making roles immediately. One employee who joined through this route said:

“MSF has a deeply ingrained culture of valuing internal experience over external experience and that led to the wells drying up basically so at some point by necessity the organisation started to experiment […] bringing in people with relevant outside experience into management roles.”

Here, the ‘wells’ of competency refers only to internationally mobile staff. Rather than giving nationals management positions, OCA hired those who had never worked for the organisation as the best way to find the necessary expertise.

The “mindset”, one employee described, was that an expat is “someone with knowledge, with expertise […] The expats are trained, or will get trained, or are experienced, by learning on the job, doing a couple of missions, and suddenly, they’re coming to teach you how to do things.” Another interviewee described receiving the same training repeatedly over at least five years from various internationally mobile staff, but that MSF continued to frame these exercises as “capacity building.”

Indeed, the justification for bringing in foreign expertise was not always clear to locally based teams: “Visitors are there, but what are the bases of their visit?” In one country, a category of supervisory position occupied by internationally mobile staff was phased out, only to be reaffirmed two years later. No explanation was given, according to one interviewee, who speculated:

“I don’t know, it’s because they want to control the project so that they have more, you know, when you have more people, you have power. So, the number of people you have is the number of power that would determine, you have. So, I think there are fears if we have less international people, the power, the voice of this [locally recruited staff] will be more powerful and then we may, they either climb up and they get stronger and there are no room for international again. So, I don’t know, really, what happened in the HQ, why they keep sending, why no one ever takes time to evaluate. We have been doing this for the past seven years, where have we reached now?”

There was an impression among locally recruited staff that employees from the Global North are “given the benefit of the doubt” and given positions of responsibility based on the “understanding that they come from this European education system, or this American/Canadian system, that you’re still going to be of value to the team.” Meanwhile, as one interviewee pointed out, “you don’t see us giving that same benefit of the doubt to the Congolese people that are applying – like, an engineer from Congo, we’re not just going to assume that they have the people skills or the management skills that we all assume a European engineer has.” Another interviewee argued that MSF’s model reproduced ethnocentric assumptions about expertise:

“MSF does this thing where we hire lots of managers who have no prior managerial experience […] So, they come to these missions […] and there is superiority complex. They come in from the US, the UK, from Australia, ‘I have graduated at the top of my class, I know what I’m doing’ […] They then superimpose upon the teams their way of working or their way of doing something […] disregarding their agency, disregarding any kind of background or knowledge that they [local colleagues] may have accrued.”

This devaluing of existing expertise poses a problem considering that the breadth across which some supervisors are expected to be subject matter experts makes it necessary to learn from others; one person cannot know it all. One employee working in a highly specialised clinic described the repeated challenges of having a supervisor responsible for many departments. At least one is bound to fall outside their area of expertise:

“There is a problem […] when it comes to managerial positions. They can hire someone to cover two to three departments but within those departments, it’s not expert or it’s not well experienced enough to run those departments but they’re wanting to lead. How will you lead if you lack those? You are given that position to mentor, to train, to bring those people up, you know, empower them. If instead, you have been given that position and you know it is mandatory, you have to do the evaluation anyway, how will you evaluate someone you don’t know what they’re doing? Like, in my department, it happened several times. They bring somebody who does not know what we are doing actually.”

The practice of describing people by their contract type was highlighted as a sign of prejudice: “in my opinion, those terms should only be used if you’re referring to someone’s contractual status. You don’t need to say, ‘this expat doctor’, or, ‘that national staff doctor’.” This employee described arriving on assignments to be told “doctor so-and-so will brief you. He’s national staff, but he’s good.”

One particularly detailed example given by an interviewee in South Sudan illustrates how assumptions about existing medical expertise played out in practice. This South Sudanese interviewee described how many internationally mobile staff seem to think that medical knowledge coming from locally recruited colleagues cannot be trusted – as a result, internationally mobile staff “might not believe in the [clinical investigation] results that you are telling them.” As a result of this “disbelief”, the interviewee explained, internationally mobile staff may try to fill the perceived gap themselves, even if they are missing the specific expertise (skills or contextually relevant knowledge) it requires:

“We have a lot of cases, for example someone has no background of [this procedure] and is international staff and then we have the trained staff on ground. So, instead of going to this person and saying: ‘Hey, this case of mine I want to post on telemedicine, can you get for me the images?’ someone will not be able to do that. He will try to do the [investigation procedure] by himself and he has no idea [of the right processes], everything is done differently.”

“Telemedicine” refers to a platform for digital consultations that MSF has set up to provide support for challenging clinical cases. Staff can post information about a case, including history and any images or scans, and receive advice from specialists. One of the consequences of internationally mobile staff taking these processes upon themselves is the lower quality images they produce, which can result in their locally recruited colleagues facing reproach because they are nominally the technicians of these systems: “out there the specialists will be shouting, you guys are sending us very poor images.” Virtual connectivity within the organisation, therefore, can have perverse consequences. So too can the very human responses that individual personnel may have: “the next time when you call me to do [a procedure] for you, I may not come. Or, if you have another colleague call me to do a [clinical investigation], I may not go because I’m completely demoralised.” The number of people involved increases, and the set-up may already differ from what personnel from foreign countries are used to, so new managers react negatively. In the words of this staff member:

“Of course it will be a shock, but for a better practice and to be a better person I think it is good to sit down with that person, yes. To ask questions and say ‘Hey, what is going on here?’ And then someone will be able to help you completely, but when you don’t ask questions and then you just begin to change things and it becomes very strained.”

Here, medical staff described a working culture where foreign managers are assumed to hold superior expertise. With a focus on transnational connectivity between (presumed) specialists and amidst a high turnover of foreign managers, local medical staff found that their own expertise was too often dismissed.

Implications for protection

Tropes about neutrality, expertise and competency have prevented locally recruited employees from holding responsibility. However, there were also genuine concerns about how locally recruited employees in coordinator positions might be more at risk of pressures or threats, especially in settings of violent conflict. Locally recruited employees described how making key decisions about, for instance, recruitment, might expose them: “For me, I prefer not to be in a position to hire staff, because you will always be accused of bias or hiring your relatives.” An interviewee in Syria described how having an international boss:

“Is kind of protecting us, from being exposed in front of authorities, or the community. If let’s say, if someone knows I’m involved in making decisions about a project here, I might be at a risk in front of the community. ‘Why do you lead the project here, because you have a family, or friends there?’ So that’s why, we say MSF protects us, when we talk to authorities, we keep saying: ‘it’s a decision made by international staff, not us’.”

Other staff were concerned that a logic of protection helped justify power hierarchies. Rather than being applied systematically, they argued, the positions of locally recruited staff should be examined on a case-by-case basis. As one employee in DRC explained, keeping foreign staff in decision-making roles has a “certain logic behind it”:

“It aims to reduce local pressure. For example, when I have to hire someone in the organisation, and I have a recommendation from the governor stating that this or that person should be hired, I would not have the capacity to say no […] But if it’s someone from the outside, they can refuse, and three to five months later, they will leave.”

Nonetheless, this employee concluded:

“It shouldn’t be systematic, because there are areas where a national project staff member might negotiate the humanitarian access better than an international Project Coordinator. Sometimes, some groups look at internationals as spies […] or people who are here to exploit the country’s resources. That can create a barrier for the organisation.”

While these issues of identity and protection often came up when interviewees discussed who could or should be placed in highly visible, senior decision-making roles, another important area that appears to have received less institutional attention is the position of staff involved in decision making about patients seeking care. Locally recruited medical staff explained that decisions at clinical points of contact can leave them exposed, specifically when decisions differ from patient expectations. For example, when triage staff deny access to patients who do not fit the inclusion criteria to receive care at a given MSF healthcare facility. One activity manager explained why locally recruited staff may try to avoid these sensitive stations:

“When they go to the communities, they get some challenges. So you know, it’s sometimes difficult for them since they are living there, so we understand. Even feeling that they don’t want [to be assigned] in to that area [the triage area]. Because they complain they want to shift to other areas because of this challenge.”

A triage nurse concluded: “I was feeling guilt for those people. They came at 7am, morning. I sent 11 patients back home who were normal in their vital signs [they did not fulfil criteria to be seen at this MSF facility].” This raised the question of why these sensitive decisions are not made by internationally mobile staff; the argument applied to supervisory roles has not been extended to these basic clinical duties.

Other interviewees highlighted another inconsistency: when security conditions deteriorate, it is often locally recruited staff who are left to continue working, despite being exposed. In Syria, for example, MSF evacuated international staff in 2019. A group of Syrian staff were tasked with helping to close the mission, maintaining a network among political leaders, and collecting security information. As one of these Syrian employees described:

“They [expats] keep managing the project and the mission remotely. And they put us in the front. They created a committee, for national staff […] I accept the responsibility and I accept the risk […] because I have obligations with MSF, I need to continue my job and continue protecting the mission and the staff. Plus, this is the only way to support my family.”

An internationally mobile employee with experience in Syria described how these Syrian employees became “representatives of MSF” and were “instrumental in allowing MSF to come back.” However, when the projects reopened and international teams returned, these Syrian staff were, in effect, told: “You go back to being [support staff].” Meanwhile, the political authorities continued to contact these Syrian staff, rather than the foreign coordinators. These Syrian employees, therefore, found themselves treated as representatives of MSF locally, but without influence in the organisation. They “cannot, of course, call the desk and tell them what to do. So, they […] developed a system to make the message pass, because they still care about what’s going on. They have a commitment to MSF that none of us have,” one senior employee concluded.

Nationalisation, or Pasteur Bizimungu?

There has been a recent shift in human resources relating to the position of national staff in their own country. The 2020 Staff Data and Trends Report indicates that the percentage of coordinators who are locally hired increased from 10.88% in 2016 to 17.6% in 2020 (Cragg and Jager, 2021, p. 31). This was in line with the 2018 ‘Human Resources Principle on Staff Mobility and Team Diversity’, which states that all positions should be accessible to staff based on their competencies rather than contractual status. The report describes how this shift was also pragmatic: “One of the factors that contributed to the increase in locally hired coordinators in 2020 was that many of the Covid-19 interventions in countries where MSF does not normally have projects were staffed by locally hired staff” (ibid). Indeed, interviewees described this shift as “opportunistic”:

“Covid didn’t allow us to move people around and then we start to promote and to be opportunistic to local staff, but if you ask me, it hasn’t been ingrained in the policy in the procedure, but not really. I think it has been opportunistic, with the current, one month before Covid: ‘no, impossible to have the national staff taking this role’. One month later, Covid hit: ‘Oh yes, for sure, this person is very qualified’.”

In DRC, for instance, some decision-making posts have been opened for Congolese staff since 2020. A Congolese employee explained: “There are many jobs that are being nationalised…This was not possible at the time that I joined the organisation.” As senior international staff returned home at the onset of the pandemic, MSF began to replace them with interim national staff, including staff who had previously been expatriated. Congolese employees described the shift:

“Activities in the field had to continue but they had to rely on the national staff since expats were going back home […] I think they realised that the test worked, and they were like, why not? […] we can thank Covid for that, there are some positive sides to Covid after all.”

Another employee added:

“There are indeed changes when it comes to local staff in responsibility roles, which is something that used to be a taboo, but today we’re talking about it […] Covid taught us a lot, because it made it difficult to find international staff. And that made MSF look for alternative solutions. It made MSF start to think differently.”

However, other Congolese employees considered that the changes had not gone far enough. Although locally recruited staff were now allowed to occupy coordination positions, there was an impression that they were not trusted with the same degree of responsibility. One employee who was given a coordinator post previously reserved for internationals described his experience:

“MSF is changing, but changes are not yet radical. There are still areas where we should improve, where we should really completely change because some changes still aren’t fully applied. Responsibilities are still not the same. It’s like if you give someone a role, but the responsibilities are a bit reduced, you deprive them of certain opportunities. These are things we should still work on […] when the FinCo left, he preferred giving the keys/password to an expat Project Coordinator that now has to do all financial transactions. If I was an expat, this wouldn’t have been the case…I think it’s clear that there is not enough trust here. They do give us responsibilities, but we still don’t have the same level of trust as our international colleagues.”

In other contexts, interviewees also had the impression that locally recruited staff in coordination positions were not given the same responsibility. In South Sudan, a clinical employee remembered that when a South Sudanese staff member began a newly created position, in practice they were not granted the full powers in the job description:

“When I look at that when the position was advertised, I see the description for the deputy, what he will do and all this. But when you get the position, the powers that were put in the paper, he is not exercising them now that he has become it. He is someone who is just presenting there, he has less power when he speaks. And I know maybe it is because he is the only person there, and he cannot do this and do that and then people are like this. So he has less power.”

Some of these powers, they observed, in fact sat with the hospital coordinator, who was technically the assistant to this ‘nationalised’ deputy role.

Reflecting on these dynamics, a Congolese employee concluded:

“They had to give national staff some key positions, but the ones who were given these roles were not even trusted. It was like they only had that role as a label. In Congo, we call these people Pasteur Bizimungu. Pasteur Bizimungu was the president of Rwanda […] He was the Rwandese President who ruled after the genocide of 1994 and was appointed to try to establish an equilibrium between the Tutsi and the Hutus. He was a Hutu, and it was his assistant, the vice president, who actually ruled the country. Bizimungu was just for appearances; labelled as president, but more like a puppet. He did not make the decisions, even though he was the president. The Vice President, Paul Kagame, is the one who made all decisions, and that story inspired the saying I just used. So, we say someone is a Pasteur Bizimungu if he is given a role, but just as a label, without actually being given the right to make decisions […] That is how our staff were treated when given decision-making roles.”

Several locally recruited staff argued that this was because of a belief that “when you give national staff responsibilities, they will steal.”

5.2 Constructing MSF identity

Ideas about differences between locally recruited and internationally mobile staff are highlighted during new employees’ first introduction to the organisation, and provide an example of one of the ways that this two-tier system is reproduced and normalised. The distinction drawn between ‘national’ and ‘international’ is based on ideas about MSF identity, and influences who is able to access it and on what terms. This section examines some of the core ways that OCA initiates new employees into the organisation and how the training reproduces certain ideas about ‘the field’ and locally recruited personnel, that elsewhere (as seen above) the organisation has sought to move beyond.

Preparing for a first ‘mission’

Preparation for Primary Departure (PPD) is a training for newly recruited international MSF employees. As the OCA PPD introduction explains, the aim is: “to prepare all new field volunteers for their first mission by introducing them to humanitarian aid, the MSF identity, programs (operations), and roles and responsibilities within MSF.” This training is intended for internationally mobile staff, while locally recruited staff do a different training, called Sanou, held in their country of origin and employment. Setting aside the practical advantages of this arrangement, it has another social, cultural and arguably ideological impact: a distinction is drawn from the start between ‘international volunteers’ and ‘locally hired employees.’

The PPD training is informed by, and reproduces, a particular “field imaginary” (Stellmach, 2020). The training is framed as essential for ‘pre-departure,’ rooted in a particular imagination of ‘the field’ as somewhere distinct and different from home. As Peter Redfield argues, MSF is based on the model of a transient expatriate. Its “assumption at the outset,” he wrote, is “that its volunteers would be eagerly and effortlessly mobile. Unencumbered by social obligations at home, the medical humanitarian should likewise acquire few in the field, living lightly on the landscape, and always ready to leave once urgency passed” (Redfield, 2012, p. 362).

Alongside briefings on topics such as MSF’s history and structures, security considerations are an important feature of the PPD. In the first PPD module: ‘MSF Identity and Actions’, remaining detached is described as essential to security. In the training, ‘local perception’ is framed as key to security, with fieldworkers needing to consider how they are perceived at all times. Similar considerations are found in other guidance materials. The ‘OCA General Safety and Security Policy’ from 2017 explains: “MSF OCA and its staff’s adherence to core humanitarian principles is instrumental in gaining acceptance by all relevant stakeholders […] acceptance remains the dominant security strategy” (MSF OCA, 2017). A Code of Conduct (MSF OCA, 2018) explains:

“When working for MSF-OCA, you are representing the organisation and your behaviour influences the way that the organisation is perceived. Your statements as well as your conduct can be interpreted as an expression of MSF’s point of view. If you do not observe the framework, you may bring yourself, your colleagues, your mission and MSF-OCA in danger.”6

Where are MSF employees performing this identity? The ‘field’ is constructed as a site of action “out there” (Malkki, 2015) – a place of hardship and danger (Stellmach, 2020). For example, during PPD, participants take part in the Orienteering Game, which aims to teach them the “importance of teamwork for the proper functioning of any MSF project.” The team, here, comprises solely international employees (though in practice, the majority of their colleagues will be ‘nationals’). The game takes place in Kottenland woods in Germany: teams must conduct an ‘exploration mission’ in order to “assess the medical and humanitarian needs of the population in Kottenland with a main focus on malnutrition.” The teams navigate roadblocks and negotiate with local leaders. The imaginary land of Kottenland is described to be: “populated by two tribes, the Venus tribe and the Eiffel tribe,” the Venus tribe are described as: “hunters and cattle-traders by nature.” The facilitators who act as local political leaders are instructed to “act bossy, authoritarian, top-down,” while the training notes instruct other facilitators to: “behave like opposition leaders, who are economically in a poor state […] you don’t like these foreigners.” The head of the Venus tribe is to act as if: “you don’t give a shit about people from the Eiffel tribe,” and the ministry of health representative is instructed to act as if: “the little hut is your office and nobody should dare to enter your office without invitation.”

6 A revised Code of Conduct began being rolled out in OCA in 2022.

The separation of home and field tries to cultivate some sort of “detachment as a marker of professionalism” (Okely, 1992, p. 8). However, this risks reproducing binaries such as us/them, strange/familiar – a ‘field’ with a native ‘other’ that is different and potentially dangerous (Gupta and Ferguson, 1997). This racialised construction of ‘the field’ also seems to present violence in the Global South as irrational and identity based. ‘The field’ is presented as a risky environment, and a potential cause of stress for internationally mobile MSF volunteers. For example, the PPD Stress Management module focuses on ‘Stress in the Field,’ and emphasises the fact that the Pychosocial support is ‘available to expats.’ One of the accompanying resources for the training module is the ‘Practice Guidelines for Dealing with Ongoing Stress and Traumatic Stress in the Field,’ written by the Psycho Social Care Unit. These guidelines explain that: “in the field, you may experience stress when challenged with the unknowns of living in a foreign country…you may experience stress when dealing with environmental hardships such as a harsh climate or primitive living conditions” (MSF, 2009 p. 9). The Guidelines warn that: “field workers may experience feelings of sadness and hopelessness when they see bombed villages, refugee camps overflowing with sick and starving people or people dying unnecessarily” (MSF, 2009, p. 17). While such portrayals are intended to prepare personnel for difficult experiences, they risk reinforcing reductive ideas about the societies among which MSF works. Imaginaries of ‘the field’ as a distant and inherently risky place, emphasised in the induction training for international volunteers, overlook the fact that the majority of MSF staff are working in their own country. They contribute to differential understandings of who can assume an MSF identity and on what terms.

Who is really MSF?

Induction trainings and guidance documents reflect a view that MSF is differently constituted by different kinds of staff members. MSF employees are required to perform a distinct, detached MSF identity as a matter of security (James, 2020; James, 2022), as these materials make clear. The prescribed codes favour internationally mobile staff by presenting them as better suited to holding positions of responsibility.

While the behaviour of all MSF employees is considered a potential source of insecurity, the PPD’s materials describe a distinctive position for locally recruited staff in relation to the management of security and wellbeing. Locally recruited staff are described as key representatives of MSF, actively contributing to ‘acceptance’, which is in turn interpreted as key to organisational security. However, they are also presented as part of ‘the field’. For instance, in the PPD module on ‘MSF Identity and Actions’, new volunteers for international posts are asked to consider “perception issues”: “How is MSF perceived by populations, beneficiaries, national staff, other organisations, host governments?” This places locally recruited staff in the same frame as external actors. By listing “communication with national staff” as one of the “stressors in the field” (p. 12), the module on Stress Management does something similar; if communication with colleagues is a potential stressor, why single out one type of contract holder?

Instead of PPD, locally recruited staff do the Sanou – a training that runs across three days and is delivered by locally recruited staff in ‘field missions.’ The overall stated objective of Sanou, as explained in the facilitator guide, is to: “strengthen the ability of MSF staff to act as ‘Ambassadors of MSF’ both internally (with colleagues and beneficiaries) and externally (with family, community, other partners, etc).” Sanou aims to facilitate ‘intercultural understanding’ of MSF as an organisation: its work, principles, and history. In effect, Sanou introduces locally recruited staff to MSF’s identity and history, so that they too, can become ‘ambassadors’ of the organisation. Differences in how locally recruited staff are initiated into MSF identity draw distinctions between international volunteers and local employees.

As the OCA Onboarding Guideline for National Staff (MSF OCA, 2017, p. 8) explains, there is a security logic at play. The additional objectives of Sanou are to: “contribute to increased acceptance of MSF and thereby contribute to MSF’s security strategy in the mission” and “enable national and international staff to improve their mutual understanding in this multicultural work environment.” By initiating locally recruited staff into a particular MSF identity, the aim is also to prevent local staff behaviour from being detrimental to MSF’s image and thus security; to encourage staff to communicate MSF’s work locally; and to prevent tensions in the team which could result in security incidents.

This logic also appears in some of the PPD materials that relate to interactions among employees. Further, these are geared towards the management role that almost all internationally mobile staff take on, given the way that senior roles in the organisation are distributed and in certain cases ring-fenced. In a PPD training module about ‘Responsible Behaviour,’ one prompt describes: “One of my national staff made a huge mistake and I get angry with him in front of the team. As I am his boss, it is justified to do this so he and the rest of the team understand the consequences of his mistakes.” The PPD trainees are asked to respond yes, no, or maybe. The correct answer is ‘no’, because (it explains) of a need to avoid “disrespect of cultural customs” and because this could lead to “unintended consequences.” Instead, “criticism has to be given professionally and, if possible, constructively.” This risks suggesting that international staff hold expertise in MSF, and need to carefully manage ‘their’ locally recruited staff.

There is thus a possibility that MSF inductions normalise from the off-set a hierarchy whereby internationally recruited staff are decision-makers, managing teams of locally recruited staff. One employee remembered:

“It had been made explicit in welcome days that all international staff are, by definition, managers of national staff. And there was an exercise […] where within each table, there was a board, where there was a divide between national staff and international staff, and folks were supposed to write down on this board the advantages and disadvantages that each group would bring […] So folks did say things like: ‘national staff, it’s great that they know all the local areas of the work, but they’re probably not objective’ as an example. Right? […] I, as a foreigner, am automatically objective and capable to see what’s actually going on, these kinds of things.”

This hierarchical construction of MSF identity also manifests in other practices or settings and is at the same time reinforced by them.

A System Reproduced

Interviewees who began on national contracts described how the two-tier hierarchy was internalised during their time in the organisation, and in turn reproduced when they themselves became international staff. After being ‘expatriated,’ one interviewee explained: “I was behaving [towards my staff] the way that the expats had behaved towards me.” After realising that they had internalised the same attitudes that had once excluded them, this employee reflected on how the “culture” in MSF reproduces a sense of superiority among international staff:

“The fact that you just enter into another country and you have a car waiting for you, someone opening the door for you, someone taking your luggage, you already feel that VIP [very important person]. And then you have a luxurious house where your colleague is not, well, don’t even have a proper shelter. You have a car picking you up, dropping you to the office, picking you up in the evening. You have the weekends where you have access to luxurious restaurants and stuff like that…then the weekends, the parties that you have there. So, this whole process, it already puts a big gap, and puts you in a higher status, regardless of how much you know or you don’t know. Regardless of how much knowledge your local colleague has. And you already feel that superiority.”

Describing the processes of revising security policies in a country, a former deputy Head of Mission described how a two-tier system that excluded locally recruited staff from strategic decision making was reproduced, despite recent nationalisations:

“With these documents you have to update them […] every year, the mission has to do it. Usually, you do it – I don’t say superficially, but you just put in some new context and maybe some new issues they’ve seen. But this time I really thought I needed to revise it. […] This was after all the debates that were coming out about inclusion, differences, coming out etc. But one paradox was that one of these documents was revised by the PC of one of the projects and he is actually [a local staff member], and he actually wrote, or maybe kept the writing: ‘This document is not to be seen by the national staff’.”

Meanwhile, many locally recruited staff described their frustration at working in similar roles for over a decade, while junior or recently recruited internationally mobile staff rotated in and out with significant career progression: “Promote people! Or they rest in the same routine, lack of motivation.” Project staff described adapting to annual operational plans which were formulated without their input, and were instead dictated by “people who do not stay long in the mission. Those people dismiss the concerns of others, and then move on, leaving everyone in a mess.” One interviewee concluded: “MSF is far from reaching that equality we dream of.” This claim made about the ‘executive’ operations of MSF also resonates with critiques of inequalities in its associative life.

5.3 Associative life

Despite attempts at reform, structural hierarchies also remain entrenched in the associative structure of MSF, influencing who can contribute to shaping the organisation’s identity and agenda. Associative structures are a fundamental part of what makes MSF a ‘movement.’ They give MSF’s staff and former staff the nominal power to direct its formal leadership: “MSF is an association; the association members are like the Board and they appoint a ‘GD’ – a General Director – who leads the business on behalf of the Board and the association in their interest.” The association can, for some, be part of the appeal of MSF. Yet even among those who value associative life, its functioning was described as ineffectual at best, and discriminatory at worst: “The stones that you pick and there’s a lot of worms under, that’s how I see the association.”

Tiers of membership

While membership of an association brings the possibility of engaging with MSF’s identity and how it is understood and put into practice, what this looks like in reality depends on giving people an incentive to engage, creating equitable systems, ensuring access to information, and executive accountability for acting on associative decisions. In theory, association membership is open to everyone, and all members are equal. In practice, interviewees described a system with different tiers of membership for staff, reflecting broader structures of global inequity.

The association’s role in defining MSF identity raises the stakes on who is able to join. The possible participation of ‘local personnel’ in the association was first floated in the 1990s by MSF Belgium (Binet and Saulnier, 2019, p. 313-14). The MSF Holland Association passed a motion allowing local staff to become members in 2004 (ibid., p. 317). However, there were concerns about how this would alter MSF’s identity. A 2007 review noted concerns that: “The number of national staff who potentially could join the associations could have an overwhelming and radical impact on MSF and dilute or change its identity” (Fotiadis and Stevenson, 2007, p. 6). The reasons given included persistent racialised tropes used to justify the marginalisation of local staff in various domains, including claims about capacity, self-interest, lack of respect for humanitarian principles, and security risks.

Today, associative life in countries of operation was described as ‘fragile.’ Although there have been efforts to increase participation, uptake remains limited and there are still obstacles. In 2022, for instance, when MSF’s programme staff were around 57,000 people, an estimated 1,450 people participated in Field Associative Debates in 42 countries (Ponpon, 2022, p. 1).7 One person who had been active in the association recounted being told by drivers that it was: “‘one of those things for the big bosses, it’s not for us, because no one cares for our voices.’ And it was not like a complaint, it was like a fact.”

Interviewees pointed to different treatment of locally recruited and internationally mobile staff. While access to information was often highlighted as a general obstacle to associative engagement, at times this was explicitly connected to a lack of trust in people considered ‘other.’ For one interviewee, concerns about “what we’re sharing to whom” revealed the nature of the power dynamics in associative life:

“When it was a group of 20 Dutch association members, they had no problem sharing the information and sending an email. Now, it’s 1,000 members with I don’t know how many in DRC, how many in Zimbabwe, they’re like, ‘Can we trust everyone?’ Nobody says who you’re not trusting, but you know what they’re saying when they say, ‘We don’t want information to end up in the wrong hands.’ Yes, it’s very clear you don’t mean your Dutch colleagues.”

Some employees described a lack of consideration for what happens when OCA closes projects or country programmes as evidence of the lesser value placed on association membership of locally recruited staff. Association members were described as “left behind”:

“They don’t have the same value, which is very clear to me. Their voices, their opinions are not valued in the same way as an association member whose base was Dutch, who probably has family who have been donating for years and years, and is influential within the networks that are important to MSF. That’s a different association member and we will treat them as such. The association member that we left in Zimbabwe, in Mozambique, in Afghanistan: ‘Yes, maybe when we need to start another project, maybe they can help, maybe we can call them and ask them how it looks,’ but [their membership is] not so important.”

7 This is a minimum figure, coordinators noted that reporting is incomplete and participation was affected by Covid-19.

In principle the association is a channel for all staff to shape the identity and priorities of MSF; however, in this description, it is instrumentalised when locally recruited staff become relevant to operations. As we heard from another employee: “for me, as an expat, MSF is like a cooperative, but I am not sure the national staff in a mission in Iran would feel the same way, that MSF belongs to them and they can carry weight.”

While the past few years have seen increased investment in promoting associative engagement, this was criticised as insufficient in light of both practical and normative challenges. Interviewees described biased structures that concentrate institutional support in the OC and section offices, rather than in countries of operation. One person involved in supporting the association said:

“I believe that is a form of discrimination. MSF claims the association is important but does not grant equal access to it. So, if you’re in Paris, you get to be close to very active coordinators, but if you are in Congo, you’re in an association that is much less dynamic and organised.”

The problem has been recognised in efforts to promote engagement, including through supporting roles known as ‘ALFies’, which stands for Associative Life in the Field. ALFies are locally recruited staff members who are representatives of the association from their project. There has been investment in strengthening the ALFie role, connecting ALFies with OCA Council members and committees. Yet these roles are unpaid and add to existing workloads.

This critique deepens into an argument that the fragility of associative engagement was also due to normative, Eurocentric biases in its assumptions. Explaining the concept of the association outside French or European contexts often requires translating it, trying to “make people understand that the association was cooperative and that everyone was a stakeholder” or “describing MSF as a family business, a business where everyone contributes to making it work.” Even more fundamentally, a former ALFie described how approaches to improve participation in programme countries were constructed around the ‘Western’ humanitarian value of volunteerism. For staff in crisis-affected countries, they asked:

“Why for me should it be a priority to invest my private time to come to an association discussion to engage people to talk about something that may impact 10 years later, maybe, my context? […] Why don’t I have a priority of making sure that my kids are not starving, that my home is not burnt, […] psychological things that are going on in my context?”

To overcome these challenges would require more sustained investment, particularly in paid association staff where MSF is working. Yet, the institutional attitude was described as: “if people don’t care about something we don’t want to force them, and they are not committed.” This attitude is likely to reproduce existing power dynamics, which are weighted towards headquarters and partner office countries.

This unequal weighting of different members was also seen in descriptions of how associative forums run once people have engaged. The chain of motions and votes – from the Field Associative Debates (FADs) to General Assemblies and on to the International General Assembly (IGA) – is long and involves obstacles of language and distance. The chance of decisions being communicated back down again was described as even smaller. The one-member, one-vote principle is challenged by practical access inequities:

“In a General Assembly my vote equals the GD’s vote or the Board member’s vote. But individually I agree, but what about collectively? How many people from my country can come to the GA in Brussels or in Amsterdam?”

Under these dynamics, and despite formal distinctions between the two, associative and executive power can appear to overlap when association meetings become dominated by the contributions of headquarter staff and senior internationally mobile staff – and particularly, in the case of the MSF Holland association, Dutch staff. As discussed in Chapter 6, in cases where associative decisions require implementation or changes to ways of working at operational levels of the organisation, if people (usually internationally mobile staff) in coordination positions are not interested in, or supportive of, decisions taken by the association, those decisions are highly unlikely to be carried forward despite the nominal role of associations in directing the executive.

Strategies for increasing engagement and participation may be unintentionally reinforcing these dynamics; they certainly influence how governance plays out. As individuals can choose which associations to join, opportunities for meaningful participation may be increased if a person joins an association tied to where they live. However, this would tend to lead locally recruited staff towards joining regional associations, reinforcing the dominance of internationally mobile staff based in Europe within the associative structures of sections with operational roles. These dynamics are closely related to inequities of representation in MSF governance.

Governance and representation

Interviewees described how key associative structures reproduced the dominance of powerholders within MSF. The two tiers of association members reflect not only differential opportunities for participation, but also who is more likely to be part of governance. Participants emphasised the impacts of restrictions on who can serve as board members.8 One person contrasted the goal of inclusion with the realities that undermine it:

8 Some of these restrictions may derive from domestic laws. For example, UK Charity Law, with which MSF UK must comply, requires that trustees be volunteers; MSF UK has received an exemption from the Charity Commission so that the position of chair can be remunerated.

“We talk about diversity, we talk about all of that, but we don’t say who can join the boards. It’s an unpaid position, so [it is] people who have some amount of financial security, and who are able to devote the kind of time you need on a board. If you want real diversity – that is young people, and then maybe non-European members of the board – you have to recognise their life situations and life conditions, and make it possible for them to engage on MSF discussions […] otherwise there will always be information asymmetry, it makes it impossible for people to engage fully.”

The requirement for board members not to be employed by MSF creates complications for the idea of building engagement among ALFies and other locally recruited staff for involvement in board or council structures.

A former board member highlighted the implications of board make-up for issues of power and inequality, arguing that despite boards often including people who are “quite conscious and quite aware of the power imbalance” and who want “progress on creating a more equitable, inclusive organisation,” ultimately “it’s not treated with the urgency it needs” because “there’s just a lack of knowledge, and a lack of personal experience on being on the negative receiving end of power imbalance.”

Effective use of the existing structures requires an understanding of how they fit together. Moreover, knowledge of governance systems, strategy, and executive actions is crucial to members’ ability to hold boards accountable, meaning that inequities in access to information affect whose opinions matter in the governance of MSF. There was a consistent view that (to quote one person who raised this) the approach of “sending people documents” without sharing with them “where the sticky points are” or what is driving discussions internally and at Management Team level, means that “you’re not bringing people along.” Another said: “ALFies can play a role, but therefore the ALFies need to know what is in the strategic plan and what is in the annual plan, normally it’s not so easily accessible.”

Different strategies for increasing engagement will shape how these dynamics manifest. In the words of one coordinator: “my aim was also to inform our association members what kind of power they have. Because for most of them, it was a signature and showing […] their […] cards during the General Assembly.” Another coordinator described their strategy as using the General Assembly “as shows, as theatre, as events to enthuse people,” rather than emphasising understanding, “so that we had people who would become board members.” These two approaches – strengthening capacity to engage versus strengthening desire to engage – will shape relationships between the membership, board and executive. They offer advantages and disadvantages depending on the member profile and the sphere of action of the associations in question.

International governance is also unrepresentative. The last major round of reforms (see Binet and Saulnier, 2019) embedded a bias that many interviewees raised as an example of inequitable power dynamics within the MSF movement. In brief, newer associations have been created on a regional basis, while older associations representing a single country have not been required to merge or regionalise.9 The regional associations represent countries in the Global South and the majority of the single-country associations are in the Global North. Proportionally speaking, this system is a mismatch not only for the locally recruited staff that make up most of MSF’s personnel, but also for the changing profile of internationally mobile staff: “half of our international mobile staff come from the Global South now, half, and half of our boards aren’t in the Global South.” With each association holding equal votes in the IGA, this means that MSF’s highest body of associative governance gives proportionally more weight to members who constitute a minority of MSF staff.

This issue has recently received much attention, suggesting another round of reforms is on the way. Yet, as has been observed in relation to other areas of MSF’s governance and operations, a seeming willingness to change has not necessarily been accompanied by processes that make this possible. The burden of resolving this tension was characterised as contradictory and inequitable:

“On one side, you’re asking the newer voices or the emergent voices in the movement to think about different models and different ways of working. And on the other side, you give them a prescription to fix. It’s a box you have to fit yourself in.”

Concerns were also raised about the concentration of operational decision-making authority in Europe, a long-standing subject of criticism within MSF. The transformation of European operational sections into Operational Centres took place in the early to mid-2000s (Binet and Saulnier, 2019). As a result, the Operational Centres hold greater power than other entities in the MSF movement. As one staff member in a partner section noted, “they are the places who have the information and the insights and the possibilities to take decisions and to prioritise one thing over another,” meaning that other sections feel “a little bit on the margin of MSF.” Their concentration in one privileged region is both entrenched and outdated:

“As an organisation, we evolved, and we wanted to be a global or international organisation with a footprint closer to operations around the world, where our people were. But next to that, we forgot that there is architecture that is missing to enable that.”

9 Every national section has an association, including the national sections that lead the Operational Centres such as MSF Belgium and MSF Holland. There are regional associations for MSF East Africa, MSF South Asia Regional Association, MSF Southern Africa, and MSF West and Central Africa. MSF International has an association and there is also a Movement Wide Association.

Motions challenging the European dominance of Operations were brought to the IGA from its earliest years. Several of these motions were the result of discussions and resolutions in Field Associative Debates (annual associative discussions timed to feed into the international associative decision-making cycle) showing the interest and concern of country programme staff regarding MSF’s governance. For example, a 2012 motion that originated in the Zimbabwe FAD argued that: “MSF’s Northern identity/image at times limits our access to humanitarian space and complicates negotiations in Southern conflict settings.” In 2014 the Nigeria FAD put forward a motion describing the concentration of operational power in Europe as a reputational, security, and personnel management risk and argued that with 50% of its operations in Africa it was ‘logical’ for MSF to develop an Operational Centre on the continent. A 2018 motion by MSF Japan linked the current set-up to a Eurocentric bias in associative power, arguing that the model “creates a two-tier system where association members of operational sections, and their boards maintain a disproportionate influence on the operations and the movement compared to other associates.”

Interviews for this study revealed a range of views about the initiatives that have emerged in the absence of wholesale reform of operational decision-making to address arguments like the above. The creation of the West and Central Africa Operational Directorate, based in Abidjan, to join the five European OCs, for example, was described positively as “a really big deal,” something that “didn’t fit in any box in MSF, completely from left field.” WaCA is significant as the first entirely new operational entity since the 1980s and the first ever outside Europe.10 While it is rooted in the engagement of locally recruited staff in its region, WaCA’s scope of action is not limited to Africa, and it has already undertaken activities in Myanmar and Indonesia. In contrast, more mixed views were expressed about the creation of regional hubs such as in Amman, Dakar, and Nairobi. These hubs house functions of multiple OCs, including hosting operational desks, as well as intersectional work. Some interviewees argued that regional specialisation through these hubs may make it easier for desks to manage their portfolios and make consultation more straightforward. One interviewee suggested that, over time, the presence of such hubs will mean more opportunities for internationally mobile staff from regions of MSF operations to access managerial positions – essentially changing the composition of headquarters staff by changing the locations of headquarters functions. Others contested these kinds of arguments, suggesting that the problem was not location per se but the perpetuation of the same kinds of people in decision-making, which (they argued) would not necessarily be changed by opening new offices.

10 From initial discussions in 2016, WaCA gained IGA approval as a new MSF association in 2019, began operations in 2021 and in 2022 had eight projects in four countries.

Opinions on the regional hubs – both positive and negative – thus reflected the importance of identity for how MSF works, both identities of individuals and of the organisation itself. One person stressed a distinction between changing location and diversifying personnel: “It’s all about people who you put in these positions, and this is what we didn’t do. We didn’t have a lot of effort to move diverse people, experienced, the really experienced, clever people to Europe.” Another pointed to the number of European ‘expats’ based in Nairobi, implying that what they called the organisational “rat race to go to Nairobi” is more about appearances than fundamental change. Fundamentally, these critiques suggest that such approaches reproduce current power structures rather than challenge them:

“It’s symbolism in my opinion because the power division remains exactly the same, and the same people. In the end, in the Amsterdam offices or the Brussels offices, they are the ones to decide to go to Nairobi. Nairobi is not making the decision to start in Nairobi. No, the decision is made in Amsterdam. There is a lot of that sort of artificiality that I believe will be recognised as artificiality.”

Conclusion

The way that MSF identity has been historically constructed in OCA draws on certain tropes about who is neutral, and who embodies expertise and competency. These informal power dynamics have been formalised over time, and interact with formal hierarchies in the organisation in complex ways. In countries of operation, the first section described how these ideas about who embodies expertise and who can embody symbolic principles justify the continued structures of inequity between different categories of staff, and continue to limit the responsibility and legitimacy accorded to certain staff members, even after structural reform. The second section outlined how these ideas about MSF OCA identity are reproduced when people are introduced to, and initiated into, the organisation, its values and its principles. As the third section describes, these dynamics are mirrored at a movement level. Despite its egalitarian aims and the recent attempts at reform, imaginaries about who is ‘really MSF’ support structural hierarchies that remain entrenched in the associative structure. This dictates who can (and cannot) contribute to shaping the organisation’s identity and agenda in practice.