In this article, historian Eleanor Davey examines the concept of failure in the humanitarian sector through the experience of MSF and its reform process, known as La Mancha, which began in the early 2000s. The text highlights the challenges faced by MSF in recognising and resolving internal inequalities within the organisation.

‘Failure’ has become one of the most powerful concepts in the humanitarian sector. It is attached to many of the largest and most high-profile responses that the international emergency sector has undertaken – in the wake of the 1994 genocide in Rwanda, for example; in the massive, disorderly response to the Indian Ocean tsunami of 2004; in Haiti following the 2010 earthquake; and today particularly in relation to the sector’s role in Syria, Afghanistan, and Yemen. The sense of failure in these cases spurred and accelerated efforts to improve. Yet, despite the political nature of the problems in these crises, attempts to address them have been identified as focusing on technocratic reforms – another failing Sarah Collinson and Samir Elhawary, Humanitarian Space: A Review of Trends and Issues (London: Overseas Development Institute, 2012), 25. .  Despite some progress, a narrative of failure is also now attaching itself to the Grand Bargain reforms that aimed to bring fundamental change to a system many declared to be ‘broken.’ Jessica Alexander, ‘As the Grand Bargain Gets a Reboot, the Limits of Aid Reform Come into Focus,’ The New Humanitarian, 15 June 2023. Available at: https://www.thenewhumanitarian.org/analysis/2023/06/15/grand-bargain-3-reboot-limits-aid-reform.Within Médecins Sans Frontières, a narrative of failure is also attaching itself to one of the most important reform efforts of the recent past. The process known as ‘La Mancha’ lasted more than 18 months, involved hundreds of people and set off a series of institutional changes in the years that followed. It was born of the realisation that, by the early 2000s, the MSF movement was ‘debating more about governance and process as opposed to our operations.’ Rowan Gillies, in Présentation de la conférence de La Mancha, undated. Available at: https://www.youtube.com/watch?v=OsdUW9nQU1Q. A series of crises had exposed weaknesses in the movement’s governance as well as disconnects between the ‘field’ and an ever-expanding headquarters. 

Today, La Mancha has an important place in MSF’s institutional narrative. The resulting agreement figures in lists of ‘essential readings’ provided to MSF employees, alongside the movement’s Charter and the 1995 Chantilly Agreement that helps to connect the Charter’s principles to the day-to-day work. La Mancha serves as a guiding light. Because, for example, it affirmed the place of témoignage (speaking out or bearing witness) as integral to MSF’s humanitarian practice, it has an important place in communications strategies. It offers a legitimating gravity – not so much a catechism that everyone can recite by heart as a point of reference that anchors the choices of today in the commitments of the past. In recent years, however, as La Mancha has been invoked in relation to the experiences of MSF staff at the hands of their employer, it has taken on a shadow.

The process

While ‘La Mancha’ as name-checked today often refers to the agreement it produced, the process leading up to this agreement was complex and ambitious. First conceived as a ‘Chantilly II’ with reference to MSF’s previous large organisational gathering, held in the aftermath of the genocide in Rwanda, the process was rebaptised ‘La Mancha’ to convey the feelings of peril and futility within a movement that seemed, like Cervantes’ Don Quixote, to be constantly tilting at windmills. It was an anxious and somewhat bitter name to adopt. (The other candidate had been ‘Nothing Toulouse,’ when organisers thought the meeting would be held in that industrial city in the south-west of France.) From the first ideas for an organisational reflection to the time of the final meeting was nearly two years See Laurence Binet and Martin Saulnier (eds), Médecins Sans Frontières, Evolution of an International Movement: Associative History, 1971-2011 (MSF, 2019), especially pp. 343-65. .

To make La Mancha into a consultative, participatory process, members of MSF were invited to hold two-person dialogues exploring a set list of questions. ‘What attracted you to MSF?’, for example. Or: ‘What do you expect from our leaders?’ In total, 760 paired interviews, representing the involvement of 1,520 people, were submitted. There were also written contributions, which made up the above-mentioned anthology: 150 of them, running to 400 pages. Short contributions from MSF members were self-nominating, while longer commentaries were sought from veterans of the movement and from some external aid experts, scholars, and fellow-travellers. Others participated through gatherings of the various MSF associative bodies.

The process culminated in a meeting held over 3 days in March 2006, in a Benedictine abbey in Luxembourg. Over 200 people attended. There were plenary sessions and working groups. As described by Renée Fox, an anthropologist who was the only ‘outside’ person invited to the conference, many speakers adopted ‘surprisingly apolitical’ expression, even when talking about issues with political implications; there was discomfort at using votes – an expression of majority will – instead of consensus to come to decisions on the movement’s future, alongside recognition that the movement’s growing size required it. The meeting ended with a song, ‘a musical message to the La Mancha assemblage that parodied MSF’s idealism, revolutionary spirit, and optimism, its foibles and conflicts, and its failures to live up to its principles.’ See chapter 6 in Renée Fox, Doctors Without Borders: Humanitarian Quests, Impossible Dreams of Médecins Sans Frontières (Baltimore: Johns Hopkins University Press, 2014). Afterwards, the International Council had the more prosaic task of drafting the document that has become the initiative’s main formal legacy – two pages of preamble followed by 28 clauses split into two topics: action and governance.

A watershed moment

La Mancha eventually offered MSF something new: explicit staff and institutional recognition of the inequalities at its heart. Indeed, although this was not among the motivations for conducting the process, participants elevated it to an important theme and the movement’s obligation to address workplace injustice is now strongly associated with the commitments that emerged from La Mancha. Discussions in the reflection process had highlighted that ‘Some people still see MSF as a group of Expats (Khawajas) who run an NGO’, as a group of contributors from Sudan put it ‘Some Thoughts on MSF from North-Sudan,’ in My Sweet La Mancha, p. 163. . At the meeting, the questions of who exactly made up MSF, and whether all MSF-ers were equally valued (they weren’t), became the subject of vivid discussion. As told by Renée Fox: ‘Hearing that “nationals” made up the overwhelming majority of MSF personnel in the field not only surprised the attendees. It also triggered a prise de conscience. It became a focus of collective dismay, self-criticism, and self-blame, and a subject to which the conference returned again and again.’ 

To channel this prise de conscience into something more aspirational, the agreement’s preamble asserted ‘the urgent need to address any issues of discrimination within MSF that are undermining our ability to realize our full operational and associative potential.’ Its two clauses on the experience of individual staff come at the very end: 

     2.13.  We acknowledge MSF’s urgent need to provide fair employment opportunities for all staff based on individual competence and commitment rather than mode of entry into the organization (either through national or international contract). This is to address the under-utilization of human resources and inclusiveness in decision-making in MSF.  This issue must be urgently and concretely addressed in order to fully engage our staff, thereby strengthening our operations.
     2.14.  We must take proactive steps to ensure fair opportunities for access to meaningful membership in associations, while preserving the spirit of volunteerism. In doing so, we accept the need to explore new avenues for associative participation, giving priority to regions where MSF is underrepresented, including for instance, through the creation of new MSF entities La Mancha Agreement, Athens, 25 June 2006. Available at: https://www.msf.org/sites/default/files/La%20Mancha%20Agreement%20EN.pdf. .

The agreement also recognised, for the first time in a document of this kind, that the majority of MSF’s staff ‘live and work in the countries of intervention.’ Although La Mancha is intended to be complementary to the Charter and Chantilly agreement, not supersede them, because these other guiding documents lack direct engagement with issues of equity and inclusion, La Mancha has borne the weight of this aspect of the organisation’s responsibility to its staff This can be compared with the presence of risk management in these documents, see Caroline Abu Sa’Da and Xavier Crombé, ‘Volunteers and responsibility for risk-taking: Changing interpretations of the Charter of Médecins Sans Frontières,’ International Review of the Red Cross, vol. 97, no. 897-98 (2016): pp. 133-55. . And as debates have intensified about the engrained biases, inequalities, and power dynamics within MSF, above all accusations of institutional racism, the memory of La Mancha is being threaded with a narrative of failure.

Invoking La Mancha

In the humanitarian sector, and elsewhere, discussions about racism, colonialism, and discrimination accelerated from 2020 onwards, propelled by mass protests and online activism alike. Workers at MSF made important contributions to this surge of dissent and critique, building on but also decrying the limits of previous efforts. Notably, the ‘Decolonise MSF’ activist group formed after an open letter from MSF staff to senior management condemning inaction on internal racial inequalities and demanding specific actions to address them Karen McVeigh, ‘Médecins Sans Frontières is “institutionally racist”, say 1,000 insiders,’ The Guardian, 10 July 2020. Available at: https://www.theguardian.com/global-development/2020/jul/10/medecins-sans-frontieres-institutionally-racist-medical-charity-colonialism-white-supremacy-msf. . The letter attracted over 1,100 signatories and hundreds of personal testimonies about racism, sexism, abuse of power and systemic barriers to equity within the movement.

Already before this, however, La Mancha was being used as a marker of MSF’s proclaimed ‘failure’ in relation to its staff. In 2017, a session of MSF’s highest executive body, known as the Full ExCom, issued a statement declaring that: ‘We are failing to foster an environment where all of our staff can contribute to their fullest potential to our social mission. We are not, as we claim, an organization operating “without discrimination”. Statements of La Mancha have been ignored. As a result, we fall short in meeting the needs of our patients.’ The following year, the top international tier of the movement’s associative leadership, the International Board, issued a call for change which began: ‘Twelve years have passed since the La Mancha agreement set out MSF’s collective ambitions, and reaffirmed our core values and principles. Yet, while La Mancha still resonates today, the dysfunctions and unhealthy trends it documents remain unaddressed, becoming even more challenging as MSF grows.’

The tenor of critique seems to have deepened since the mass movements of 2020, used by members of the organisation pushing for change, as well as some in positions of leadership that they were criticising. Evoking the La Mancha agreement in relation to his own experience of ‘pervasive racial bias’ and hostility within MSF, Arnab Majumdar wrote: ‘I thought of MSF’s La Mancha Agreement [...] I thought of all the people who had suffered since then, in undoubtedly worse ways than I had. I thought of how MSF’s own inclusion surveys continue to exclude national staff from engagement or analysis entirely, of the stories that remain untold.’ Arnab Majumdar, ‘Bearing witness inside MSF,’ The New Humanitarian, 18 August 2020. Available at: https://www.thenewhumanitarian.org/opinion/first-person/2020/08/18/MSF-Amsterdam-aid-institutional-racism.  In the words of an internal statement from two key members of MSF’s international leadership, Christos Christou and Samuel Bumicho, in June 2020: ‘as an organisation we have failed people of colour, both staff and patients. We have failed to tackle institutional racism within MSF; failed to voice uncomfortable truths; failed to act against the discrimination subjected to people of colour all across the world.’

As part of a research team examining power dynamics within MSF, focusing on Operational Centre Amsterdam Eleanor Davey, Lioba Hirsch, Myfanwy James, and Molly Naisanga, In Service of Emergency: Understanding Power and Inequality in MSF (London: MSF UK, 2024). Available at: https://msfuk.unbounddocs.com/power-analysis/ , I also heard this refrain several times in interviews. One person, for instance, argued that ‘the moral principle that was enunciated in La Mancha, whether it’s accountability to beneficiaries or urgent anti-discrimination, doesn’t have traction.’ Another suggested that ‘we should all be ashamed of the fact that, following La Mancha, very, very little happened.’ Of course, as those same people would acknowledge, the seventeen years since La Mancha do not constitute a period with no change whatsoever. Nevertheless, a strikingly wide range of people associated with MSF, from its executive leadership, to elected representatives of staff bodies, to insurgent activist groups, today adopt some version of this narrative. It is a discourse also seen in the humanitarian system at large, as observed – and critiqued – by Heba Aly, the former CEO of The New Humanitarian: ‘often in the sector, it’s easy, and frankly a bit lazy, to just say, “Oh, you know, nothing’s changing, progress is slow, etc.” That's not to say progress isn’t slow, but I think there has been movement.’ ‘In Conversation with Heba Aly,’ Rethinking Humanitarianism podcast, hosted by Melissa Fundira, The New Humanitarian, 14 March 2024. Available at: https://www.thenewhumanitarian.org/podcasts/2024/03/14/rethinking-humanitarianism-conversation-heba-aly.

Making a definitive assessment of the ‘successes’ and ‘failures’ of La Mancha would be difficult, and is certainly beyond the scope of this piece. A few comparisons, nonetheless, can illustrate the degree to which these claims are a rhetorical choice and more a comment on the present than the past.

Take the example of treatment of locally recruited staff. In 2006, an internal study of the position of ‘national staff’ (to use the language of the time) in MSF found that, with two modest exceptions, issues concerning them had ‘not been systematically addressed in any international platform’. There were significant gaps in knowledge about and provisions for national staff – no reliable numbers for how many people MSF employed on such contracts, for example; limited efforts to inform national staff about complaint mechanisms; few policies to support their security and no data about incidents affecting them. As documented in another internal review from 2007, many associations in MSF did not even open their doors to national staff until the early- to mid-2000s (the first was MSF Belgium in 1998). Since that period, significant inroads have been made, and meaningful – albeit uneven – improvements across a range of internal inequalities Jean-Hervé Bradol, ‘From bureaucratic inertia to “policy fragility”,’ MSF CRASH blog, 9 August 2020. Available at: https://msf-crash.org/en/publications/humanitarian-actors-and-practices/bureaucratic-inertia-policy-fragility. .

Echoes of this period, however, continue to sound. A contributor to the La Mancha reflections wrote this, in 2005:

In MSF we have a lot more national staff than expats in our projects, and yet the voices of national staff are seldom heard in our discussions about the organisation, and MSF does not have enough clear common policies for national staff. As a result, a lot of time and energy is spent on simple things such as whether national staff can have name tags or t-shirts with the MSF logo.

In 2023, participants in the power analysis study observed that a ‘mentality’ that questioned ‘can national staff supervise international staff?’ continued to operate in MSF. Certain discussions, then, hinge around recurring themes of identity, legitimacy, trust, and representation. The activities being debated have changed – from wearing t-shirts, to running recruitment, to taking on senior roles – but often the same fulcrum remains. Reflection and analysis on the experiences of staff within the organisation continue to identify systems and behaviours that contradict MSF’s stated values and beliefs.

These issues reach deep into questions of organisational identity, philosophy, and operational model, as internal and external observers have highlighted See for example, Françoise Duroch and Michaël Neuman, ‘Should we discriminate in order to act? Profiling: a necessary but debated practice,’ Humanitarian Practice Network, 28 January 2021; Myfanwy James, ‘“Who can sing the song of MSF?” The politics of “proximity” and performing humanitarianism in eastern DRC,’ Journal of Humanitarian Affairs, vol 2, no. 2 (2020): 31–39; Peter Redfield, ‘The unbearable lightness of ex-pats: double binds of humanitarian mobility,’ Cultural Anthropology, vol. 27, no. 2 (2012): 358-82. . They also reflect global and social inequalities that structure societies beyond the humanitarian world; as Jean-Hervé Bradol stated, humanitarian actors are not ‘a moral élite’ Bradol, ‘From bureaucratic inertia to “policy fragility”.’ . Recognising this reality means that aid organisations must think about which inequalities they reproduce, as well as those they create, how these interact, and what powers they have to address or at least mitigate them. 

As systemic problems continue to be identified within MSF – as people continue to deal on a daily basis with the impacts of inequalities – there is no agreement on how long a time frame might be necessary and acceptable. In the meantime, people are reacting not only to the empirical situation but also to the related narratives. On one hand, there are concerns that statements of intent are essentially covering for inaction; on the other, there is fatigue with ‘that discourse that nothing is changing, nothing is happening, it’s the same status quo’, critiqued as ‘unfair’ and ‘not true’ See Davey, Hirsch, James, and Naisanga, In Service of Emergency, 170-74. .

Where to?

In the context of reform, a diagnosis of failure often comes with a call for redress. Marking a gap between expectations and delivery This point has been made in relation to the discourse of failure in Haiti following the 2010 earthquake. See Jan Wörlein, ‘The emergency of humanitarian failure: the case of Haiti,’ in Humanitarian Action and Ethics, ed. Ayasha Ahmad and James Smith (London: Zed Books, 2018): 160-80. , ‘failure’ becomes a herald of renewal, either in the form of redoubled efforts or a radical new line. MSF’s leadership has committed to ‘tackling’ (another telling word) issues of racism and inequality. Yet the challenges to this undertaking are manifold and significant.

Central among them is the movement’s sheer size. At its 50-year mark, MSF’s history of growth and appetite for its continuation are both dramatic: its combined workforce is some 68,000 strong and its annual income an enormous 2.25 billion euros. Here too we can trace links with La Mancha, the final agreement of which mostly sidestepped the vexed problem of ‘unhealthy growth’ that had been identified previously, while nonetheless committing the organisation to a logic of expansion by asserting that ‘MSF’s primary responsibility is to improve the quality, relevance and extent of our own assistance’.

Yet, like MSF’s operating model based on the perceived neutrality and institutionalised seniority of staff working outside their home countries, size creates problems for workplace justice reform. A bigger house may get more done, but it is not necessarily more just or more inclusive. The already complex issues of power, inequality, identity and reform are made even more difficult by the tensions between universalism and particularism that MSF's work engenders. Efforts to make space for a wider range of voices are made more difficult by the pressures of scale. The intellectual and imaginative labour required to re-examine a model, fundamentally based – like Cervantes’ knight-errant on his quest – on mobility and outside intervention, become all the harder.

Quixotic as it might have felt to those who feared for the movement’s future, from today’s viewpoint La Mancha appears as an ambitious and even optimistic response to the crises of the time. As a process, it was reflective and self-critical. Yet it was also inherently limited; La Mancha produced an orientation, not a roadmap. More profoundly, its ability to bring about a reckoning with the exclusionary tendencies structured into the organisation’s model also had limits – some practical, some ideological. It is not clear how far such a reckoning could go within a frame that simultaneously reaffirmed existing values and ways of thinking.

The focus on staff appears to be shifting the collective meaning of ‘La Mancha’ from a vision of the future to a failure of the past – a shift that is better understood as a sign of the current appetite for change than as an assessment of what La Mancha did, or could, achieve. What else might be learned from the experience of La Mancha, and where other moments, other movements, will lead remains to be seen.