No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
"Nationals" and "Expatriates": Challenges of Fulfilling "Sans Frontières" ("Without Borders") Ideals in International Humanitarian Action
Abstract
The international humanitarian organization, Médecins Sans Frontières (MSF), is strongly committed to principles of universalism, egalitarianism, and equity, in both its internal and external relations. Nevertheless, the organization distinguishes between so-called "national" staff members (those who are indigenous to the countries where MSF projects are located), and "expatriate" staff (those who are involved in projects outside their countries of residence), in certain ways that it has self-critically termed "discriminatory", "colonialist", and even "racist". It has resolved to remedy such practices. Through a first-hand case study of MSF activities in Russia, this article demonstrates that the dynamics of the "nationals"/ "expatriates" divide is a more complex phenomenon than MSF's self-accusatory diagnosis implies; that a fuller recognition and utilization of nationals' local knowledge would mitigate some of the conditions of inequality and inequity that they experience; but that it would not necessarily be desirable to expunge all differences between the two groups of staff Furthermore, because they are intrinsic to the structure and conditions of international humanitarian action, some of these differences could not easily be elminated by MSF, or by any other organization engaged in this kind of action.
... In this vein, Selmer (2000) showed that Swedish (expatriate) bosses in Hong Kong could recognize only one third of locals' contributions to their respective workgroups. As several humanitarian field reports highlight (Alcayna & Al-Murani, 2016;Bjerneld, Lindmark, Garrett, & Diskett, 2004;Da Costa, 2012;McWha, 2011;Shevchenko & Fox, 2008;Vaughan-Smith, 2012), these problems may emerge even more acutely in the aid context due to the various differences between expatriate and local aid workers. As a result, they may be less willing to collaborate. ...
... This quote speaks to a larger expatriate mindset-that it may actually be more efficient to lead operations independently of locals' perspectives (e.g., Alcayna & Al-Murani, 2016). Case in point: in a Doctors without Borders field office, expatriate leaders never invited locals to biweekly meetings where operational plans were discussed and updated (Shevchenko & Fox, 2008). In turn, locals may retaliate by withholding information that could help expedite critical processes, such as needs assessment or procurement (Obrecht, 2016;Sanderson & Ramalingam, 2015). ...
... In light of these findings, leaders who are perceived as in-group prototypical-and who then make tangible behavioral efforts in pursuing collaboration (e.g., between locals and expatriates)-may be more effective at persuading their in-group members to adopt collaborative behaviors. Stated differently, we posit that perceived leader in-group prototypicality can be a powerful amplifier for aid workers' interpretation of boundary-spanning behavior, especially in field offices where collaboration is not typically the group's norm or even welcomed (e.g., Hunt, 2009;Pfeiffer, 2003;Shevchenko & Fox, 2008). As such, when group members (either locals or expatriates) perceive the leader as prototypical of their respective in-group, his/her displayed boundary-spanning behavior may be more readily accepted as a (new) norm and thus emulated through intergroup collaboration. ...
Many humanitarian aid workers receive training prior to being dispatched into the field, but they often encounter challenges that require additional learning and creativity. Consequently, aid organizations formally support collaboration among the expatriate and local workers in a field office. At best, those aid workers would not only exploit their joint knowledge but also explore novel ways of managing the challenges at hand. Yet differences between expatriate and local groups (e.g., in ethnicity, religion, education, and salary) often thwart intergroup collaboration in field offices and, by extension, any joint learning or creativity. In response to this issue, we study the role of field office leaders—specifically, how their boundary-spanning behavior may inspire collaboration between the two groups and therefore facilitate joint learning and creativity. We propose that a leader's in-group prototypicality additionally catalyzes this process—that is, a leader's behavior has more impact if s/he is seen as representing his/her group. We tested and found support for our hypothesized moderated mediation model in a field sample of 137 aid workers from 59 humanitarian organizations. Thus, our study generally highlights the pivotal role that field office leaders play for crucial outcomes in humanitarian aid operations. Furthermore, we offer concrete steps for field office leaders who want to inspire better collaboration between the expatriate and local aid workers they lead.
... The language of "national staff" and "international staff" is increasingly problematized within MSF; however, at the time of data collection this terminology was commonly used. While MSF has taken steps to address inequities around human resources practices and ensure that employment position is based on skills and experience rather than country of origin, ongoing challenges persist [44]. ...
... Yet unequal power between health professionals, rigid hierarchies, and lack of attention to the role of nurses are known barriers to effective team work in palliative care [77]. MSF struggles to disentangle itself from the colonial legacies that structure power differentials between international "expatriate" staff, locally hired "national staff", and communities [44]. While there were examples in this study of national staff who appreciated palliative care related guidance offered by international staff, there were also times when they felt unable to challenge the decisions that international staff made. ...
Introduction
The Médecins Sans Frontières (MSF) Goyalmara Hospital in Cox’s Bazar, Bangladesh is a referral centre offering the highest level of care available in the Rohingya camps for pediatrics and neonatology. Efforts are underway to integrate pediatric palliative care due to high mortality and medical complexity of patients, yet little is known about the experiences of staff delivering palliative and end-of-life care. The purpose of this study was to understand the moral experiences of MSF staff to inform program planning and implementation.
Methods
This focused ethnography was conducted between March-August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of documents including MSF clinical guidelines, admission and referral criteria, reports, and training materials. Data analysis followed a modified version of the Qualitative Analysis Guide of Leuven and data were coded using NVivo software.
Results
The prevailing understanding of pediatric palliative care among national and international staff was care that prioritized comfort for infants and children who were not expected to survive. Staff’s views were informed by their sense of obligation to do no harm, to do their best on behalf of their patients, and religious beliefs about God’s role in determining the child’s outcome. The authority of doctors, international staff, as well as protocols and guidelines shaped palliative care decision-making. Staff saw clinical guidelines as valuable resources that supported a consistent approach to care over time, while others were concerned that palliative care guidelines were rigidly applied.
Conclusion
When integrating palliative care into humanitarian programs, it is important to emphasize the active role of palliative care in reducing suffering. Advocacy for access to the highest level of care possible should continue alongside palliative care integration. While palliative care guidelines are valuable, it is essential to encourage open discussion of staff concerns and adapt care plans based on the family’s needs and preferences.
... Moreover, mutual interaction remains limited outside the office because expatriates hang out in bars that locals either cannot afford or do not consider culturally appropriate to join (Rodon et al. 2012). Taken together, these differences often encourage expatriates to look down on their local colleagues and, as such, perceive their cooperation as unnecessary (e.g., see field reports in Shevchenko and Fox 2008). ...
... Practitioners' experience (Shevchenko and Fox 2008) and social identity theorizing (Abrams and Hogg 2010) speak to the same phenomenon: Humanitarian workers naturally spend more time within, and construct identities around, their respective subgroups (local and expatriate). Such subgroup entrenchment then thwarts intra-organizational cooperation and, ultimately, humanitarian operational performance. ...
International humanitarian organizations (IHOs) always strive to improve their operational performance in the field. While anecdotes from practice suggest that IHO field office leadership plays a crucial role in this regard, these claims have not been deeply substantiated by primary data. In response, we collected survey data from 125 humanitarian workers, concentrated in disaster response and development programs, on the issues of field office leadership and operational performance. Building on the operations management and organizational behavior literature, we find that leaders who adopt an intergroup leadership style can significantly improve operational performance via enhancing cooperation between local and expatriate subgroups inside a field office. Notably, we find that the intergroup leadership style becomes more effective as humanitarian workers become more entrenched within cohesive subgroups. These results should help IHOs to better select and train their field office leaders and achieve higher operational performance. This article is protected by copyright. All rights reserved.
... Although language skills (or lack thereof) of international staff are mentioned in several studies (De Jong, 2017;Jackson, 2005;Nowicka and Kaweh, 2009;Shevchenko and Fox, 2008;White, 2002), the role that language and linguistic capital plays in unequal aid encounters is rarely addressed. Instead, translation is primarily discussed with respect to process of transferring and negotiating concepts and practices (Cornwall and Eade, 2010;Lewis and Mosse, 2006). ...
... There were institutional barriers to the promotion of multilingual staff from aid-receiving countries (cf. Shevchenko and Fox, 2008). One African respondent, who spoke English, French, and Arabic in addition to her mother tongue, had worked for many years as protection interpreter for a UN agency. ...
Globalisation processes and the spread of English as a Lingua Franca are closely related. I consider language skills as symbolic capital and focus on the hegemony of English as Lingua Franca in international aid organisations. I argue that more attention must be paid to the role of language and linguistic capital when analysing global inequality and post-colonial power relations. Humanitarian and development organisations have so far received less sociological attention than other aspects of globalisation processes, whereas in the context of development studies, attention to language usually focuses on the ‘discourse of development’ rather than on the role of linguistic capital in multi-lingual settings. Aid work, which includes the transfer of skills and resources, simultaneously addresses and perpetuates global inequalities. Language structures power relations and inequality within aid organisations, in particular between national and international staff. My article is based on qualitative interviews with multi-lingual and mono-lingual aid workers from a wide variety of aid organisations. My article is innovative by demonstrating how linguistic capital intersects with other aspects of inequality in the global context of aid organisations. It makes an important contribution to the understanding of globalisation processes and to post-colonial sociology.
... Previous scholarship on values-based organisations has highlighted the informal powers and privileges (or disadvantages) of certain individuals, position-holders, or social groups (Hopgood, 2006;Benton, 2016;James, 2022;Kothari, 2006). Research on MSF has shown that norms within parts of the movement reflect different forms of cultural capital and intersect with social and political hierarchies and inequalities (Rambaud, 2009;Shevchenko and Fox, 2008;Souley Issoufou, 2018). Histories of MSF highlight the role of key individuals in defining, expanding, transgressing, and subverting formal structures, further valorising and mythologising the role of individual agency in an emergency culture where improvisation is often more important than institutionalisation (Vallaeys, 2004;Davey, 2015;Redfield, 2013). ...
... 12 An MSF think tank even argued that expecting 'local actors' to adhere to humanitarian principles in conflict zones 'might be nothing short of utopian': the reasons that these employees might not follow principles could be 'intentional (from a conscious decision to privilege a particular group), unconscious (such as a repetition of culturally normalized patterns of exclusion), or driven by a (perceived) fear of immediate or future retaliation by local power actors. (Schenkenberg 2016, 23) In effect, the supposed 'detachment' of foreign employees is framed as central to decision-making, whilst humanitarians who are hired in their own country are portrayed as having potential particularistic attachments (Shevchenko and Fox 2008). Instead of the largescale promotion of staff in their own country, MSF has focused on improving opportunities for 'national staff' to become 'international staff' . ...
This article describes how events are turned into fables in humanitarian organisations. It explores how these fables circulate, the lessons they come to embody and their influence in maintaining an organisational status quo. The article argues that such stories teach new humanitarian employees certain ‘facts’ about ‘the field’ and help form and consolidate consensus about why things are the way they are in an organisation. By describing three such fables circulating amongst Médecins Sans Frontières ‘international’ employees in the Democratic Republic of the Congo, each of which suggested a need for foreign humanitarians to maintain a certain distance from local citizens (including their nationally hired colleagues) as a means of personal and organisational security, the article illustrates how such fables can ‘justify’ certain organisational decisions that ultimately reinforce structures of unequal power relations between different humanitarian employees.
... This group runs a greater risk to be killed, wounded or kidnapped (Stoddard et al., 2020), and reported greater psychological distress compared to iHAWs (Cardozo et al., 2005). Considering that national staff makes up for 90 % of the aid workers (Stoddard et al., 2009), further investigation into the distinction between international and national staff is warranted (Shevchenko and Fox, 2008). ...
Research findings show humanitarian work impacts one's health. We conducted a prospective observational study among 618 international humanitarian aid workers (iHAWs)’ recruited from 76 countries to investigate health changes and ill-health risk factors after mostly short-term (<1 year) medical emergency assignments. The aid workers were assigned to 27 countries. Data collected between 2017 and 2020.
We also compared a gold-standard clinical interview with self-report questionnaires to assess whether self-report scores overestimate the prevalence of clinical anxiety, depression and PTSD. Analyses consisted of repeated measures ANOVAs and adjusted odds ratios, using pre-assignment (T1), post-assignment (T2) and two-month follow-up data (T3). Humanitarian workers experienced on average, 2.6 experienced and witnessed potential traumatic events, and 4.8 male and 5.6 female assignment-related stressors. Self-report health indicators demonstrated a significant increase in emotional exhaustion, loss of vitality, decreased social functioning and emotional well-being between T1 and T2, all of which improved between T2 and T3. PTSD, depression, experienced role limitations, physical functioning, pain, and general health – remained stable. Anxiety levels decreased significantly between T1 and T2. The presence of DSM-5 disorders anxiety (6.6 %), depression (1.3 %) and PTSD (0.3 %) was low compared to norm populations, except for alcohol-use disorder (13 %). None of the reported T2 risk factors was significant at T3. Compared to the clinical interview, self-report cut-off thresholds inflated the presence of a potential anxiety disorder (3×), PTSD (8×) and depression (25×). Humanitarian work is highly stressful but most iHAWs remained healthy. Looking into how iHAWs stay healthy may be a more useful way forward.
... More so and given the fact that, as we learned from our experience there, eating together as a group is an important tradition, and therefore agreeing so easily to single out a person who eats alone appears suspicious. Of course, Dr. Smith is White and has a marked British accent, which materializes a clear socioeconomic privilege, as well as an obvious colonial stake, that locals cannot ignore (Shevchenko & Fox, 2008). Also, we are in Dadaab, one of the most dangerous regions of the world, where the notion of always having at least one medical staff member present with the patients may seem a futile matter given the surrounding chaos. ...
This article explores the collective practices through which ethics is handled at the humanitarian aid organization Doctors Without Borders. As an international nongovernmental organization operating in 72 countries, many times facing extreme contexts and yet able to uphold its ethical standards, we consider that studying the practical achievement of ethics at Doctors Without Borders is an occasion to learn how workers themselves deal with it. Our analysis of ethnographic data suggests that the question of what is right or wrong is materialized through what we call ethical matters of concern. We focus on the communicative practices through which apparent individual ethical decisions are in fact collaborative in the sense that they imply people, principles, and other artifacts that substantiate organizational ethics in everyday work.
... Such conceptualization links humanitarianism to the world of diplomacy and conflict resolution. For others the main emphasis is on témoignage, while the respective agencies maintain their main role as service providers (Fox 1995;Shevchenko and Fox 2008). Critics have also claimed, however, that témoignage is liable to essentialize the victims, as long as the new humanitarianism's call for introducing the 'political' into NGOs' activities grounds its interpretation of politics on ethics rather than on an understanding of power relations or a vision of social justice (Leebaw 2007). ...
The present article examines two projects of Physicians for Human Rights-Israel (PHR-IL)-a clinic in the Occupied Palestinian Territories and a clinic for undocumented migrant workers and asylum seekers-in order to examine the tensions between medical humanitarian aid, human rights advocacy and egalitarian political activism. Through the examination of PHR-IL the article argues that it is possible to create a hierarchical synergism between those three modes. © The Author 2014. Published by Oxford University Press. All rights reserved.
... In the 1960s and 1970s developed a "new humanitarianism" that expanded humanitarian activities from "the provision of immediate assistance … to the greater commitment of solidarity and advocacy work for victims and concerns for the longterm protection of human rights" (Chandler 2001, p. 682). However, "new humanitarians", while stressing the importance of giving testimonies of human rights' violations, still considered the provision of services in order to alleviate suffering their main role (Shevchenko & Fox 2008;Fox 1995). The self-assumed apolitical and "neutral" stand of humanitarian organizations contrasts with an increasingly political human rights discourse, which is related to the growing awareness among human rights activists that rights are socially embedded and that they should thus address them in their socio-political dimension. ...
... However, unwilling to sacrifice "their neutral and 'non-political' status" proponents of the new humanitarianism justified "their strategic choices through the language of morals and ethics rather than politics" (Chandler, 2001: 683). They emphasized the need for témoignage, but still saw their role mainly as providers of services in order to alleviate suffering (Fox, 1995;Shevchenko & Fox, 2008). ...
In this paper I reflect on my anthropological research on Tanzanian foreign aid experts and private sector development professionals in Kenya and Europe. Their cases serve as examples of three possible shifts in attention in research on aid workers: from Euro-American expats to development professionals from the global South; from state agencies and NGOs to the growing field of profit-making aid; and from the personal to the professional. The paper explores some of the methodological and ethical implications of studying these “new” areas of Aidland for the many aidnographers, like myself, whose roots lie in its “traditional” (white, expatriate, grants-based) areas.
In this essay, our analysis takes important insights on diversity and inclusion from the behavioral literature but critically contextualizes them against the reality of humanitarian operations. Humanitarian operations are characterized by system immanent diversity, particularly between local and expatriate aid workers, who not only bring valuable different perspectives to the table but also differ along multiple dimensions of diversity into a so-called diversity faultline. Such a faultline, however, provides fertile ground for continued conflict resulting in relational fractures and, ultimately, inefficient collaboration. While, in theory, inclusion could help overcome the negative effects of faultlines, in practice, the time pressure for humanitarian organizations to quickly respond to disasters makes it effectively impossible to engage in it. Against this background, we argue, humanitarian organizations should take preemptive action before disaster strikes. Specifically, we posit that the pre-disaster phase presents an opportunity to engage in inclusion in order to cultivate relational resilience between local and expatriate aid workers. Such resilience would enable them to not only better weather the inevitable relational fractures during a disaster response (and thus stay more functional throughout), but also quickly realign with each other in the post-disaster phase. We conclude with a set of concrete recommendations for practicing inclusion in the pre-disaster phase.
Many field office leaders contend that authoritarian leadership improves the performance of humanitarian operations. The common narrative is that authoritarian leadership helps aid workers more quickly adapt to changes and thus deliver better job performance (e.g., by improving operations in their field office). However, given that field reports often highlight extant leadership as the source of serious operational failures, could leaders with an authoritarian style be part of the problem? We draw on psychological theorizing on the nature of human motivation to address this question. Specifically, we note that many aid workers primarily join humanitarian operations with the prosocial motive to help beneficiaries. While proactive adaptability is inherent to prosocial motivation, we hypothesize that authoritarian leadership may curtail the relationship by impeding aid workers’ autonomy. We find support for our theorizing in a sample of 299 humanitarian aid workers from the field. Additionally, we conducted 31 expert interviews to contextualize and validate our empirical findings. The paper concludes by discussing the findings’ theoretical and managerial implications for humanitarian operations. This article is protected by copyright. All rights reserved
This paper aims to explore the ways which expertise is covertly racialized in the contemporary humanitarian aid sector. While there are considerable discussions on the expat-local divide among aid professionals, such dichotomization is still inherently nationality-based, which may be an over-simplified explanation of the group dimensions within aid organizations. This study seeks to uncover that professional categorizations of “expatriate” and “local” are not race-neutral and, instead, colorblind. Organizations within the contemporary humanitarian aid apparatus have come to appeal to what Michael Omi and Howard Winant would characterize as a new racial discourse—one that does not require explicit references to race in order to be perpetuated, as racial subordination has been reconfigured to rely on implicit references to race woven within the everyday social fabrics of the humanitarian profession. The research suggests that embedded under the contemporary professional structure of the liberal humanitarian space is a covert power hierarchy fueled by perceptions of expertise and competency along racial lines—particularly around one’s whiteness.
This article explores the everyday practice of security management and negotiations for access conducted by Médecins Sans Frontières (MSF) in North Kivu, in the Democratic Republic of the Congo (DRC). Based on ethnographic fieldwork, interviews and archival exploration, it examines the experience of MSF Congolese employees, who navigate a complex politics of humanitarian fixing and brokerage. Their role in MSF is simultaneously defined and circumscribed by their political and social situation. MSF's security management relies on local staff's interpersonal networks and on their ability to interpret and translate. However, local staff find themselves at risk, or perceived as a 'risk': exposed to external pressures and acts of violence, while possibilities for promotion are limited precisely because of their embeddedness. They face a tension between being politically and socially embedded and needing to perform MSF's principles in practice. As such, they embody the contradictions of MSF's approach in North Kivu: a simultaneous need for operational 'proximity', as well as performative distance from everyday conflict processes.
bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Research problem:
With the extensive use of the internet, cyber language management has become a critical issue for international organizations (IOs). IOs’ language choices on their official websites represent the very interests of member nations and form a key factor in organizational image construction. However, research on IOs’ cyber language management is rather limited.
Literature review:
Previous studies examined the use of different languages on websites of large corporations, state institutions, and organizations that aim to reach linguistically diverse populations, but discussions of language management of international organizations generally focus on traditional offline language policies. This article attempts to examine the choices of languages on IOs’ official websites.
Research questions:
1. What languages are used on international organizations’ official websites? 2. How do intergovernmental organizations differ from nongovernmental organizations in such language choices and cyber language management?
Methodology:
Data from the official websites of 50 intergovernmental organizations (IGOs) and 20 nongovernmental organizations (NGOs) were collected, and both qualitative and quantitative approaches were adopted to analyze the data.
Results:
The findings show that English is the dominant language on IOs’ official websites, and is especially preferred by NGOs; inconsistency of IOs’ cyber language policy is found among the languages used on specific pages, e-documents, and the general available languages; and IGOs’ language choices are more diversified, unified, and standardized than NGOs’.
Conclusion:
Accordingly, the effect of technology on IOs’ language policy is further analyzed, and suggestions for IOs’ language management are presented concerning the linguistic ecology at supra-national levels.
Ethics for Global Mental Health examines the limitations of current normative approaches to global mental health (GMH) work and argues for a values-based framework that prioritizes accountability and contextual relevance of humanitarian and profession-specific values. It cautions against using aspirational ideals as operational guidance. Chapters are organized around challenges arising in humanitarian research, disaster relief, post-conflict recovery, fieldwork, and refugee resettlement and are designed to equip readers with strategies for resolving professional dilemmas and negotiating conflicting priorities. Also included is a sample training curriculum as well as case studies and exercises that help professionals address countertransference and burnout, and recognize ethically questionable practices such as trauma tourism, rescuer fantasy, or savior complex.
This article explores international development space at the micro-level through the career stories and discursive representations of three aid workers—two nationals, one expatriate—who worked together on the same project in Tajikistan in 2008–9. Findings bear witness to the ‘liminal subjectivity’ of development where professional aid workers are, vocationally and socially, culturally and politically, neither domestic nor foreign. Aid workers’ careers demonstrate the resilience of ‘the international’ in contemporary humanitarian practice. At the same time, their biographies are not easily sutured into emergent cosmopolitanism as they remain encumbered by the boundaries of the national and international. Moreover, the article demonstrates that, while the rhetoric of international development and its putative leaders are criticized within the community itself, the international community may be formed by subordinate individuals in their liminal subjectivities.
A 'study abroad' program, which was designed to conscientize students at the University of Michigan through a year-long, three-course series using an innovative oral module to teach human immunodeficiency virus (HIV) prevention both in the United States and South Africa, was developed to transform the students and also the community by using the principles of Paulo Freire's educational theories. The story and etiology of the Pedagogy of Action will reveal how transformations were achieved through the three courses, The Pedagogy of Empowerment: Activism in Race, Gender, and Health; Preparation for the Field; and The Pedagogy of Action, which is the praxis course conducted in South Africa for 7. years..
Life in Crisis tells the story of Médecins Sans Frontières (Doctors Without Borders or MSF) and its effort to "save lives" on a global scale. Begun in 1971 as a French alternative to the Red Cross, the MSF has grown into an international institution with a reputation for outspoken protest as well as technical efficiency. It has also expanded beyond emergency response, providing for a wider range of endeavors, including AIDS care. Yet its seemingly simple ethical goal proves deeply complex in practice. MSF continually faces the problem of defining its own limits. Its minimalist form of care recalls the promise of state welfare, but without political resolution or a sense of well-being beyond health and survival. Lacking utopian certainty, the group struggles when the moral clarity of crisis fades. Nevertheless, it continues to take action and innovate. Its organizational history illustrates both the logic and the tensions of casting humanitarian medicine into a leading role in international affairs.
Médecins Sans Frontières /Doctors Without Borders (MSF) is a private international medical humanitarian organization that was created by a small group of French doctors and journalists in 1971. In 1988, MSF was awarded the Nobel Prize for Peace in recognition of the worldwide assistance it provides for people in distress who are victims of manmade and natural disasters and armed conflict. Committed to the principles of neutrality, impartiality, and independence, the men and women of MSF bear witness by speaking out about conditions of extreme need and suffering, acts of violence against individuals or groups, and threats or hindrances to medical care that they observe in the course of carrying out their work. Renée C. Fox is a sociologist known particularly for her pioneering work in medical sociology and for her ethnographic research and writing. Doctors Without Borders is based on the first-hand research she conducted about and within MSF since 1993. Its vivid, “thickly descriptive” data are derived from her participant observation, in-depth interviewing, and collection of primary and secondary documents in numerous MSF contexts. The book begins on the ground with the blogs of women and men of MSF in the field, recounting their experiences in moving detail. From there it chronicles MSF’s early history and development, paying special attention to its inner struggles, during the first decades of its existence, to clarify and implement its principles and to more fully realize its “without borders” transnational vision. Detailed case studies form the core of the book, describing MSF in postapartheid South Africa, dealing with that nation’s rampant epidemic of HIV/AIDS, and MSF in postsocialist Russia, responding to the thousands of homeless persons on the streets of Moscow and to the massive epidemic of tuberculosis in the penal colonies of Siberia. The book ends with an account of the fortieth anniversary meeting of MSF in Paris and with the author’s exit from the field. Doctor Without Borders tells a narrative enriched by photographs of MSF missions and by ironic, self-critical cartoons drawn by a member of the Communications Department of MSF France.
This article addresses legacies of national origin within global forms. Focusing on tensions related to human resources, I consider the case of the humanitarian organization Médecins Sans Frontières (MSF, or Doctors Without Borders). Since 1971, MSF has grown into a large, transnational NGO sponsoring a variety of medical projects worldwide. Amid recent efforts to "decolonize" its human profile, MSF has debated the appropriate role, motivation and remuneration of both international volunteers and local support staff it hires at mission sites. Given the different degrees of ease with which situated persons can travel, the organization's conflicting impulses place it in a classic double bind: to remain mobile it must limit local attachments, while to achieve equality it must embrace them. The figure of the ex-patriate thus suggests a mundane but precise measure for the threshold of inequality.
This article explores the role that skills and knowledge play in the relationships between national and international volunteers and staff. Based on biographical interviews with people working for a wide range of aid organisations, the experiences and strategies of individuals and organisations dealing with inequality and diversity are explored. In particular, the paper addresses the question of whether professionalisation processes that can currently be observed in the field of humanitarian aid might contribute to minimising or perpetuating the gap between national and international aid personnel. Professionalisation processes can have positive effects not only for aid recipients, who obtain better services, and for the careers of aid personnel, but also for donors and hiring aid organisations, which benefit from a skilled workforce. However, we need to critically reflect on what kind of knowledge is validated, where it can be obtained and whether credentials guarantee hiring and promotion of qualified staff from all regions.
Created as part of the 2009 Jackson School for International Studies SIS 495: Task Force. Robert T. Huber, Task Force Advisor; David Kramer, Evaluator; Michael Jussaume, Coordinator.
The politics of life and death is explored from the perspective of Doctors Without Borders (Médecins sans frontières [MSF]), an activist nongovernmental organization explicitly founded to respond to health crises on a global scale. Following the work of Michel Foucault and Giorgio Agamben, I underline key intersections between MSF's operations that express concern for human life in the midst of humanitarian disaster and the group's self-proclaimed ethic of engaged refusal. Adopting the analytic frame of biopolitics, I suggest that the actual practice of medical humanitarian organizations in crisis settings presents a fragmentary and uncertain form of such power, extended beyond stable sovereignty and deployed within a restricted temporal horizon.