Keeping the Flame

Chapter 7. Keeping the Flame

Introduction

In the MSF movement, the “high degree of internal politics” can take many forms, influenced by “the fact that we have so many different offices now” as well as by the internal dynamics of any given site. The OCA office in Amsterdam has been the subject of several studies examining the experiences of specific groups (Heyse, 2006; Damman, Heyse and Mills, 2014; Rengers et al, 2019). This chapter takes a different approach, drawing on the study’s concept of currencies of influence to examine the politics of legitimacy at headquarters level. What are key markers of legitimacy in MSF’s organisation, how do they manifest in the offices of OCA and its partner sections, and how do they intersect with or counteract existing inequalities within MSF? The chapter draws primarily on interviews from current and former headquarters personnel, focusing on the dynamics they experienced.

These politics of legitimacy play out in a context where organisational arguments can take moral forms. To illuminate these dynamics, the chapter borrows from Stephen Hopgood’s analysis of the “keepers of the flame” in Amnesty International, who “form a kind of amateur (vocationally oriented) profession inside a bureaucracy,” acting as the “border guards” of the “sacred core” of the organisation: its moral authority and role (Hopgood, 2006, p. 15). In MSF, the ability to lay claim to certain markers of legitimacy, derived from the organisation’s principles and mythologies, can form the basis of prominence or influence in internal discussions and ultimately creates or blocks pathways to change.

The first section looks at the spirit of volunteerism within MSF’s ideology and how it presents in attitudes towards remuneration, impacting upon access to the organisation for people of lower socio-economic backgrounds. The second section shows how the ability to represent MSF’s ‘mission’ at headquarters level is derived from experience in the field. It argues that operational experience serves as the foundation for an “old guard” to occupy decision making posts and speak with authority, with implications for priority-setting within the organisation. Throughout, the chapter highlights how the politics of legitimacy also contribute to a lack of trust in ‘management’ and leadership of different kinds, seen in competing narratives: about the willingness or unwillingness of formal authorities to act, their ability or inability to do so successfully, and the merit or demerit of different areas in which MSF and its staff should invest resources.

7.1 The spirit of volunteerism

The principle of volunteerism has been an important marker of MSF identity since its founding. In this, it is not alone: organisations such as the International Committee of the Red Cross, for example, also relied upon volunteer staff in their early years (Palmieri, 2012) and “voluntary service” remains one of the fundamental principles of the International Red Cross/Red Crescent Movement. Amnesty International also began with a volunteer ethos, gradually evolving towards a distinction between members (who remained volunteers) and staff, who were paid but retained and reproduced a sense of an original moral calling (Hopgood, 2006). In MSF, the spirit of volunteerism has two main aspects: an emphasis on values-based, individual commitment, and a valorisation of ‘disinterest,’ These aspects are reproduced in specific policies, with impacts that interviewees described as exclusionary.

Reproducing volunteerism

Volunteerism is written into the foundational texts of MSF. The current MSF Charter, described as: “The document that cements the collective identity of the organization and its members” (Abu Sa’Da and Crombé, 2016, p. 134), states as one of its four core principles that: “As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them” (MSF, undated). The Chantilly Principles of 1995 further cemented MSF’s identity as “an organisation of volunteers,” meaning that the “principle of disinterest” is at once an ideal for the organisation, a material consequence for its employees, and an intended guarantee of a “spirit of resistance against compromise, routine, and institutionalisation” (MSF, 1995). The La Mancha Agreement also referred to “preserving the spirit of volunteerism” (MSF, 2006).

Interviewees described the importance of being seen as a ‘volunteer’ in the sense of a commitment to the humanitarian imperative. In MSF’s emergency culture, this often manifests as a willingness to work long hours:

“If you come in and you haven’t swallowed the MSF pill, and completely align with our principles, and our values, and you come in and you do the 9 to 5 and you’re not willing to give more, then you’re not seen in the way that, maybe, you would be in another organisation, because that’s the culture and environment that’s perpetuated.”

In this culture, negotiating individually on pay is out of step with organisational culture, the attitude being described as: “if you’re not happy with the salary, then you’re welcome to leave.” The emphasis on altruism was parodied by one interviewee when asked about their MSF career: “I’ve had a few other interviews and I start with this: it’s not going to be a fancy story. It’s not going to be like I talk to many field workers and they’re like, ‘Yeah, I dreamed about MSF when I was a little child’.”

The notion of volunteerism is part of the importance of external intervenors. A senior employee explained that the principle of volunteerism “means something very different in English as it does in French, this sans-frontièrisme, which is very much in the charter of the organisation that doctors and other medical staff and support staff go freely to support others in need.” This, they argued, was fundamental to a way of thinking that centres on who can or should adopt certain roles. As Caroline Abu Sa’Da and Xavier Crombé (2016, p. 136) explain, the Charter’s reference to ‘volunteers’ came to mean those who worked for the organisation in the ‘field’; while internationally mobile staff could be understood within this spirit of volunteerism even when they were remunerated, organisational practices relied on different assumptions about locally recruited staff until the early to mid-2000s, when the topic of staff categories became the subject of discussion.

Today, despite the intervening decades, the influence of this differentiated access to the ‘volunteer’ spirit is still felt by locally recruited staff (see box 6). Interviewees argued that volunteerism also has direct impacts for recruitment by MSF’s national sections, whether for headquarters roles or for international contracts. These impacts are discussed in the next section.

BOX 6: VOLUNTEER SPIRIT AND LOCALLY RECRUITED STAFF

Historically, across MSF, the identification of the organisation with its internationally mobile ‘volunteers’ meant that the number of locally recruited personnel and their conditions of employment were not recorded by the organisation, nor were these staff allowed to join associations (Dollé, 2006). A decade and a half later, there continue to be split systems in many areas – different induction trainings, different HR monitoring systems, different health care policies, and so on. This is in part a necessity, as MSF entities must comply with and adapt to national employment legislation.

However, internal consultations in 2018 found that volunteerism was still associated with crossing borders and additionally with origins in wealthy countries. The report summarised that:

“[V]olunteerism is considered by many an out-dated and divisive notion (‘volunteerism excludes’) that warps people’s ability to recognize the multiple shades of commitment to MSF’s social mission that actually exist and negates the day to day necessity of earning a living and – if possible – having access to a social security safety net as faced by the vast majority of MSFers today.” (Harvey and Delaunay, 2018, p. 13)

Interviews for this study continued to highlight it as an issue. For example, one employee said: “We still have meetings, we still have comments in Souk about if we pay people from the Global South equally, what guarantees that they don’t want to do it for the money?” MSF employees who were initially recruited on local contracts described the difficulty of proving their “MSF-ness”, and countering assumptions that they were simply joining the organisation for money. A Learning and Development specialist observed that during recruitment interviews:

“If the question is, ‘how do you see yourself in the future?’ if they say, […] ‘I hope after a couple of years of experience here, I would like to become an administration manager in the government structure.’ Immediately, it’s a, ‘No, because you’re working only for 2 years with us? How dare you? You’re not committed to the organisation. You love your government better than MSF. So, we don’t want to recruit you.’ Well, the issue is, first, what opportunity or guarantee do you provide from in MSF, for the person to grow? Well, none, usually.”

Locally recruited employees described having to enter MSF through routes that discounted their professional expertise. A person with a medical background described how after several unsuccessful attempts, a friend inside MSF advised them to change strategy:

“Since you are trained and have ambitions, start at the lowest level – apply to be a guard – because there aren’t as many requirements to get in. After that, with your background, it will be possible to access other roles because you will be already inside the organisation. It was the best way to join.”

Another person had been positively surprised: “when I applied, I was told that MSF never considers applicants who hadn’t worked with it before, those from outside,” yet was one of two appointed, and considered the other (who had already worked for MSF) to have been appointed on merit. Such stories suggest that recruitment to MSF can (in some places at least) become the subject of received truths, which may or may not reflect documented policies and practices, but which nonetheless raise questions about how different staff perceive their value in the eyes of the organisation. They also raise questions about how recruitment processes interact with wider socio-economic inequalities: entry into the organisation, even at the lowest grade, may favour those with access to education and/or to the linguistic skills (requiring colonial rather than vernacular languages) that are often expected of locally recruited staff, reinforcing class barriers.

Barriers to entry

One of the perceived impacts of the emphasis on volunteer spirit is to create barriers to entry for staff from lower socio-economic groups. This is because of the way that the ‘disinterest principle’ is embedded in MSF and OCA’s salary system. The Chantilly Agreement (MSF 1995) specifies that in MSF “the proportion of salaried positions remains limited” and “Management staff salaries are lower than those in comparable sectors of the employment market.” In the Amsterdam office, salaries are benchmarked to the lowest quartile of salaries in chosen sectors (MSF Holland, 2008, p. 2). A headquarters employee with children said: “I cannot work for less, literally.” The emphasis on ‘commitment’ is integral to the pay scale (under revision at time of writing), which classes jobs according to internal “perspectives” on their complexity, level of responsibility, and so on; the framework explicitly excludes any consideration of “required qualification or competences,” “performance of the jobholder,” or “inconveniences that are an inextricable part of a job such as field visits, on-call duties or regular work beyond office hours” (ibid, p. 4). The effect of the salary framework, a senior manager in Amsterdam argued, is that “if you select on that level, you select higher middle class, people that have an extra [source of support] somewhere.” The impacts of this approach have been the subject of previous internal discussions, as among OCA networks – and more widely – there have been calls for MSF to consider how the volunteerism principle is contributing to its workforce being most accessible to those in a financial position to accept low remuneration.

With these dynamics in mind, interviewees noted a “class divide” affecting MSF. One described MSF as “a project of internationally-orientated, well-educated, somehow privileged part of the [partner section] society.” “Middle class, white, university trained,” another summed up, referring to a partner office. This affected the recruitment of internationally mobile staff, a senior manager noted:

“I do not see a Dutch nurse [from a low-income, immigrant background] working for us because if you finally got yourself through nursing education, and you’ve got your higher education degree, you have debts, and you cannot work away your debts working for us. You probably still live with your parents in a social housing complex, and they are not going to say: “Sure we’re going to finance you for another year so you can work for almost nothing with MSF in the field somewhere.” 140

As these examples suggest, socio-economic privilege was often linked to broader racialised inequalities in European society, which interviewees argued were being reproduced within MSF as a result of its policies. Access to education was repeatedly underscored as a form of “class power.” A partner section employee working in communications reflected on the “bias” in the workforce: while the need for specific qualifications or expertise may be shaping profiles among internationally mobile staff, they observed that their office also lacked “a good representation of the [partner section] society as a whole. Perhaps sometimes we are a bit blind to some realities of the [partner section] society, but this is also not our main scope.” As this interviewee observed, the operational mandate of MSF may serve to distract organisational attention from understanding and then addressing exclusionary elements in its own ways of working.

Indeed, the idea that the organisation lacked awareness of or “attention” on class was often raised in these discussions. One senior manager commented on the reduced attention on issues of class within OCA:

“I very often think that we look at passports or colour. […] Because this is a super international bunch that I’ve got here in the Amsterdam office, and therefore it is diverse, but whether they’re black or white, they’re all upper middle class, and that’s not necessarily diverse.”

People are told “everything is open, but you need to initiate the opening,” said an employee based at another office, arguing that “the organisation is designed for a certain socioeconomic background […] and I would wonder whether, to an extent, that prejudice is the bigger prejudice than others that we worry about within MSF.” Another argued that lack of “social class diversity” affected the “diversity of thought” in MSF:

“How does the organisation genuinely put in systems to improve diversity of thought? I don’t think we do enough. The UK is one example but even, say, in the India context, in India office, how many of them are from the same caste? How many of them actually are privileged middle-class Indians and how much do they really represent the rest of society?” 141

Support for relocation costs to work in Amsterdam was also highlighted as an example of how “the concept of MSF modesty” can translate into “policies being structurally racist” when applied to employees from the Global South appointed to positions at headquarters level. For example, a 2019 version of OCA’s relocation policy reportedly defined a list of eligible items and specific shops from which expenses will be reimbursed. In the words of a participant in consultations on revising the policy, “you can only get basic stuff from IKEA and they had a list of furniture and cooking items that you could get,” prompting feedback highlighting diverse needs, such as, “what if somebody wants a rice cooker because they’ve come from South East Asia […] what if somebody needs an orthopaedic mattress rather than the IKEA basic mattress because they have chronic pain or back issues.” Although a new policy has been drafted that would see these lifted, they remain the normative basis for the estimation of relocation costs; in other policies, provisions are tied to minimums in Dutch law. When concerns about the equity impacts were raised, employees described how the organisational priority remained “saving money” rather than creating a welcoming and inclusive environment. They concluded: “stop saying you’re writing these policies with an equitable lens” if equity is less important than “MSF modesty.” The dual goals of perpetuating a ‘volunteerist’ ethos and saving money contribute to the imposition of constraints, showing how MSF’s emergency culture extends into areas of organisational practice far from programming and operational decision making.

7.2 Proximity to operations

As outlined in Chapter 4, ‘time in the field’ is a significant currency of influence in MSF. As one person said: “legitimacy is conferred from having worked in Afghanistan, DRC, South Sudan. You’ve got to be able to tick off the big five or six, otherwise no-one’s interested.” In this environment, proximity to operations allows some MSF-ers to rhetorically occupy positions as the guardians of MSF’s identity and mandate, whether that be in discussions about where and whether to open or close projects, for example, in conversations about the movement’s structures, or in debates about its potential futures. This contributes to an organisational culture similar to that described by Hopgood (2006, p. 191), in which “management has no natural writ over identity” and “authority was so dispersed that individuals felt empowered to speak even against corporate decisions of the management and movement.” This section argues that the legitimacy held by those with operational experience affects internal communication, management and where attention is directed within the organisation.

Who represents operations?

At headquarters level, legitimacy was considered integral to the pre-eminent position of operational teams. This power is both formal and informal. Formally, in the words of a senior manager, OCA’s Operations Department makes decisions about issues such as “which country to go [to], how many projects there are,” while the Management Team is responsible (in concert with the OCA Council) for the overall budget; the General Director can “have an opinion” on operational issues and “of course the opinion is heard, but the decision is not there.” Informal power in Operations is strongly tied to currencies of influence within the organisation:

“There’s a lot of informal power-wielding that goes on in MSF, as well, and I think that if I was to really say, ‘Well, where does the power reside within MSF?’ If I had to summarise that in one sentence, I would say: ‘The power resides within the operations teams.’ That’s where the true power in MSF sits. It is the operations teams that spend the majority of MSF’s money. It is the operations teams that, obviously, have the day-to-day connection with the country programmes, and there is a huge amount of moral authority as well, if you like, that is held within operations teams in terms of who has the power to, and the legitimacy to, speak on certain issues.”

Numerically speaking, the Operations Department is small within the overall workforce of OCA headquarters yet oversees the direct action in which the majority of MSF’s staff are engaged. In 2022, OCA’s annual plan had 470 posts at headquarters level, adding up to 416 full-time equivalent positions; of those posts, the Operations Department represented roughly 30 positions. It is organised into 6 cells – 3 based in Amsterdam, 2 based in Berlin, and 1 based in Nairobi – as well as an Emergency Support Department. Each cell is headed by an Operations Manager (an OM, sometimes referred to as the ‘desk’) who is responsible for managing their portfolio of countries. These structures head OCA’s operations, which in 2022 engaged 752 internationally mobile staff and 11,264 locally recruited staff. As the boundaries between roles in the Operations line are not fully fixed or enforceable (despite the existence of job descriptions), who is in what position interacts with contextual conditions to shape the reach or scope of those roles, resulting in a shifting series of negotiations as people move in and out of programme positions.

The power of ops is formally inscribed in the way that the Operations Department interacts with other departments or teams in OCA. In brief, and to generalise, formal decision-making authority lies with the Director of Operations or the Operations Managers. The Operations Manager manages Heads of Mission, who in turn manage Project Coordinators. Outside operations, other colleagues are in advisory roles, of which there are many. One member of the department summarised: “we have a lot of advisers. We have a health adviser, an HR adviser, a logistics adviser, and some are more adviser than others. Some are advisers on certain parts of their job profile and decision makers on others.” This advisory relationship carries through into programme structures, for example through the medical support team chaired by the health management.

As outlined in Chapter 4, being a medic may carry leverage for individuals but in the larger scheme of things the Operations Department prevails. Two scenarios described during different interviews illustrate this dynamic, one at headquarters and one at programme level:

“The MST [Medical Support Team] might be having all these technical discussions about how to do a particular [project], where to start a new cholera project for example, but in ops they’ve already taken the decision. ‘Well, we don’t care about that region.’ Or ‘This is a security whatever.’ And, almost, this discussion’s happening in parallel and you find out in the next MST: ‘Oh hey, this has been decided’.”

“For example, here in the field, we may give suggestions for a given intervention, we have data which proves that the intervention is possible, and the medical coordination encourages us to make and give suggestions, but once we’ve finished doing that work the answer is ‘This is not the priority. Cool it down. Get on with some other things.’ Operations are the only decision-makers.”

Questions of credibility, legitimacy, and influence are perceived as very important to internal exchanges. While colleagues in other departments may also have significant experience and credentials, including ones that are internally valued, they tended to describe their views as lacking authority or weight in the eyes of colleagues with operational experience. Some spoke of having to counteract assumptions that undermined their contribution or pointed to the importance of being able to speak in the ‘language of operations’ when making a point. For these reasons, some staff emphasised the value of institutional know-how, such as the knowledge and ability to persuade key decision-makers, including notably in exchanges between Operations and OSCAR. Thus, in advisory positions, one said, “you have to fight for influence, to exert your influence on the decision-maker.” Another example is the high regard in which the ‘ops platform’ is held, seen in the idea that it was “the height of influence for a humanitarian affairs adviser to be able to engage with the people who sit at that meeting.” However, not all members of the Operations Department interviewed described the ops platform as primarily a decision-making space, highlighting its consultative role with regards to the ultimate decision-making authority of the Operational Director.

People spoke of the networked connections between staff members within Operations, which add up to a strong concentration of internal power. The people in this group have often served within MSF, and OCA particularly, for many years. They tend to know each other, their careers having criss-crossed through many of the same places and they have potentially worked together in different configurations, including who is managing whom. They form “very strong bonds” from working in “volatile settings,” said one experienced colleague. Historically, the E-desk has been characterised as “a very closed circle of people who are extremely comfortable and familiar with each other and have very high levels of confidence in each other’s capabilities.” Experience in high-profile, acute emergencies can catapult a person up through the ranks of prestige; having an assignment “in a huge emergency that has everyone looking at you” is a stepping-stone that can change an entire career.

11 The ops platform, which has doubled in size over the past twenty years, brings together the Director of Operations, Deputy Director of Operations, Senior Operations Advisor, Medical Director, Deputy Medical Director, Head of OSCAR, Head of E-Desk, and the Operations Managers.

If programme or ‘field’ experience is at its most concentrated in the Operations Department, it is also frequently found elsewhere in headquarters. Indeed, as anthropologist and former MSF staff member Darryl Stellmach (2020, p. 5) has written: “Many office people are field veterans: career aid workers who moved to the headquarters to maintain family ties and a more sustainable rhythm of life.” One interviewee pointed to the pattern in which:

“A lot of the people that have taken the seats, taken the senior management seats, particularly the ones that are more medically operationally related, they have gone through a similar trajectory of having spent that time in the field, and then therefore earned that recognition.”

Staff members who had worked outside OCA in section offices also described situations where “the entire upper echelon of the management team was composed of individuals that had previously worked in the field but were not necessarily seen as experts or qualified in the positions that they were working in.”

This reflects MSF’s operational culture, which perpetuates the currency of influence of time in ‘the field’ (see also Chapter 4). In interviews, internal complexity was cited as a reason for MSF’s “priority on growing our own leaders,” because alongside “the complexity of the places that we work […] MSF is a complex animal” with many different and interacting parts. Exposure to acute emergency settings was contrasted with “giving the right answer in the book” as a form of expertise, a justification for the emphasis on length of service “not because we need to win a badge of honour but because there’s only so much you can be taught on how to be a Project Coordinator.” ‘Field’ experience, then, becomes a short-hand for a proven ability to cope and perform in the challenging environments with which MSF is most associated. While it appears to be most visible and authoritative in the Operations Department, it also sits across headquarters departments and shapes the way staff members interact, cutting across departmental lines and formal seniority. The impacts of this on internal communication are outlined below.

Internal communication

Proximity to programmes can be invoked as a way to marginalise the roles or voices of staff members with less or no equivalent experience. Hopgood (2006, p. 17) found in Amnesty that a strong values base can make “problematic the integration of those with commercial skills who could not, almost by definition, be ‘part of the heartbeat’” of the social mission. In OCA, headquarters employees without programme experience described their feeling of being delegitimised. The example of conversations about HR was used to capture calls for non-operational colleagues to “shut up, because it is your fault that we don’t have staff in Ethiopia and people are dying because of that.” Commenting on the resulting culture, a manager argued that “we need to modernise and respect staff also if they say, ‘Hey, give me decent pay,’ or, ‘I am for the cause here, but I don’t need to go 15 years in the field before I can run your database management’.” Headquarters staff said that entire departments can be marked as distant from programmes and ‘HQ-centric’ despite having mixed staff profiles (including individuals with ‘field’ experience), operationally relevant roles, and daily contact with the country programmes. As explained in Chapter 3, this can contribute to an at times heated or antagonistic approach to communication, although some headquarters offices have invested in processes to articulate and improve cultures of interpersonal communication.

The keepers of MSF’s flame appear to assume an entitlement to speak that others are not able to access. Perceptions of legitimacy affect people’s decisions about whether to participate in internal discussions, as seen in one person’s account of deciding to speak up on an issue even though, with several international assignments and roughly two years at headquarters, they considered themselves “kind of a nobody” who did not yet have “organisational headquarters tenure.” Conversely, people who can speak from proximity to operations are able to challenge those further up in the formal hierarchy, as authority and legitimacy are independent from formal structures. A senior manager, while recognising the centrality of the social mission, argued that:

“Saving lives is also used in order to get your way against compliance, get your way against funding and so on, because who can argue with this? If somebody says, ‘patients are dying because we don’t put more money in this,’ then I could never get money for an investment in HQ because there’s always a patient somewhere that deserves more than an investment in an IT tool. So, that is something that can be very dangerous in the organisation if it’s misused.”

Although these dynamics were very pronounced at headquarters level across different departments or between colleagues with different backgrounds, prestige related to length and locations of service also shaped dynamics within the Operations line in-country. One person in a coordination role recounted their experience of debates among Operations colleagues:

“I’ve been told a lot of times, both at country level and OC level, ‘I’ve got 25 years’ experience,’ ‘I’ve got 28 years’ experience,’ ‘I’ve got 20 years’ experience.’ I’m, like, ‘That’s commendable, that’s respectable, and your input is valued, but can we not use that as the end-all of a conversation? Can we not use that as the justification for why we should take your approach and not another approach?’”

The identity of MSF becomes essentialised, with phrases like “that’s not how we do things” being “used with great frequency to shut down ideas that don’t fit a certain mould.” Another employee gave an example of this in action:

“In everyday meetings, when something would come up, a practice, a policy, a way of working – and I would share: the Interagency Guidelines actually don’t recommend that any more, this is not what others are doing in other organisations – the reflection still was this tension of, ‘Do you know us, and are you one of us?’ Like: ‘The MSF way is the right way, and we don’t have this outside perspective’.”

It is possible that this dynamic is limiting both the contribution of a more diverse range of staff to MSF’s existing work and the development and/or implementation of different approaches. For example, one interviewee identified a “catch-22” affecting operations. On one hand, in the Operations Department, “most of our time is spent staying afloat and trying to do a good job by the missions, and not so much succeeding and revising the way we are organised” because “we just generally speaking don’t have a lot of brain space for reform.” On the other, the department is unlikely to accept outside help: “whether it’s appropriate or not, that centrality of ops means that if an initiative doesn’t come from that department, things are not likely to progress.” The gravitational pull of operations, by this account, is not something that the Operations Department is able to harness. Instead, it perpetuates the influence of individual keepers of the MSF flame across the executive and association, who can leverage a position of legitimacy to push their own, personal version of what they believe is right or necessary.

Underpinning the clashes described above is a profound question about the stewardship of the organisation. Inevitably, priorities conflict – between different programming possibilities, between ‘institutional’ and ‘operational’ domains. Some, perhaps many, staff members hold strong views about where resources should be focused, which tap into ideas about the identity and purpose of MSF. An Amsterdam-based employee described the dynamic:

“A lot of people in Operations have quite a clear point of view on how it should function. And also they see the field as the core of the organisation, and they find sometimes that other priorities step a little bit away from that core, and that can sometimes clash a little bit.”

Views from ‘the field’ are agreed to be essential. Yet the many obstacles in the way of programme personnel being able to participate in discussions, especially the locally recruited staff who make up the vast majority, increases the importance of voices within or accessible to headquarters that can claim to speak with authority from a ‘field’ perspective. At the same time, many staff appear to also have a lack of trust that managers are properly positioned to make the right choices and see ‘management’ shortcomings as part of the problem. These dynamics raise the stakes for discussions about conflicting priorities. How legitimacy shapes management is discussed in the next section.

Management

Interviewees frequently expressed a lack of confidence in what could be summarised as the ‘higher-ups.’ Depending on the speaker and context, this could refer to supervisors, line managers, decision-makers, or ‘management’ in the sense of organisational leadership (whether at OC level or at international, movement level). The lack of confidence thus appears to inform, for example, Project Coordinators’ attitudes to key coordinators in the capital, capitals’ positions towards headquarters, and views from a range of staff about senior OC and international management. In OCA headquarters, the lack of trust in ‘management’ was multidirectional – that is, it was expressed by some staff about various layers above them in the hierarchy; by some of those in senior management in relation to layers of management below them; and by some with associative governance experience about the executive (and indeed about associative leadership as well). Additionally, there were several critiques of management approaches and habits overall. This section does not seek to explain all these concerns and criticisms but to highlight those that relate to the legitimacy that operational experience carries in the organisation.

Though turnover also affects MSF’s workforce, there are colleagues in headquarters and elsewhere who have spent many years working for OCA or other parts of the movement. Having personnel with internal careers that can sometimes be counted in decades is perceived to affect management styles, not just in OCA but in MSF at large. Interviewees described how career trajectories shape how people approach management roles, amplifying the weight of precedent and maintaining the emphasis on direct intervention even for those who sit at more strategic levels. According to these accounts, managers are too focused on understanding detail and not sufficiently concentrating on strategic considerations. “I think that different managers and advisers and decision makers of all kinds exercise their authority quite differently,” one person said, but “a generalisation that holds is that everybody’s working two levels down from where they should be.” Another said that as people move up the management line, “they come from below, and they bring an attitude from, ‘this is how we used to do it,’ and a very hands-on attitude,” which makes it “very difficult for people to space out and think, ‘let me only do the highlights’.”

While this may not be particular to MSF, or indeed to humanitarian organisations, there may well be specificities to how these legacies shape choices. The humanitarian sector has undergone rapid professionalisation in the years since MSF first arrived as a prominent player on the international stage. Some interviewees highlighted the impact of this evolution on the attitudes of different generations of humanitarian workers. A key cohort in MSF, it was argued, experienced formative years when the organisation’s identity was dominated by the emergency imaginary in its most archetypal form:

“A lot of the people who worked in the late 80s-90s, they are the ones who, when they joined MSF, the version of MSF that they saw was the one – I’m physically going to go to these countries and help people now. I’m going to stop people from dying, now. I’m less worried about stopping people from dying in 5 years’ time, by changing this policy or by doing this research that allows this new drug cure to come on the market.”

While the number of people still working in MSF who started their career in the 1980s may be few, the legacies of this period are perceived to still be active in attitudes that have been replicated and passed on within the organisation and in the modes of action that are valued according to MSF’s self-identity (see Chapter 3).

Several triggers over the past five to ten years have brought intense scrutiny to questions of expertise, professionalisation, and identity in relation to the upper levels of management and governance in OCA. The resulting discussions have at times pitted internal and external expertise against each other, resulting in aggravated discussions in executive and associative forums alike about whether, for example, people would “rather see a person who knows all about the MSF supply chain and has experience of 20 years than somebody with a Masters, without any experience in that.” While few interviewees argued that expertise developed outside MSF has no value, many sought to articulate limits on how much value should be placed on that expertise (the ‘balance’ between staff with different backgrounds) or the levels of seniority to which it is relevant (the rank that so-called ‘externals’ should occupy).

A distinctive element of current positions is the identification of a cohort of experienced staff with the legitimacy, assuredness, and motivation to challenge formal powerholders. This sees the keepers of the MSF flame operating as a kind of bloc: interviewees identified an “old guard” cohort of operations veterans as constituting a kind of “middle management” in OCA, with one interviewee describing this as a form of “networked nepotism.” Some interviewees linked the influence of this cohort to their roles within management structures. In this telling, as we heard from one senior manager, there is a pattern of former leaders returning to less senior positions after the end of their tenure (contracts for directors are limited to a maximum of two terms of three years). While some former directors move on, others return:

“They go out for half a year on unpaid leave or they go somewhere else or they take a break or they need to mend their mental issues, and then they come back in middle management with lower pay, but they’re willing for the good cause, the social mission, and, ‘This is my family.’ So they come in middle management, which means that they then have all the informal power to continue what they were doing, and the person that took their place is put in a spot where the former boss is working lower there.”

A consistent perception of interviewees was that this bloc was opposed to at least some of the current calls and drives for reform in OCA and MSF. It appears as a counter-power to the formal leadership in the OCA Management Team and able to apply that power in both executive and associative forums.

Several interviewees observed that the top management of MSF reflected broader racialised dynamics within the organisation. One person said, “whiteness is still very dominant,” which they felt posed challenges for the present and future identity of the organisation:

“If you look at the composition of the key international decision-making bodies, it’s changing a bit, but it’s changing very slowly, and I think we have to ask the question whether the current leadership in MSF is capable of implementing a much more radical change in the distribution of power and influence. It’s very hard for anyone to jump over their own shadow, obviously, so I don’t mean that as criticism, but as a key question underpinning all of this.”

Another reflected on the potential for such arguments to be experienced as a personal affront, as individual profile becomes decoupled from and stressed more than MSF-ness; a feeling that “I’ve dedicated my career and life to this organisation, now you’re coming and telling me that I’m not a legitimate representation of everybody in it.” While not everyone used the language of race, many felt that the ability to access and define MSF identity played a part in resistance to change:

“There is a big middle part of the organisation who really, either don’t want to change because that is something that personally will affect them, or they want to be in charge of the narrative. So they want to lead that change on their own terms. Or they simply believe that the organisation doesn’t need to change, because what they’re doing is right.”

During interviews, these differences of opinion became apparent in different attitudes to what constituted legitimate issues on which to focus collective attention. As the next section discusses, proximity to programmes brings advantages when defining what constitutes legitimate priorities.

Defining legitimate attention

Within the frame of operational decision-making, disputes between Operational Centres are infamous in the history of the MSF movement and colleagues have alluded to the “transactional costs” that can mount when there are disagreements in intersectional platforms. When looking within OCA, there are “battles” and “old turf wars” about operational decision-making both in terms of collaborations between departments and different approaches within them. These may be on a wide range of topics, such as use of resources, risk management, medical techniques, advocacy choices, and so on.

On a strategic level, given that resources are finite, choices about how to invest can falsely appear to be a zero-sum game where what goes into the ‘institution’ takes away from what can go towards the ‘social mission’. According to a senior manager, this creates a dilemma for requests for support services, because “you can’t just ask for a lot of resources, you know very well that any of this resource would be best placed to save a child.”

While this applies to funds, interviewees often raised it in relation to attention and time, both also finite resources. This attitude shapes responses to calls for a focus on MSF as an institution, including on issues gathered under the ‘diversity, equity, and inclusion’ agenda. DEI was described as “the institutional sanctioned terminology” for addressing interpersonal as well as structural problems affecting staff members, attached to the creation of strategies, action plans, and focal points. Although ‘DEI’ is a widespread shorthand, and definitions of its component terms are made available, as a grouping it is not clearly defined nor are its boundaries made explicit. OCA’s DEI page on SharePoint highlights the goal in the 2020-2023 strategic plan of becoming “a global organisation within which all staff are valued and respected, and do not face structural barriers to communication, mobility and professional development” – with DEI by inference referring to activities in support of that goal.

While no interviewees expressed opposition to the broad idea of ending discrimination and valuing all staff, some expressed considerable reservations about the level of attention on institutional issues. In this line of argument, examining biases in organisational culture or structures becomes a ‘distraction’ from ‘core business.’ It feels, in the words of one senior manager, like “an addition.” In short, as one sympathetic staff member summarised: “ops, they do ops. They save lives. They respond to emergencies. They cannot sit there and listen to racism topics all day.”

Being part of operations allows these critiques to be presented as channelling ‘field’ priorities. This was summed up by one OCA employee reflecting on the need to maintain focus on the social mission:

“Your goal is still your beneficiaries in the field, and not just – sometimes we talk more about diversity than about our operations, our beneficiaries, and this is what is starting to bother me, because I feel that the balance is really shifting. I know it’s also a big hype in the world, people talk about climate change, diversity, et cetera. But sometimes we spend too much time on it, we are not discussing our choices in some countries, we don’t discuss what’s going on in Ethiopia, we’re not going to push, to speak out on all this Tigray conflict, whatever. We talk a lot about diversity, and it’s important but we will not change it at once, and you really need to balance it.”

There was a disconnect in how different employees understood the relevance or importance of DEI, in particular in relation to OCA’s operational priorities and emergency programming. In some discussions, ‘DEI’ was pitted against operations and the medical mission. The focus, interviewees argued, was on short-term, lifesaving programmes: discussions around internal inequalities were navel-gazing, especially when MSF has ‘actual’ work to do (saving lives in the field). For instance, one employee expressed their concern at the “tremendous quantity of attention going, but also of resources going” into “DEI efforts”:

“It’s always at the cost of something. All that attention and all the discussion and it is also at the cost of what happens […] and what it is all about in the end, and that is delivering quality medical humanitarian assistance to people who are victim in conflicts and natural disasters. If I summarise, basically […] I’m afraid that what happens at this moment, it’s positive that the discussion is there, but I am a bit afraid that it’s too much.”

Some of these criticisms were framed as less about the importance of the goals themselves than the approaches to achieving them (see discussion of DEI in Chapter 8). In contrast, other interviewees emphasised the connection between internal inclusion and OCA or MSF’s ability to maintain the quality and reach of its work. At headquarters level as much as elsewhere, some argued, “ultimately, who we recruit and how they feel in their jobs impacts how well we’re able to do our patient care.” According to this logic, attention devoted to DEI does not come at the cost of operational matters but supports them, a view that has been substantiated by numerous studies relating to medicine and organisational and corporate development more generally (Rosenkranz et al., 2021; Cohen et al., 2002; McKinsey, 2020). Yet, as explored in the next chapter, lack of confidence in management was also often expressed by those who support calls for greater attention to be paid to internal questions of diversity, equity and inclusion. People with diverging views of where collective attention should be directed thus find common ground in narratives about the capacity – or otherwise – of leadership and the institution at large to meaningfully address the major problems of which many are aware.

Conclusion

Building on preceding chapters, this chapter examines perceptions within MSF that current approaches to ‘keeping the flame’ in MSF involve negative consequences for individual staff and for some of OCA’s ways of working. Certain value systems have become embedded in structures and perpetuated both through codification in policy and in norms that shape expectations and behaviour. Specifically, the chapter focused on some of the forms and implications of the spirit of volunteerism and proximity to operations, both deeply rooted in MSF’s emergency culture and the currencies that hold sway in the organisation.

Amnesty International and MSF have different dynamics; their purposes, structures, and identities are not the same. Nonetheless, understandings of power dynamics inside both are furthered by reflecting on the role of a core group of keepers of the flame, strongly associated with the identity of the organisation, able to speak as guardians of its moral authority and role. An organisational culture built on debate and individual initiative favours those who feel legitimate and equipped to wade in. What this looks like in practice is inevitably shaped by internal currencies of influence and by internal and external axes of inequality with which they interact. As one long-standing employee reflected, MSF’s culture appears to be built for a certain type of person:

“One needs to be bold, not even maybe bold, but just have the assumptions as part of one’s way of thinking that if I speak up, my voice – if I’m engaged – my voice will be heard. […] But, if you don’t initially have that mindset, way of thinking, then in many senses, the doors are closed, because one wasn’t encouraged in.”

There are many forms of privilege, some of which intersect with currencies of influence, that interact to produce this effect, and many reasons why a range of staff may not feel “encouraged in.” Some interviewees reported successes in promoting changes to cultures, such as working on communication styles in specific offices or holding constructive self-reflection processes among their departments. Some interviewees also recognised the potential for line managers to create positive environments for their colleagues: “When you feel safe normally it is when you are working with a manager, with a boss, that is very comprehensive and respectful towards what you have to share.” However, in Amsterdam in particular, the politics of legitimacy were described as creating barriers to entry and participation. These dynamics are both distinct from and tied to the ways that unequal systems structure MSF’s operational workforce, adding to an image of the organisation as damagingly hierarchical, exclusionary, and paternalistic. Chapter 8 considers how employees described the likelihood and potential routes for this to change.