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MéDecins Sans FrontièRes

Médecins Sans Frontières: An International Humanitarian Medical Non-Governmental Organisation

Médecins Sans Frontières (MSF), a name that resonates with courage and a stark commitment to humanity, is an international non-governmental organization renowned for its unwavering provision of humanitarian medical care. Pronounced [medsɛ̃ sɑ̃ fʁɔ̃tjɛʁ], the French phrase translates simply to "Doctors Without Borders," a moniker that perfectly encapsulates their mission. This organization, born from the crucible of conflict and disease, operates on the front lines of crises, offering critical medical assistance in zones ravaged by war, natural disasters, and epidemics. Their work extends to treating a vast spectrum of human suffering, from the chronic burdens of diabetes and HIV/AIDS to the immediate devastation of tropical and neglected diseases, tuberculosis, and the ever-present threat of drug-resistant infections. Even in the face of global pandemics like COVID-19, MSF remains a steadfast presence, delivering care and advocating for those most vulnerable.

In 2019 alone, the organization marshalled its forces across 70 countries, deploying over 35,000 dedicated individuals. The vast majority of these personnel are local medical professionals—doctors, nurses, and specialists—augmented by logistical experts, water and sanitation engineers, and administrators, all working in concert. This immense undertaking is powered not by governments or international bodies, but by the profound generosity of private donors, who contribute approximately 98% of the organization's funding, resulting in an annual income that hovers around €2.36 billion. This financial independence is a cornerstone of MSF's ability to act swiftly and impartially, unburdened by political agendas.

The genesis of MSF can be traced back to the devastating Biafran famine during the Nigerian Civil War in 1970. It was in the aftermath of this humanitarian catastrophe that a group of French doctors and journalists, deeply moved by the suffering they witnessed, envisioned an organization that could transcend borders and offer medical aid without prejudice. They recognized the urgent need for an entity that would prioritize the welfare of survivors above all else, irrespective of race, religion, creed, or political affiliation. The foundational principles that guide MSF's operations are enshrined in its Charter, the Chantilly Principles, and the La Mancha Agreement, documents that underscore their commitment to impartial humanitarian action.

The operational heart of MSF beats across six distinct centers: Amsterdam (OCA), Barcelona-Athens (OCBA), Brussels (OCB), Geneva (OCG), Paris (OCP), and West and Central Africa (WaCA), with its administrative hub in Abidjan, Ivory Coast. These operational centers, while autonomous in their decision-making, are united by common policies coordinated through the International Council, where each of the 24 national sections is represented. The International Council convenes in Geneva, Switzerland, the seat of the International Office, which orchestrates the global coordination of activities. This decentralized yet interconnected structure allows MSF to remain agile and responsive to diverse global needs.

MSF's tireless efforts have not gone unnoticed on the international stage. The organization holds general consultative status with the United Nations Economic and Social Council, a testament to its significant role in global humanitarian affairs. In 1999, MSF was honored with the prestigious Nobel Peace Prize in recognition of its members' unwavering dedication to providing medical care in acute crises and for their crucial role in raising international awareness of dire humanitarian situations. James Orbinski, then president of the organization, accepted the award on behalf of MSF, highlighting the profound sacrifices and unwavering commitment of its personnel. Prior to this, MSF had also received the Seoul Peace Prize in 1996, further cementing its reputation as a beacon of humanitarianism. In June 2019, Christos Christou took over the mantle of international president, succeeding Joanne Liu, and continuing the organization's vital work.

History

1967 to 1970 – Biafra

The seeds of Médecins Sans Frontières were sown in the ashes of the Nigerian Civil War, specifically during the brutal Biafran famine from 1967 to 1970. The Nigerian military's blockade of the secessionist south-eastern region had created a devastating humanitarian crisis, with conditions largely unknown to the outside world. A number of French doctors, driven by a sense of urgency, volunteered with the French Red Cross to provide aid in besieged Biafra. Among these courageous individuals was Bernard Kouchner, who would later embark on a prominent political career in France, even serving as Minister for Europe and Foreign Affairs.

Inside the blockaded territory, these volunteers, alongside Biafran health workers and hospitals, faced harrowing conditions. They witnessed firsthand the atrocities committed by the Nigerian Armed Forces and the devastating impact of starvation on the civilian population. The doctors found themselves in a moral quandary, witnessing what they perceived as the Red Cross's complicity in the face of such widespread suffering. This experience forged a conviction: a new kind of aid organization was desperately needed, one that would operate independently of political and religious boundaries, solely focused on the survival and dignity of those caught in the crossfire.

Beyond Nigeria, MSF’s early engagement laid the groundwork for its expansive presence across Africa. The organization established missions in numerous countries, including Benin, Zambia, Uganda, Kenya, South Africa, Rwanda, Sudan, Sierra Leone, and many others, responding to diverse humanitarian emergencies.

1971 Establishment

The formalization of this vision began in 1971 with the establishment of the Groupe d'intervention médicale et chirurgicale en urgence ("Emergency Medical and Surgical Intervention Group"). This group comprised the French doctors who had served in Biafra, united by their desire to provide immediate aid and champion the rights of survivors. Concurrently, Raymond Borel, the editor of the French medical journal TONUS, had initiated his own relief efforts, forming Secours Médical Français ("French Medical Relief") in response to the devastating 1970 Bhola cyclone that had ravaged East Pakistan (now Bangladesh), claiming over 625,000 lives. Borel’s aim was to assemble a corps of doctors ready to assist in the wake of natural disasters.

On December 22, 1971, these two nascent organizations, driven by a shared humanitarian impulse, merged. This union gave birth to Médecins Sans Frontières (Doctors Without Borders).

MSF’s inaugural mission was dispatched to Managua, the capital of Nicaragua, following the catastrophic 1972 earthquake that had leveled the city and claimed an estimated 10,000 to 30,000 lives. While the Red Cross had already established a relief presence, MSF, true to its future reputation, arrived swiftly to offer its support. A few years later, in September 1974, Hurricane Fifi unleashed devastating floods across Honduras, resulting in thousands of fatalities. In response, MSF initiated its first long-term medical relief mission.

The period between 1975 and 1979 witnessed a massive exodus of Cambodians fleeing the brutal regime of the Khmer Rouge following the fall of South Vietnam to North Vietnam. MSF responded by establishing its first refugee camp missions in Thailand, providing essential medical care to these displaced populations. When Vietnam withdrew from Cambodia in 1989, MSF continued its commitment by launching long-term relief efforts to aid survivors of the mass killings and to assist in the reconstruction of the country’s shattered healthcare system.

While its missions to Southeast Asia could be considered early wartime engagements, MSF’s first deployment into a genuine war zone, with direct exposure to hostile fire, occurred in 1976. For nine arduous years (1976–1984), MSF provided surgical assistance in hospitals across various cities in Lebanon during the intense Lebanese Civil War. During this period, the organization cultivated a reputation for its unwavering neutrality and its willingness to operate under fire, extending aid to both Christian and Muslim soldiers alike, prioritizing those in greatest need. In 1984, as the security situation in Lebanon deteriorated significantly, making sustained operations untenable, MSF regrettably withdrew its volunteers.

Original Founders:

1970s

In 1977, Claude Malhuret assumed the presidency of Médecins Sans Frontières, ushering in a period of internal debate regarding the organization's future direction. A central point of contention was the concept of témoignage ("witnessing"), which championed the act of speaking out against the suffering encountered, as opposed to maintaining silence. Malhuret and his supporters favored a more discreet approach, advocating that MSF avoid direct criticism of the host governments. Conversely, Kouchner strongly believed that documenting and publicizing the plight of those affected was the most effective means of driving positive change.

This divergence in philosophy would later contribute to a significant split within the organization. In 1979, following years of refugee movements from South Vietnam and neighboring countries by sea, a group of French intellectuals issued an appeal in Le Monde for "A Boat for Vietnam," a project aimed at delivering medical aid to refugees. Although this initiative did not garner widespread support within MSF, a faction, including Bernard Kouchner, chartered a ship named L'Île de Lumière ("The Island of Light"). Accompanied by doctors, journalists, and photographers, they sailed into the South China Sea to provide medical assistance to the "boat people." This splinter group eventually evolved into Médecins du Monde, an organization that would champion the concept of humanitarian intervention as a duty, particularly for Western nations. By 2007, MSF issued a clarification, stating that for nearly three decades, they had maintained public disagreements with Kouchner on issues such as the right to intervene and the use of armed force for humanitarian ends. While Kouchner supported the latter, MSF remained steadfast in its commitment to impartial humanitarian action, independent of all political, economic, and religious powers.

1980s

The 1980s marked a period of significant growth and professionalization for MSF. In 1982, under the leadership of Malhuret and Rony Brauman (who became president in the same year), the organization introduced fundraising-by-mail, a strategic move that greatly enhanced its financial independence and ability to collect donations. This decade also saw the establishment of several new operational sections, expanding MSF's global reach. MSF-Belgium was founded in 1980, followed by MSF-Switzerland in 1981, MSF-Holland in 1984, and MSF-Spain in 1986. MSF-Luxembourg became the first support section in 1986. The early 1990s witnessed the creation of the majority of the remaining support sections, including MSF-Greece (1990), MSF-USA (1990), MSF-Canada (1991), MSF-Japan (1992), MSF-UK (1993), MSF-Italy (1993), and MSF-Australia (1994), alongside national offices in Germany, Austria, Denmark, Sweden, Norway, and Hong Kong. Malhuret and Brauman were instrumental in professionalizing MSF’s operations and fundraising.

In December 1979, following the Soviet army's invasion of Afghanistan, MSF immediately deployed field missions to provide medical aid to the mujahideen. By February 1980, the organization publicly denounced the Khmer Rouge. During the devastating 1983–1985 famine in Ethiopia, MSF established crucial nutrition programs in 1984. However, the organization was expelled from the country in 1985 after vocally condemning the misuse of international aid and the government's forced resettlement policies. MSF's outspoken criticism of the Ethiopian government drew criticism from other NGOs, who accused them of abandoning their supposed neutrality. This incident fueled a significant debate in France concerning humanitarian ethics. In the aftermath of the October 10, 1986 earthquake that struck San Salvador, the capital of El Salvador, MSF also provided vital equipment for the production of clean drinking water for the affected population.

1990s

The 1990s saw MSF confronting complex and protracted conflicts across the globe. In 1990, the organization first entered Liberia to provide assistance to civilians and refugees caught in the brutal Liberian Civil War. The ensuing Second Liberian Civil War meant that MSF volunteers remained actively engaged throughout the decade, delivering essential nutrition, basic healthcare, and conducting mass vaccination campaigns. They also consistently spoke out against attacks on hospitals and feeding stations, particularly in the besieged capital, Monrovia.

Field missions were also established to support Kurdish refugees who had endured the horrific al-Anfal Campaign, a period marked by systematic atrocities, for which evidence was being meticulously collected in 1991. That same year also marked the beginning of the civil war in Somalia. MSF initiated field missions in 1992, working alongside a United Nations peacekeeping force. Despite the UN's eventual withdrawal in 1993, MSF personnel persevered, continuing their vital relief work by running clinics and hospitals for the beleaguered civilian population.

MSF first arrived in Srebrenica, Bosnia and Herzegovina, as part of a UN convoy in 1993, a year after the outbreak of the Bosnian War. The city had become a besieged enclave, surrounded by the Bosnian Serb Army and housing approximately 60,000 Bosniaks, all under the protection of a United Nations Protection Force. MSF was the sole organization providing medical care to the trapped civilians. In this precarious situation, the organization chose not to publicly denounce the unfolding genocide, fearing expulsion from the country, though they did highlight the lack of access for other humanitarian groups. MSF was forced to evacuate the area in 1995 when the Bosnian Serb Army overran the town. The subsequent events saw the deportation of 40,000 Bosniak civilians, with approximately 7,000 victims of mass executions.

Rwandan Genocide

The outbreak of the genocide in Rwanda in April 1994 presented MSF with one of its most profound ethical and operational challenges. Some MSF delegates working within the country were integrated into the medical team of the International Committee of the Red Cross (ICRC) for protection. Together, these teams managed to keep the primary hospitals in Rwanda's capital, Kigali, operational throughout the most intense period of the genocide. However, in 1995, MSF, along with several other aid organizations, was compelled to withdraw from the country. This period was marked by intense internal debate within MSF regarding the delicate balance between maintaining neutrality and fulfilling the role of witnessing and speaking out against atrocities. The experiences in Rwanda led to a significant shift in MSF's operational stance, moving its position on neutrality closer to that of the ICRC, a remarkable evolution given the organization’s origins.

An aerial photograph of a Mihanda, Zaire refugee camp in 1996. Over 500 tents are visible in the Mitumba Mountains.

The human cost of this period was immense. The ICRC lost 56 local staff members, while MSF tragically lost nearly one hundred. MSF-France, having made the difficult decision to evacuate its international team from Rwanda (leaving local staff to face the danger), publicly denounced the killings and called for a French military intervention to halt the genocide. MSF-France’s controversial slogan, "One cannot stop a genocide with doctors," was widely disseminated by the media, preceding the deployment of the controversial Opération Turquoise less than a month later. This intervention, directly or indirectly, triggered the mass displacement of hundreds of thousands of Rwandan refugees into Zaire and Tanzania, an event that became known as the Great Lakes refugee crisis. This crisis was further compounded by subsequent cholera epidemics, widespread starvation, and continued mass killings within these large refugee populations. MSF-France returned to the affected region to provide critical medical aid to refugees in Goma.

During the genocide, competition among MSF, the ICRC, and other aid groups for resources and impact reached unprecedented levels. However, the horrific conditions in Rwanda catalyzed a fundamental reevaluation of how humanitarian organizations approached their missions. In 1994, the ICRC developed the Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes, establishing a framework for humanitarian operations. MSF became a signatory to this code, which emphasizes the provision of humanitarian aid exclusively, urging organizations to remain independent of political, religious, or governmental interests and to avoid being used as tools by foreign powers. While MSF has continued to condemn government actions, as seen in Chechnya in 1999, it has refrained from calling for military interventions since the Rwandan experience.

2020s

Accusations of Racism

In 2020, a petition signed by over a thousand staffers brought to light deeply concerning accusations of systemic racism within the charity. A staff member from Cameroon shared harrowing personal experiences of racial discrimination perpetrated by the organization's leadership. Many of the grievances centered on perceived differential treatment between expatriate staff, predominantly from Europe and North America, and national staff. In an interview with NPR, the organization's president acknowledged that MSF had indeed been "founded in racism" and pledged a commitment to significant improvement.

Snakebite Prioritization in WHO

MSF played a pivotal role in the inclusion of snakebite envenoming as a Category A Neglected Tropical Disease by the World Health Organization (WHO). This advocacy led to the development of a global strategy aimed at reducing the devastating burden of snakebites worldwide. MSF brought critical attention to the severe scarcity of anti-venom in Africa, a situation exacerbated by the cessation of manufacturing, and spearheaded media advocacy efforts to highlight the urgency of the crisis.

Access to Medicine Campaign

On June 20, 2024, MSF announced the cessation of its dedicated access-to-medicines campaign, which had focused on improving access to vital medications in resource-limited settings. The organization intends to pivot its focus towards products, including medicines and vaccines, that are directly required for its own field operations. This strategic shift has drawn criticism from various advocates, including the Treatment Action Group.

Activities by Location

In 1999, MSF voiced concerns regarding the inadequate humanitarian support in Kosovo and Chechnya, having established field missions to assist civilians impacted by the respective political crises. Although MSF had been active in the Kosovo region since 1993, the onset of the Kosovo War led to the displacement of tens of thousands of refugees and a severe decline in living conditions. MSF provided essential shelter, water, and healthcare to civilians affected by NATO's strategic bombing campaigns.

A significant internal crisis within MSF unfolded in Kosovo when the Greek section of the organization was expelled. The Greek MSF section had gained access to Serbia by agreeing to Serbian government-imposed restrictions on their movements and observations—terms that the broader MSF movement had rejected. A source external to MSF alleged that the exclusion of the Greek section stemmed from its members' decision to provide aid to both Albanian and Serbian civilians in Pristina during the NATO bombings. This rift was eventually healed in 2005 with the re-admission of the Greek section into MSF.

A similar critical situation was observed in Chechnya, where the civilian population was largely forced from their homes into dire living conditions and subjected to the brutal violence of the Second Chechen War.

MSF has maintained a continuous presence in Haiti since 1991. However, following the ousting of President Jean-Bertrand Aristide, the country experienced a marked increase in civilian attacks and widespread rape perpetrated by armed groups. In addition to providing much-needed surgical and psychological support in existing hospitals—offering the only free surgery available in Port-au-Prince—MSF established field missions to rebuild vital water and waste management systems and to treat survivors of severe flooding caused by Hurricane Jeanne. Patients suffering from HIV/AIDS and malaria, both highly prevalent in the country, also received enhanced treatment and monitoring. The devastating 2010 Haiti earthquake on January 12th inflicted severe damage on all three of the organization's hospitals; one facility collapsed entirely, while the other two had to be abandoned. In the aftermath of the quake, MSF dispatched approximately nine planes laden with crucial medical equipment and a field hospital to aid in treating the overwhelming number of victims. However, the landing of some of these flights faced delays due to the sheer volume of humanitarian and military aircraft converging on the island.

The protracted Kashmir conflict in North India led to a more recent MSF intervention. The first field mission was established in 1999 to provide assistance to civilians displaced by the fighting in Jammu and Kashmir, as well as in Manipur. Psychological support emerged as a significant focus of these missions, alongside programs dedicated to treating tuberculosis, HIV/AIDS, and malaria. Mental health support has been a critical component of MSF's work across much of southern Asia, particularly in the wake of the devastating 2004 Indian Ocean earthquake.

MSF underwent a comprehensive process of introspection and internal dialogue between 2005 and 2006. This period was characterized by extensive discussions on a wide range of issues, including the ethical treatment of both "nationals" and "expatriates," the principles of "fair employment," and the imperative of self-criticism.

In the wake of the Dobbs v. Jackson Women's Health Organization decision by the U.S. Supreme Court, MSF issued a statement advocating for safe abortion access.

Sub-Saharan Africa

MSF has maintained a decades-long presence in a multitude of African nations, often serving as the sole provider of essential healthcare, food, and water. Despite MSF's consistent efforts to amplify media coverage of the crisis in Africa to garner greater international support, the necessity for sustained, long-term field missions remains paramount. A significant focus for MSF volunteers is the treatment and public education surrounding HIV/AIDS in sub-Saharan Africa, a region disproportionately affected by the disease, accounting for the majority of global deaths and cases. The World Health Organization (WHO) estimated that out of the 14.6 million people requiring anti-retroviral treatment in developing countries, only 5.25 million were receiving it. MSF continues to exert pressure on governments and pharmaceutical companies to bolster research and development efforts for HIV/AIDS treatments, advocating for reduced costs and increased accessibility.

Sierra Leone

In the late 1990s, MSF missions were established to address tuberculosis and anaemia among residents of the Aral Sea region, and to provide care for civilians afflicted by drug-resistant diseases, famine, and outbreaks of cholera and AIDS. In 1996, the organization vaccinated three million Nigerians against meningitis during a widespread epidemic. In 1997, MSF publicly denounced the Taliban's neglect of health care for women. Arguably, the most impactful country for MSF's field missions in the late 1990s was Sierra Leone, then embroiled in a brutal civil war. By 1998, volunteers were actively engaged in surgical assistance in Freetown to treat an escalating number of amputees. They meticulously collected statistics on civilians—men, women, and children—who were systematically attacked by groups claiming allegiance to ECOMOG. These brutal attacks involved the systematic chopping off of one or both arms, rape of women, execution of families, and the razing of homes, forcing survivors to flee. Following the cessation of the civil war, long-term projects focused on providing psychological support and managing phantom limb pain.

Sudan

Since 1979, MSF has been a consistent provider of medical humanitarian assistance in Sudan, a nation tragically afflicted by widespread starvation, protracted civil war, pervasive malnutrition, and one of the highest maternal mortality rates globally. As of March 2009, MSF reported employing 4,590 field staff in Sudan, actively addressing critical issues such as armed conflicts, epidemic diseases, healthcare provision, and social exclusion. MSF's sustained presence and extensive operations in Sudan represent one of the organization's largest interventions. MSF offers a comprehensive suite of healthcare services to the Sudanese population, including nutritional support, reproductive healthcare, treatment for kala-azar, counseling services, and surgical interventions. Common diseases prevalent in Sudan include tuberculosis, kala-azar (also known as visceral leishmaniasis), meningitis, measles, cholera, and malaria.

Kala-azar in Sudan

Kala-azar, or visceral leishmaniasis, has historically posed a significant health challenge in Sudan. The period following the Comprehensive Peace Agreement between North and Southern Sudan on January 9, 2005, saw an increase in regional stability, which facilitated enhanced healthcare delivery efforts. In 2008, Médecins Sans Frontières conducted trials of a combination therapy involving sodium stibogluconate and paromomycin, which proved effective in reducing treatment duration from 30 to 17 days and also lowered costs. In March 2010, MSF established its first dedicated kala-azar treatment center in Eastern Sudan, providing free treatment for this otherwise fatal disease. Left untreated, kala-azar carries a staggering fatality rate of 99% within one to four months of infection. Since the center's inception, MSF has successfully treated over 27,000 kala-azar patients, achieving a remarkable success rate of approximately 90–95%. Plans are underway to open an additional kala-azar treatment center in Malakal, Southern Sudan, to accommodate the overwhelming influx of patients seeking care. MSF has consistently supplied essential medical supplies to hospitals and has been instrumental in training Sudanese health professionals to effectively manage kala-azar cases. In collaboration with the Sudanese Ministry of Health and other national and international institutions, MSF is actively working to improve the diagnosis and treatment of kala-azar. Ongoing research into potential cures and vaccines is also being conducted. In December 2010, South Sudan experienced its most severe kala-azar outbreak in eight years, with the number of patients seeking treatment increasing eightfold compared to the preceding year.

Health Care Infrastructure in Sudan

Sudan's most recent civil war commenced in 1983 and concluded in 2005 with the signing of a peace agreement between North Sudan and South Sudan. MSF medical teams were actively engaged throughout and preceding the civil war, delivering emergency medical humanitarian assistance across numerous locations. The dire state of infrastructure in Southern Sudan was further exacerbated by the civil war, leading to a catastrophic decline in the region's already appalling health indicators. An estimated 75 percent of the population in the nascent nation lacked access to basic medical care, and one in seven women tragically died during childbirth. Malnutrition and recurrent disease outbreaks remain perennial concerns. In 2011, an MSF clinic located in Jonglei State, South Sudan, was looted and attacked by raiders, resulting in the deaths of hundreds, including women and children. Valuable medical equipment and drugs were lost during the raid, and parts of the MSF facilities were destroyed by fire. This incident had severe repercussions, as MSF was the sole provider of primary healthcare services in this critical part of Jonglei State.

Democratic Republic of the Congo

While MSF had been active in the Congo region since 1985, the devastating First and Second Congo War significantly escalated violence and instability in the area. MSF has been forced to evacuate its teams from regions such as those surrounding Bunia in the Ituri district due to extreme levels of violence. Nevertheless, the organization continues its vital work in other areas, providing essential food supplies to tens of thousands of displaced civilians and treating survivors of mass rapes and widespread armed conflict. The prevention, treatment, and potential vaccination against a range of diseases, including cholera, measles, polio, Marburg fever, sleeping sickness, HIV/AIDS, and bubonic plague, are critical priorities to curb the spread of these devastating epidemics.

Uganda

MSF has been operational in Uganda since 1980, providing critical relief to civilians during the country's protracted guerrilla warfare in the Second Obote Period. However, the emergence of the Lord's Resistance Army ushered in a prolonged campaign of terror and violence across northern Uganda and southern Sudan. Civilians endured mass killings, systematic rape, torture, and the abduction of children, who were often forced into lives of sexual servitude or conscripted as child soldiers. Faced with over 1.5 million people displaced from their homes, MSF established crucial relief programs within internally displaced person (IDP) camps, focusing on providing clean water, food, and sanitation. Diseases such as tuberculosis, measles, polio, cholera, ebola, and HIV/AIDS frequently manifest as epidemic outbreaks within the country. MSF volunteers administer vital vaccinations (for measles and polio) and provide treatment to affected populations. Mental health support is also a crucial aspect of MSF's medical interventions in Uganda, as many individuals remain in IDP camps, paralyzed by the constant fear of renewed attacks.

Ivory Coast

MSF established its first field mission in Côte d'Ivoire in 1990. However, the escalating violence and the 2002 division of the country between rebel factions and the government led to numerous massacres, prompting MSF teams to suspect that ethnic cleansing operations were underway. MSF's initiatives have included mass measles vaccinations, tuberculosis treatment, and the reopening of hospitals that had been closed due to the fighting. In many parts of the country, MSF remains the sole provider of humanitarian aid.

MSF has been a vocal proponent of contraception use across Africa.

West African Ebola Outbreak

During the devastating Ebola outbreak in West Africa in 2014, MSF found itself shouldering a significant portion of the medical response, particularly after the organization's early warnings about the escalating crisis were largely disregarded.

An MSF staff member adjusts the goggles of Dr. Joel Montgomery, Team Lead for CDC's Ebola Response Team in Liberia, before Montgomery enters the Ebola treatment unit (ETU) at ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

Burundi

MSF-Burundi has been actively involved in providing medical care to casualties resulting from the 2019 Burundi landslides.

Asia

Sri Lanka

MSF maintains a presence in Sri Lanka, adapting its activities to continue its mission in the aftermath of the 26-year civil war which concluded in 2009. Their work includes providing physical therapy for patients with spinal cord injuries, conducting counseling sessions, and operating an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries."

Cambodia

MSF first began providing medical assistance to civilians and refugees who had sought refuge in camps along the Thai-Cambodian border in 1979. Decades of conflict had left the country with a severely underdeveloped health care system.

In 1999, Cambodia was struck by a severe malaria epidemic. The situation was exacerbated by a shortage of qualified practitioners and poor quality control, which fueled a market for counterfeit antimalarial drugs. Tragically, these fake medications were responsible for the deaths of at least 30 people during the epidemic. In response, MSF initiated efforts to establish and fund a malaria outreach project, enlisting the support of Village Malaria Workers. MSF also spearheaded the adoption of a switching strategy for first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat drug resistance and reduce fatalities associated with traditional treatments.

Cambodia stands as one of the countries in Southeast Asia most severely affected by HIV/AIDS. In 2001, MSF began offering free antiretroviral (ARV) therapy to AIDS patients, a treatment that significantly prolongs their lives and provides a long-term management strategy. In 2002, MSF, in collaboration with the Cambodian Ministry of Health, established chronic disease clinics in various provinces. These clinics aimed to integrate HIV/AIDS treatment with care for other prevalent conditions such as hypertension, diabetes, and arthritis, thereby reducing stigma associated with specialized treatment centers by offering care in multi-purpose facilities. MSF also provided humanitarian aid during natural disasters, including a major flood in 2002 that impacted up to 1.47 million people.

In 2004, MSF introduced a community-based tuberculosis program in remote villages, where local volunteers were trained to facilitate medication adherence for patients. In partnership with local health authorities and other NGOs, MSF actively promoted decentralized clinics and localized treatment services to reach more rural areas from 2006 onwards. Since 2007, MSF has extended general healthcare, counseling, and HIV/AIDS and TB treatment to prisons in Phnom Penh through mobile clinics. However, prisons in Cambodia continue to suffer from poor sanitation and a severe lack of healthcare, remaining among the most overcrowded worldwide.

In 2007, MSF collaborated with the Cambodian Ministry of Health to provide crucial psychosocial and technical support for pediatric HIV/AIDS treatment programs for affected children. MSF also contributed medical supplies and personnel during one of the country's worst dengue outbreaks in 2007, which saw over 40,000 hospitalizations and claimed 407 lives, primarily children.

In 2010, Cambodia's southern and eastern provinces were struck by a cholera epidemic, prompting MSF to respond by providing medical support tailored to the specific needs and context of the country.

Cambodia is among the 22 countries identified by the WHO as having a high burden of tuberculosis, with an estimated 64% of the population carrying the tuberculosis mycobacterium. Consequently, MSF has shifted its primary focus away from HIV/AIDS, gradually handing over most HIV-related programs to local health authorities.

Middle East and North Africa

Libya

The 2011 Libyan civil war spurred MSF to establish a hospital and mental health services to assist civilians affected by the conflict. The widespread fighting resulted in a significant backlog of patients requiring surgical intervention. As parts of the country began to stabilize, MSF initiated collaborations with local health personnel to address the evolving needs. The demand for psychological counseling surged, prompting MSF to develop mental health services to support individuals grappling with the fear and stress of living in precarious conditions, often without basic amenities like water and electricity. As of late 2016, MSF remained the sole international aid organization with an active presence within Libya.

In November 2025, MSF was abruptly ordered to leave Libya without any stated reason.

Search and Rescue in the Mediterranean Sea

MSF actively participates in Maritime Search and Rescue (SAR) operations in the Mediterranean Sea, striving to save the lives of migrants attempting perilous crossings in unseaworthy vessels. This mission commenced in 2015, following the European Union's discontinuation of its extensive SAR operation, Operation Mare Nostrum, which had significantly diminished crucial SAR capabilities in the region. Throughout its involvement, MSF has operated its own vessels, including the Bourbon Argos (2015–2016), Dignity 1 (2015–2016), and VOS Prudence (2016–2017). Additionally, MSF has provided medical teams to support the operations of other NGOs and their ships, such as the MOAS Phoenix (2015), the Aquarius (2017–2018) with SOS Méditerranée, and the Ocean Viking (2019–2020) also with SOS Méditerranée and Mediterranea Saving Humans. In August 2017, MSF made the difficult decision to suspend the activities of the VOS Prudence in protest against the restrictions and threats imposed by the Libyan "Coast Guard."

In December 2018, MSF and SOS Méditerranée were compelled to cease operations of the Aquarius, which at that time was the last vessel supported by MSF. This decision followed sustained pressure from EU states, which resulted in the vessel being stripped of its registration and MSF facing criminal accusations. Up to that point, the mission had facilitated the rescue or assistance of approximately 80,000 individuals. Operations resumed with the Ocean Viking in July 2019, but the ship was subsequently seized in Sicily in July 2020. In May 2021, MSF returned to refugee rescue operations in the Mediterranean with a new vessel, the Geo Barents. Within a month, this initiative led to the rescue of some 400 individuals. In December 2024, MSF announced the suspension of further operations of the vessel. During 2023 and 2024, bureaucratic blockages imposed by the Italian government resulted in the ship spending approximately 160 days docked in port. In November 2025, a smaller, 20-meter-long vessel named Oyvon began service as a replacement for the larger Geo Barents, operating under the German flag with a crew of 10 MSF activists.

Yemen

MSF is actively involved in addressing the profound humanitarian crisis unfolding in Yemen, exacerbated by the ongoing Yemeni Civil War. The organization operates eleven hospitals and health centers across Yemen and provides crucial support to an additional 18 facilities. According to MSF, since October 2015, four of its hospitals and one ambulance have been destroyed by airstrikes carried out by the Saudi-led coalition. In August 2016, an airstrike on Abs hospital resulted in the deaths of 19 people, including one MSF staff member, and left 24 wounded.

Europe

The Netherlands

In August and September 2022, MSF provided essential medical care to asylum seekers who were residing outside the severely overcrowded migration center in Ter Apel, the Netherlands.

Italy

MSF has been active in Italy since 1999, delivering comprehensive assistance—encompassing humanitarian, medical, psychological, and socio-health support—to migrants, asylum seekers, and refugees throughout the country. Over the years, their initiatives have ranged from aiding migrant arrivals to operating within reception centers and informal settlements across various Italian regions.

As of Spring 2024, MSF is engaged in projects in three key locations within Italy. In Calabria, the organization provides medical and psychological aid during migrant arrivals and ensures ongoing care within the region's reception centers. In Ventimiglia, situated on the Italo-French border, MSF operates a mobile clinic specifically serving migrants transiting through the area. Meanwhile, in Palermo, in collaboration with local health authorities, MSF has launched a program to support foreign nationals who have survived torture and other deliberate acts of violence. Furthermore, MSF Italy possesses the capability to offer psychological first aid to individuals who have endured particularly traumatic experiences during their crossings of the Mediterranean Sea.

Organisation of Activities

Before establishing a field mission in a country, an MSF team undertakes an "exploratory mission" to thoroughly assess the nature of the humanitarian emergency, evaluate the safety of the area, and determine the specific types of aid required.

While medical assistance forms the core objective of most missions, some operations extend to critical areas such as water purification and nutritional support.

Field Mission Team

A typical field mission team comprises a select group of coordinators responsible for each component of the operation, led by a "head of mission." The head of mission, usually possessing extensive experience in humanitarian contexts, is tasked with managing media relations, liaising with national governments, and coordinating with other humanitarian organizations. It is important to note that the head of mission does not necessarily require a medical background.

Medical volunteers include a diverse range of professionals: physicians, surgeons, nurses, and various specialists. Beyond overseeing the medical and nutritional aspects of the mission, these volunteers often lead teams of local medical staff, providing essential training and capacity building.

Medical Component

Vaccination campaigns constitute a significant portion of the medical care delivered during MSF missions. Diseases such as diphtheria, measles, meningitis, tetanus, pertussis, yellow fever, polio, and cholera, which are rare in developed nations, can be effectively prevented through vaccination. Certain diseases, notably cholera and measles, have a propensity to spread rapidly within large populations living in close proximity, such as in refugee camps. Consequently, immunizing hundreds or thousands of individuals within a short timeframe becomes imperative. For instance, in Beira, Mozambique, in 2004, an experimental cholera vaccine was administered twice to approximately 50,000 residents within a single month.

Equally critical is MSF's commitment to AIDS treatment, which includes the provision of antiretroviral drugs, AIDS testing, and comprehensive public education. In many African countries, MSF serves as the primary, and sometimes sole, source of treatment for individuals living with HIV and AIDS, a population that constitutes the majority of those affected worldwide. Given the limited availability of antiretroviral drugs (ARVs), MSF typically focuses on treating opportunistic infections and educating the public on strategies to mitigate disease transmission.

In most host countries, MSF endeavors to enhance the capacity of local hospitals by improving sanitation infrastructure, supplying essential equipment and medications, and providing training to local hospital staff. When local personnel are overwhelmed, MSF may establish specialized clinics for the treatment of endemic diseases or for surgical interventions for victims of conflict. While international staff initiate these clinics, MSF is dedicated to bolstering the ability of local staff to manage these facilities independently through ongoing training and supervision. In certain countries, such as Nicaragua, MSF actively engages in public education initiatives to raise awareness regarding reproductive healthcare and venereal disease.

Given that many areas requiring MSF field missions have been impacted by natural disasters, civil wars, or endemic diseases, the local populations often experience profound psychological distress. While the presence of an MSF medical team can offer some measure of solace to survivors, specialized teams of psychologists or psychiatrists are frequently deployed to assist individuals suffering from depression, survivors of domestic violence, and those with substance use disorder. These medical professionals may also train local mental health personnel. This comprehensive approach extends to contexts such as Palestinian refugee camps, where prolonged displacement and complex geopolitical circumstances can leave residents feeling adrift and lacking a sense of purpose or clear strategies for action. Humanitarian actors, including Médecins Sans Frontières, have responded by offering coping mechanisms to residents as a humanitarian objective and outcome. In the late 2000s, Médecins Sans Frontières launched a mental health program within the Bourj el-Barajneh camp in Lebanon, providing sexual and reproductive health services, mental health support, and health promotion activities.

Nutrition

In many situations where MSF establishes missions, moderate to severe malnutrition is a prevalent consequence of war, drought, or governmental economic mismanagement. Intentional starvation has also been employed as a weapon during wartime, and MSF, in addition to distributing food, actively works to raise awareness of these situations and advocates for foreign government intervention. Infectious diseases and diarrhoea, both of which contribute to weight loss and physical weakening, particularly in children, necessitate prompt medical treatment and proper nutrition to prevent further complications and weight loss. A confluence of these factors, such as a civil war occurring during periods of drought and infectious disease outbreaks, can precipitate famine.

An MSF health worker examines a malnourished child in Ethiopia, July 2011.

In emergency scenarios characterized by a scarcity of nutritious food, but not yet constituting a full-blown famine, protein-energy malnutrition is most commonly observed among young children. Marasmus, a form of severe calorie deficiency, is the most prevalent type of childhood malnutrition, marked by extreme wasting and often fatal weakening of the immune system. Kwashiorkor, resulting from a deficiency in both calories and protein, represents a more severe form of malnutrition in young children and can have detrimental long-term effects on both physical and mental development. Both forms of malnutrition significantly increase the risk of fatal outcomes from opportunistic infections. In such circumstances, MSF establishes Therapeutic Feeding Centres to closely monitor children and any other individuals suffering from malnutrition.

A Therapeutic Feeding Centre (or Therapeutic Feeding Programme) is specifically designed to address severe malnutrition through the gradual introduction of a specialized diet aimed at promoting weight gain after the individual has received treatment for other concurrent health issues. The treatment program is structured into two distinct phases:

  • Phase 1: This phase lasts for 24 hours and involves the provision of basic healthcare and several small meals, low in energy and protein, spaced throughout the day.
  • Phase 2: This phase focuses on ongoing patient monitoring and the administration of several small meals, high in energy and protein, spaced throughout each day, until the individual's weight approaches normal levels.

MSF utilizes specially formulated foods designed for the treatment of severe malnutrition. During Phase 1, patients are given a therapeutic milk known as F-75. F-75 is a low-energy, low-fat, low-protein milk powder that is mixed with water and administered to patients to prepare their bodies for the subsequent phase. During Phase 2, patients receive a therapeutic milk called F-100, which contains a higher concentration of energy, fat, and protein than F-75. Often, this is supplemented with a peanut butter-based mixture known as Plumpy'nut. Both F-100 and Plumpy'nut are engineered to deliver substantial amounts of nutrients rapidly, enabling efficient patient treatment. Other specialized foods distributed to populations at risk of starvation include enriched flour and porridge, as well as a high-protein biscuit called BP5. BP5 is a popular choice for population-wide feeding programs due to its ease of distribution and portability, allowing individuals to take it home, or it can be crushed and mixed with therapeutic milk for specific treatments.

Dehydration, often resulting from diarrhoea or cholera, can also be a critical issue within a population. MSF establishes rehydration centers to combat this life-threatening condition. A specialized solution known as Oral Rehydration Solution (ORS), containing glucose and electrolytes, is administered to patients to replace lost fluids. Antibiotics are sometimes prescribed to individuals experiencing diarrhea if a diagnosis of cholera or dysentery is confirmed.

Water and Sanitation

Access to clean water is fundamental for maintaining hygiene, for safe consumption, and for the successful operation of feeding programs (essential for mixing powdered therapeutic milk or porridge). It is also crucial in preventing the spread of water-borne disease. Consequently, MSF water engineers and volunteers are tasked with establishing reliable sources of clean water. This typically involves modifying existing water wells, drilling new wells, and/or initiating water treatment projects to ensure a supply of potable water for the community. Water treatment methods employed in these contexts may include sedimentation, filtration, and/or chlorination, depending on the available resources.

Sanitation plays an equally vital role in field missions. This can encompass educating local medical staff on proper sterilization techniques, implementing sewage treatment projects, ensuring appropriate waste disposal practices, and educating the general population on personal hygiene. Effective wastewater treatment and water sanitation are the most effective means of preventing the transmission of severe water-borne diseases, such as cholera. Simple wastewater treatment systems can be constructed by volunteers to safeguard drinking water sources from contamination. Waste management strategies may include designated pits for general waste and incineration for medical waste. However, the most critical element in sanitation is the ongoing education of the local population, ensuring that proper waste and water treatment practices are sustained long after MSF's departure from the area.

Statistics

To accurately convey the severity of humanitarian emergencies to the global community and governing bodies, MSF meticulously collects data on a range of critical factors during each field mission. The rate of malnutrition among children serves as a key indicator for determining the overall malnutrition rate within a population, thereby informing the need for feeding centers. Various mortality rates are employed to quantify the seriousness of a humanitarian crisis. A common method for measuring mortality involves staff consistently monitoring the number of burials at local cemeteries. By compiling data on the frequency of diseases treated in hospitals, MSF can track the incidence and geographical distribution of epidemic increases (or "seasons") and proactively stockpile necessary vaccines and medications. For example, the "Meningitis Belt," encompassing sub-Saharan Africa and experiencing the highest global incidence of meningitis, has been meticulously mapped. The typical meningitis season occurs between December and June. Shifts in the geographical boundaries of the Belt and the timing of the season can be predicted by analyzing cumulative data collected over many years.

In addition to epidemiological surveys, MSF utilizes population surveys to assess the prevalence of violence in various regions. By estimating the scale of massacres and quantifying rates of kidnapping, rape, and killings, MSF can implement targeted psychosocial programs designed to reduce suicide rates and foster a greater sense of security within the affected population. Large-scale forced migrations, excessive civilian casualties, and massacres can be systematically documented through surveys, enabling MSF to leverage the findings to advocate for government assistance or even to expose instances of genocide. MSF conducted the first comprehensive mortality survey in Darfur in 2004.

However, the collection of such sensitive statistics can present ethical challenges, raising questions about privacy and consent.

Innovation and Use of Technology

In 2014, MSF embarked on a significant partnership with satellite operator SES, alongside other NGOs such as Archemed, Fondation Follereau, and German Doctors, and with the support of the Luxembourg government. This collaboration marked the pilot phase of the SATMED project, an initiative designed to leverage satellite broadband technology to deliver eHealth and telemedicine services to remote and isolated areas in developing countries. SATMED was initially deployed in Sierra Leone to bolster the efforts in combating the Ebola epidemic.

Governance and Structure

List of International Presidents:

As of 2020, in addition to the global headquarters in Geneva and the five regional operational centers, MSF maintained national offices in the following locations:

  • MSF Australia
  • MSF Austria
  • MSF Belgium
  • MSF Brazil
  • MSF Canada
  • MSF Czech Republic
  • MSF Denmark
  • MSF Eastern Africa
  • MSF Finland
  • MSF France
  • MSF Germany
  • MSF Greece
  • MSF Hong Kong
  • MSF Ireland
  • MSF Italy
  • MSF Japan
  • MSF Republic of Korea
  • MSF Lat (Spanish Speaking South America)
  • MSF Luxembourg
  • MSF Mexico
  • MSF Netherlands
  • MSF Norway
  • MSF South Africa
  • MSF SARA (South Asia Regional Association: India, Pakistan, Afghanistan, Sri Lanka, Bangladesh)
  • MSF Spain
  • MSF Sweden
  • MSF Switzerland
  • MSF Taiwan
  • MSF United Kingdom
  • MSF United States
  • MSF West and Central Africa

In-house Organisations

Epicentre

Established in 1986, Epicentre operates as MSF's in-house research organization, dedicated to supporting its field activities. Epicentre plays a crucial role in training personnel, disseminating scientific findings through publications, and developing innovative techniques for MSF operations. Its research encompasses epidemiological studies, clinical vaccine trials conducted during active outbreaks where MSF is responding, investigations into vaccine stability, and the analysis of vaccine deployment strategies.

Campaign for Access to Essential Medicines

The Campaign for Access to Essential Medicines was launched in 1999 with the primary objective of enhancing access to essential medicines in developing countries. Essential medicines are defined as those drugs required in sufficient quantities to treat diseases prevalent within a population. However, many diseases common in developing nations are no longer prevalent in developed countries, leading pharmaceutical companies to deem their production unprofitable. This can result in increased prices per treatment, reduced investment in drug development (including new treatments), or even the complete cessation of production. MSF frequently encounters critical drug shortages during its field missions, which was the impetus for initiating this campaign to exert pressure on governments and pharmaceutical companies to increase funding for essential medicines.

In 2006, MSF leveraged its influence to urge the drug manufacturer Novartis to withdraw its legal challenge against India's patent law, which prevented Novartis from patenting its drugs within India. This action followed a similar lawsuit filed by Novartis against South Africa years earlier, aimed at preventing the country from importing more affordable AIDS drugs. On April 1, 2013, an Indian court ruled in favor of invalidating Novartis's patent on imatinib (Gleevec), making the drug available through generic production at a substantially lower cost on the Indian market.

In March 2017, Els Torreele, who had led the campaign from 1999 to 2003, rejoined MSF as the executive director of the Access Campaign. For the subsequent three years, she spearheaded a global analysis and advocacy team focused on ensuring the development, availability, affordability, and adaptation of essential medicines, vaccines, and diagnostics to meet the needs of people worldwide.

As of 2022, the campaign's most pressing concerns included the escalating issue of antimicrobial resistance and the recurrent outbreaks of epidemic diseases like Ebola and COVID-19. Despite these efforts, a significant number of vaccines, diagnostics, and medicines remained inaccessible to those in dire need.

Security Risks to Staff

MSF staff members are frequently exposed to risks of attack and kidnapping. In certain countries, humanitarian aid organizations are perceived by some groups as aiding the enemy. If a humanitarian mission is seen as exclusively serving one side of a conflict, it may become a target. Furthermore, the war on terrorism has fostered attitudes in some regions, particularly in US-occupied countries, that non-governmental aid organizations like MSF are either allied with or directly employed by the Coalition forces. The rise in insecurity in cities such as Afghanistan and Iraq, following US military operations, led MSF to declare that providing aid in these countries had become too perilous. The organization was compelled to evacuate its teams from Afghanistan on July 28, 2004, after five staff members—Afghan nationals Fasil Ahmad and Besmillah, Belgian Hélène de Beir, Norwegian Egil Tynæs, and Dutchman Willem Kwint—were killed on June 2nd in an ambush by unidentified militia near Khair Khāna in Badghis Province. In June 2007, Elsa Serfass, an MSF-France staff member, was killed in the Central African Republic. In January 2008, two expatriate staff members (Damien Lehalle and Victor Okumu) and a national staff member (Mohammed Bidhaan Ali) were killed in an organized attack in Somalia, leading to the closure of the project.

Volunteers also face the risk of arrest and abduction in politically unstable regions. In some instances, MSF field missions have been expelled entirely from a country. Arjan Erkel, Head of Mission in Dagestan in the North Caucasus, was kidnapped and held hostage from August 12, 2002, until April 11, 2004, by unknown abductors. In May 2005, Paul Foreman, head of MSF-Holland, was arrested in Sudan for refusing to disclose documents used in compiling a report on rapes allegedly carried out by the pro-government Janjaweed militias (refer to Darfur conflict). Foreman cited the privacy concerns of the women involved, while MSF contended that the Sudanese government had arrested him due to the negative publicity generated by the report.

Incidents

The following is a partial list of notable incidents involving direct violence against MSF staff or facilities, presented in chronological order:

  • August 14, 2013: MSF announced the closure of all its programs in Somalia due to escalating attacks on its staff by Al-Shabaab militants and a perceived lack of concern or inurement from governmental authorities and the wider society.
  • October 3, 2015: Fourteen staff members and 28 other individuals lost their lives when an MSF hospital was bombed by American forces during the Battle of Kunduz.
  • October 7, 2015: U.S. President Barack Obama issued an apology for the incident. However, Doctors Without Borders expressed dissatisfaction with the apology.
  • October 27, 2015: An MSF hospital in Sa'dah, Yemen, was bombed by the Saudi Arabia–led military coalition.
  • November 28, 2015: A hospital supported by MSF was hit by a barrel bomb dropped by a Syrian Air Force helicopter near Homs, Syria, killing seven people and wounding forty-seven.
  • January 10, 2016: A hospital supported by MSF in Sa'dah was bombed by the Saudi Arabia-led military coalition, resulting in six fatalities.
  • February 15, 2016: Two hospitals supported by MSF in Idlib District and Aleppo, Syria, were bombed, causing the deaths of at least 20 patients and medical personnel and injuring dozens more. Both Russia and the United States denied responsibility for the attacks or claimed to have not been in the vicinity at the time.
  • April 28, 2016: An MSF hospital in Aleppo was bombed, claiming the lives of 50 individuals, including six staff members and patients.
  • May 12, 2020: An MSF-supported hospital in Dasht-e-Barchi, Kabul, Afghanistan, was attacked by an unidentified assailant. The assault resulted in 24 deaths and at least 20 injuries.
  • June 25, 2021: Three MSF employees were reported killed in Tigray, Ethiopia.
  • November 18, 2023: An evacuation convoy of MSF vehicles was attacked in Gaza, Palestine during the Gaza war. The incident resulted in the deaths of two family members of MSF workers, one of whom was a volunteer supporting MSF at Al-Shifa Hospital. MSF stated, "MSF considers that all elements point to the responsibility of the Israel Defense Forces for this attack."

Awards

1999 Nobel Peace Prize

James Orbinski, the president of MSF at the time, delivered the Nobel Peace Prize acceptance speech on behalf of the organization. His address poignantly began by recounting the harrowing conditions faced by survivors of the Rwandan genocide, focusing on the story of a specific female patient:

There were hundreds of women, children and men brought to the hospital that day, so many that we had to lay them out on the street and even operate on some of them there. The gutters around the hospital ran red with blood. The woman had not just been attacked with a machete, but her entire body rationally and systematically mutilated. Her ears had been cut off. And her face had been so carefully disfigured that a pattern was obvious in the slashes. She was one among many—living an inhuman and simply indescribable suffering. We could do little more for her at the moment than stop the bleeding with a few necessary sutures. We were completely overwhelmed, and she knew that there were so many others. She said to me in the clearest voice I have ever heard, 'Allez, allez...ummera, ummerasha'—'Go, go...my friend, find and let live your courage.'

Orbinski powerfully affirmed the organization's commitment to publicizing the critical issues MSF encountered, stating:

Silence has long been confused with neutrality, and has been presented as a necessary condition for humanitarian action. From its beginning, MSF was created in opposition to this assumption. We are not sure that words can always save lives, but we know that silence can certainly kill.

Other Awards

Other Recognition

MSF's "Bracelet of Life," a Mid-Upper Arm Circumference (MUAC) measuring band, was featured in "Pirouette: Turning Points in Design," a 2025 exhibition at the Museum of Modern Art. The exhibition highlighted "widely recognized design icons [...] highlighting pivotal moments in design history." The museum also incorporated the MUAC into its Architecture and Design collection.

Namesakes

Numerous other non-governmental organizations, inspired by Médecins Sans Frontières, have adopted names incorporating "Sans Frontières" or "Without Borders." Examples include: Engineers Without Borders, Avocats Sans Frontières ('Lawyers Without Borders'), Reporters sans frontières ('Reporters Without Borders'), Payasos Sin Fronteras ('Clowns Without Borders'), Bibliothèques Sans Frontières ('Libraries Without Borders'), and Homeopaths Without Borders.

It is worth noting that the French game show Jeux Sans Frontières ('Games Without Borders') predates MSF, having first aired in Europe in 1965.

Ethical Concerns and Criticism

Concerns have been raised regarding the ethical treatment of MSF staff, patients, and the communities they serve, stemming from certain organizational policies and practices. These issues have been brought to light by employees, other professionals within the development sector, and media outlets.

MSF has historically maintained separate employment conditions and pay scales for its "national staff" (locally hired personnel for field missions) and its "international staff" (individuals deployed from regional or national units to field missions in other countries). International staff typically occupy senior positions within a mission, with national staff often reporting to these expatriate superiors. Persistent complaints from national staff highlight perceived differential treatment, including assignment to more dangerous tasks, significantly lower pay, and a lack of access to benefits such as housing and healthcare that are afforded to incoming expatriate staff. In 2020, MSF announced a review of this policy with the stated intent of eliminating differential treatment. These practices, among other concerns, were a significant catalyst for a 2020 statement by 1,000 current and former employees, articulating their apprehensions regarding the organization's perceived structural racism. The collective staff statement included personal testimonies of racism within MSF, encompassing both adverse workplace treatment and what was described as a "white supremacist and colonial mindset" evident in the formation and implementation of programs.

Despite MSF hiring approximately ninety percent of its staff "in-country," the organization continues to exhibit a preponderance of European individuals in its senior management positions. Although the percentage of international program coordinators originating from the Global South has increased from 24 percent to 46 percent between 2012 and 2022, the international president, Christos Christou, acknowledged that the highest echelons of MSF leadership remained dominated by individuals from the Global North. With its headquarters and five operational units situated in Western Europe, MSF's policies and operations were characterized as "Eurocentric" in the 2020 staff statement.

In 2018, revelations emerged concerning sexual misconduct by MSF employees, including instances of sexual harassment and abuse directed at patients, local community members, or fellow MSF staff. Investigations by MSF resulted in the dismissal of nineteen individuals. The complaints ranged from sexual harassment among MSF colleagues to the exploitation of local sex workers (potentially including minors or engaging in "survival sex") by field staff, in direct violation of MSF policy. Disparaging attitudes and remarks from staff regarding the perceived sexual availability of patients or community members, or an expressed intent to barter medical treatment for sexual favors, were also reported. Notably, nearly all of the dismissals were related to inter-staff sexual misconduct.

Another controversy involved the use of images taken without informed consent of vulnerable patients, some of whom were minors without adult guardians. Certain photographs were criticized as exploitative and objectifying, including an image of a mother mourning her deceased infant, with the child's body visible, and images of child rape survivors and victims of sexual and domestic abuse, accompanied by details of their experiences. While these images were intended to raise awareness of the dire conditions in MSF's operational areas and the necessity of their programs, they were disseminated on MSF and community websites and in print publications, with licensing available for sale to image databases. The ethics of exposing devastated or victimized individuals, sometimes with partially identifying information, were questioned. In response to the criticism, MSF decided to cease the use of these images, a decision which itself drew further criticism.

MSF's funding model faced scrutiny after BlackRock donated $500,000 towards its COVID-19 crisis fund, sparking accusations of hypocrisy from staff and other humanitarian organizations.

Selected Non-Fiction Works About MSF

See also