How this Research was Carried out
The research began as a result of internal conversations, but it was designed and conducted by external researchers. Insider access and a broad remit gave the study the opportunity to explore dynamics not often formally noted or considered together.
Five Questions
The study was structured around five questions, developed by the research team following consultations and feedback:
1
What are the currencies of influence within MSF?
2
Who holds these currencies, and how do they operate?
3
How do they interact with inequalities (in the organisation, the humanitarian sector,
and societies)?
4
What does MSF do to counteract these inequalities or perpetuate them?
5
What are the implications for the medical mission?
Researchers explored these questions using document analysis, focus groups, ethnographic observations and 147 in-depth interviews with current and former employees, as well as patients. These have all been kept anonymous and were conducted primarily with people working through the OCA and three case study project sites in eastern Democratic Republic of the Congo, North East Syria and South Sudan.
The researchers approached the five questions via four interlocking themes:
- Being and becoming MSF – opportunities, career progression and ideas of expertise in MSF.
- Care and protection – how MSF protects or cares for its own employees, and how this affects structures of inequality.
- Inclusion, change and participation – discussions and approaches to institutional culture, and who is able to speak within MSF.
- Doctor-patient dynamics – how power plays out during medical activities within MSF staff and between staff, patients and communities.
The research isn’t a complete account of how power plays out across MSF, and can only offer a partial view of a very complex issue with many aspects to it across its huge network of different Operational Centres, governance structures, coordination offices and project sites. However, the experiences and opinions represented in it vary enormously, and you may find yourself agreeing with some and not others.
A word from the research team
“Thank you for taking the time to engage with this research project. We hope that it offers insights into the workings of power within MSF and highlights the experiences of those MSF voices that are, for organisational, structural and functional reasons, often marginalised. As a contribution to critical reflection about the roles of humanitarian organisations and how they work, this research may become a resource for those who wish to challenge power dynamics and inequalities – including members of the MSF movement, patients and the communities where MSF works.”
We would like to dedicate this research to Seán Healy, who supported this research from its beginnings. His sharp insights, generous counsel, and balanced views were invaluable, and will be sorely missed.
How to navigate these findings
For each chapter, there is a summary of its findings and a link to the full chapter. Those of you who wish to read the full research you can download as a PDF on the Contents page or Conclusions page.
Emergency Culture
Introduces the idea of MSF’s ‘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 MSF’s decision-making and prioritisation, and therefore on its employees and the power inequalities between them.
Currencies of Influence
Introduces the ways inequality runs through MSF. It then describes six attributes that tend to contribute to a person having influence in the organisation: time in ‘the field’, friends in high places, whiteness, English language skills, masculinity and medical expertise.
MSF Identity
What does it mean to ‘be MSF’? This chapter looks at how the MSF identity draws on certain assumptions about who is neutral, expert and competent. It shows how this reinforces power hierarchies in countries where MSF operates, as well as in the movement’s associative structure.
Filters & Circuit Breakers
Examines the power concentrated in coordination positions. It argues that, as intermediaries between headquarters and the majority of (locally recruited) staff, these posts filter information, opportunities and particular policies into practice. This form of power is strictly hierarchical but also highly individualised, with direct consequences for career progression, opportunities for participation and the handling of the safety, security and health of different staff.
Keeping the Flame
Looks at who and what are seen as ‘legitimate’ in MSF. It focuses on the spirit of volunteerism and closeness to ‘the field’, and the way these impact on opportunities to enter MSF and on internal dynamics. In doing so, it highlights one of the ways informal power is used: to define what subjects or activities are viewed as legitimate uses of resources.
Diagnostic Disconnect
Looks at some of the reasons staff give for why, in their eyes, MSF struggles to act on its stated ambitions to change power dynamics. It looks at understandings and beliefs that impact the space and motivation for action.
Conclusion
Reflects on efforts to make meaningful change, different ideas about how that could or should happen, and the combination of faith and dismay that appears to shape how employees in OCA and MSF relate to the organisation.
Delve deeper
Image credit:
2. Alice Gotheron/MSF
3. Isaac Buay/MSF