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Emergency Culture

This chapter introduces the idea of ‘emergency culture’, something that shapes MSF’s work and mindset. Not all of MSF’s work takes place in the urgent setting of an emergency situation, but the emergency culture has a huge impact on employees and the power inequalities between them.

Key Findings

MSF’s work is shaped by an ‘emergency  imaginary’ – this directs some actions, while rationalising a lack of focus on others.

The way MSF operates, and its inherent inequalities, are based on the moral appeal to saving lives in an emergency, resulting in an operational model in which external decision-makers need to make decisions urgently.

A short-term emergency mindset fails to consider the longer-term view – what are the impacts over time, and what happens to communities when MSF leaves?

MSF focuses on saving lives and alleviating suffering.
This means some things get prioritised over others, which also helps justify exceptional measures and particular intervention structures, including ones that create or tolerate inequalities.

In medical emergency response, some aspects of power – such as hierarchies – are seen within MSF as indispensable.
Decisions must be made quickly, and formal and informal power dynamics that allow certain individuals to take charge of a situation are vital.

A Project Coordinator argued that in some settings power inequality

“can be a positive […] it’s not necessarily a bad thing.” During a mass casualty incident, for example, “where we activated the plan and we want to respond to it efficiently, categorising patients and attending to their needs according to severity, it’s important that these power dynamics exist.”

However, emergency can be used to justify a paternalistic model of intervention.
It can also justify a failure to accommodate diverse needs and realities on the ground, and to consider longer-term issues, such as the environment.

The emergency culture doesn’t always correspond with the situation on the ground.
Many projects are complex and long-term, sometimes running for decades, but planning remains fixed on a one-year cycle. Seeing MSF as temporary in a location can be used to explain doing nothing about local staff concerns on salaries or health coverage.

MSF has power to change the lives of local communities simply by being able to decide whether to help them or not.
The people MSF serves sometimes feel powerless, especially in comparison to MSF. They’re also in an environment shaped by existing power structures, both those during a crisis and more deeply engrained ones.

“When you think about communication with beneficiaries, in a lot of places – and South Sudan is a great example of that – where healthcare infrastructure is poor and weak, MSF is a Godsend, essentially. We deliver free quality healthcare but that comes at this price, which a lot of people I think sometimes don’t acknowledge, which is that MSF then has power over the community through the act of delivery […] When we say something to the community sometimes, they may be receptive or seem receptive and accept what we’re saying. That’s not really because they accept it; maybe they do, maybe they don’t. But that’s also partially because us are the ones who hold all the power, the ones who give the healthcare, the ones who save the children.”

The focus on speed and urgency means that MSF often doesn’t give local communities a say in the actions it takes to help them.

Patients risk being seen as subjects to be acted upon and treated as if they have no expertise or agency. This reflects elements of ‘saviourism’ also present in MSF’s model of internationally mobile staff, who are brought in from abroad and too often considered to be ‘experts’, while expertise held by locally recruited staff may not be valued.

Employees worry about the longer-term impact of MSF’s projects.

For instance, local communities can become dependent on services and opportunities provided by MSF, and the change in people’s expectations can impact the relationship between leaders and community members.

“When you talk about things like measles, that comes back every few years. That’s a revolving disease. You can’t really treat it like just an emergency. It is a structural problem. So I think it’s worth looking at it with a bit more of a mid-term, long-term view, and looking also at it maybe more with a prevention view of what role the communities can play.”

There’s an image of MSF as the ‘mavericks’ of the aid sector.
This creates a culture in which ‘charismatic’ leaders can thrive and where the organisation’s independent spirit is perpetuated. It inspires strong loyalty among employees, but also limits change and results in an inward-looking mentality suspicious of outside views and experience.

Emergency shapes MSF imaginary,

leading to short-term vision focussed on the immediate task with urgency and speed. In the case of staff who aren’t based at HQ, and in particular locally recruited staff, this results in an unsettled workforce who are…

 

Expected to make personal sacrifices
Working long hours
In the case of locally recruited staff, worried about a lack of reasonable job security

Delve deeper

Image credit: 

4. Oliver Barth/MSF

5. Omar Haj Kadour

6. Alexis Huguet

https://MSFUK.unbounddocs.com/power-analysis/how-this-report-was-compiled/,https://MSFUK.unbounddocs.com/power-analysis/currencies-of-influence/