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Off the cuff
Humanitarian Actors and Practices

How do humanitarian aid workers think and act?

This work focuses on how humanitarian organisations operate, including their members, self-portrayals, messages, practices and cultures.

Two MSF workers in the Sahel region.
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Should we discriminate in order to act? Profiling: a necessary but debated practice

In this article for the Humanitarian Practice Network, head of the Research Unit on Humanitarian Stakes and Practices (UREPH) for MSF Geneva Françoise Duroch and Crash director of studies Michaël Neuman discuss the implications and reasons behind the growing practice of staff profiling for MSF.

In October 2020, MSF organised a workshop in Dakar on staff profiling in operations in the Sahel. Profiling involves the selection of staff based on non-professional criteria, including nationality, skin colour, gender and religion. As such, it raises a number of ethical and practical concerns. As a result of profiling, US nationals have not been deployed in MSF operations in Colombia because of the risk of kidnapping, and Chadians and Rwandans have been excluded in the Central African Republic and eastern Democratic Republic of Congo respectively, because of regional conflicts. The use of profiling has increased in recent years in West Africa, as the threat of kidnapping of Westerners by radical jihadist groups has intensified.

Le Che Guevara au Congo
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A “partnership” experience, A guided reading of Che Guevara's diary in Congo

Operational partnerships between two organisations are a practical approach to humanitarian responses. MSF considers such partnerships when the objective it is pursuing in a country is similar to that of an existing national organisation, and when there is potential for synergy between these two entities. I would like to take a bit of a detour by looking at an experience that is in some ways similar: when Che Guevara tried to lead the revolution in Congo - Zaire by supporting the organisation of the guerrilla movement in the east of the country.

A mother who gave birth to her child at the obstetric and newborn care service in Dasht-e-Barchi before it was attacked in 2020.
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Afghanistan : Should MSF accept the risk of targeted killings?

The May 12th massacre at the MSF-supported maternity hospital in Dasht-e-Barchi (Afghanistan)  raises, yet again, the question of our limits with regard to risk. What is an acceptable level of danger for humanitarian aid workers? How do we set limits? Why would MSF decide to leave Kabul but remain in Herat, for example, or leave Afghanistan but remain in Niger, Burkina Faso, Mali, or Somalia, where the teams also face extreme danger?

MSF provides support to two centres set up in north Marseille to test and refer people testing positive for coronavirus.
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Communicating and convincing: a humanitarian perspective on the French response to the coronavirus epidemic

In this paper, the two authors examine certain aspects of the French response to the epidemic in the light of the experience of Médecins Sans Frontières (MSF) in that field, primarily with respect to the relationship between the actors of the response and the beneficiaries.

MSF office
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Management at MSF - Part 2

In our first interview, Marion Péchayre discussed a variety of management-related problems at Médecins Sans Frontières: working in silos, the ever-growing number of management tools for monitoring, the endless validation requests, the vanishing role of the individual in favour of pseudoscientific presentations of events and projects, etc. This interview, conducted by Elba Rahmouni, focuses on solutions to these problems and hypotheses on how to improve our ways of working. Rather than offering set recipes, Marion Péchayre advocates an approach based on “practical wisdom” (a concept from the sociology of professions) and deliberative management that every individual and team can apply in their own way. 

MSF office
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Management at MSF

In this interview, different issues related to management at MSF are broached with Marion Péchayre, Director of Studies at the CRASH, such as the fragmentation of different components of our work, professionalisation drifting towards an attitude of control as embodied by the multiplication of management tools and the omnipresence of requests for validation, and the devaluation of the role of the individual against the promotion of a pseudo-scientific presentation of facts and projects.

MSF logistician Jennifer Bock and her colleagues unload 58 boxes one ton of medical supplies, mainly malaria testing kits, destined for the MSF-supported health centre in Boguila.
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To work

We’d like to share with you today some recommended reading around the issue of management, work, and ways of working. This choice will probably surprise some regular CRASH readers; isn’t this a far cry from the usual subjects of our critical analysis? Far from being chosen at random, the selection that follows in reality grew out of several years of reading.

Food distribution in Borno state
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Borno, Nigeria : a critical look at our operations

In 2016, the Operations Department commissioned a critical review of the operations carried out between 2015 and 2016 in Borno State by MSF France in the north east of Nigeria. In response, and with the help of Epicentre, Judith Soussan and Fabrice Weissman from CRASH produced a detailed historical account of the analyses made of the situation by the teams, capital and headquarters at the time, as well as the objectives they set themselves, the actions they undertook, the obstacles they encountered and the results they achieved.  As part of this project, some of the directors and operations managers who had been involved in these operations took a retrospective look at their own practices: were they late in responding to the catastrophic situation in the IDP camps in rural areas and on the outskirts of Maiduguri, the capital of Borno State, in 2016 and, if so, why?  What conclusions can be drawn a posteriori about the operational choices made and the effectiveness of MSF intervention strategies? And, to take things a step further, what does this experience teach us about how MSF functions and how our teams work? Interview with Isabelle Defourny, Operations Director at MSF-OCP. By Elba Rahmouni. 

Ebola response in Mangina
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Ebola in the DRC: between operational trial and error and scientific uncertainty

Rebecca Grais, Research Director at Epicentre, MSF’s epidemiology arm, and Pierre Mendiharat, Deputy Director of Operations for MSF-France, offer their insights on the Ebola outbreak in North Kivu Province in the eastern Democratic Republic of the Congo (DRC). This joint interview in four parts (the outbreak, social context, treatments, and vaccination) aims to show how science and practice interact around each outbreak.

Ngala, Nigeria: Emergency aid to victims of violence and displacement
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Mortality emergency threshold: A case for revision

The crude mortality rate (CMR) is one of the most widely used indicators at MSF and the humanitarian sector to evaluate the severity of a health crisis within a given population. It is widely recognized that a CMR equal to or greater than one death per 10,000 persons a day signifies an emergency situation requiring an immediate response. However, the usage of the standard emergency threshold as “1/10,000/day” is very questionable: it goes against the official recommendations endorsed by humanitarian organizations and ignores the worldwide decline in mortality rates over the last 30 years.

Woman carries a child in the Grande Synthe camp
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Temporary palliatives to an ongoing humanitarian need: MSF’s intervention in Dunkirk

In this paper, Angélique Muller and Michaël Neuman attempt to explore the lessons learnt through examining the decisions as well as the difficulties MSF encountered in its provision of assistance to migrants in Grande-Synthe. This article was originally published in Humanitarian Exchange Magazine #67 in September 2016.