Doctors Without Borders: Humanitarian Quests, Impossible Dreams of Médecins Sans Frontières

9. A “Non-Western Entity” Is Born

CHAPTER NINE A “Non-Western Entity” Is Born Informed and active associations and their representatives are crucial to assuring the relevance of our actions and the maintenance of a strong MSF international movement. Invigorating participation . . . at all levels of MSF is essential to building and maintaining credible, competent and relevant international governance. DOCTORS WITHOUT BORDERS / MÉDECINS SANS FRONTIÈRES, “LA MANCHA AGREEMENT” (2006) MSF South Africa officially became a new MSF “association” on December 16, 2011, the first day of MSF’s first International General Assembly in Paris, France, and of the simultaneous fortieth anniversary celebration of the movement ’s foundation.1 Discussions at MSF’s international “La Mancha” conference in 2004 had catalyzed the recognition of MSF South Africa, bringing home to members that as many as ninety percent of the field positions in the countries where MSF had missions were filled by indigenous “national” personnel, and that over seventy percent of its projects were situated in Africa. Notwithstanding its “without borders” vision and commitment, MSF was still mainly run by western Europeans, however, and in many contexts where it worked, it was perceived as a predominantly foreign and white, if “international,” organization.2 “New Entities”: Initiatives and Deterrents Within the post–La Mancha framework, questions arose about how to deal with MSF’s extraordinary growth. The challenge was to fuse furthering MSF’s 186 In South Africa internationalization and its social mission with the “desire for a compact and dynamic movement, cautious of being headquarters-heavy and eager to engage the great growth that MSF had undergone over time.”3 New “entities” were developing around MSF in countries where it was in the field—including Argentina, Brazil, the Czech Republic, India, Ireland, Kenya, Mexico, Portugal, South Africa, Turkey, and the United Arab Emirates—and a number of these had asked for formal status in MSF. They wanted to be recognized at least as something akin to a branch office, but perhaps hoped, as was true of the group that had coalesced in South Africa, to be eventually recognized as a “real MSF section.” As the vagueness and generality of the term “entities” suggests, it was not at all clear what such units ought to be—or what they should be called, or how to go about creating them, or what criteria they would have to meet to be approved, presumably by MSF’s International Council. This uncertainty is apparent in a 2007 memorandum concerning “new entities in Brazil and South Africa” that Gorik Ooms, then the director-general of the Brussels Operational Center (OCB), sent to the OCB board and the International Office’s committee of direction. In this memo, Ooms spoke of his perplexity about what to advise the groups in Brazil and South Africa about the necessary next steps toward becoming MSF affiliates: I personally informed the MSF International Office about the intention to create MSF entities in Brazil and South Africa, and asked which procedure I needed to follow to obtain permission. I was told that there is no procedure for new entities as long as they don’t become independent sections (as long as they are controlled by one of the 19 sections). . . . We can only guess which criteria the International Council will use to accept or reject the demand coming from the new MSF entities to become a real MSF section.4 The two most important of these criteria would probably be “the existence of a solid associative basis,”5 he conjectured, consisting of “a majority of field staff or former field staff members . . . to make sure that [these entities] can develop an independent position on all [the] dilemmas MSF is confronted with” and “financial independence.” The latter seemed “almost impossible” for South Africa, he stated. “This is a bit of a headache,” he pointed out, “because as long as MSF South Africa is not accepted as a real MSF section, it must be under the control of an existing MSF section or operational center. It is a ‘catch 22’ situation”: A “Non-Western Entity” Is Born 187 • As long as MSF South Africa cannot achieve financial independence, it will not be accepted as an MSF section; • As long as MSF South Africa is not accepted as an MSF section, it cannot have a formal associative structure. What Ooms proposed was “creating a formal associative structure, with a board of which at least 50% of the members are appointed by...