APPENDIX C
MÉDECINS SANS
FRONTIÉRES
NAO summary of meeting with a representative of
Médecins sans Frontiéres 10 June 2009
Present from Médecins sans Frontiéres:
Vickie Hawkins, currently MSF-UK's Head of Programmes,
previously MSF's head of mission in Afghanistan
OVERVIEW AND
CONTEXT
Médecins sans Frontiéres (MSF)
does not engage with governments in the planning or delivery of
the Comprehensive Approach. MSF's position on, and views of, the
Comprehensive Approach are framed by its role as an exclusively
humanitarian, medical NGO that delivers emergency aid according
to need. Its prime objective is to save lives and alleviate immediate
suffering. MSF's focus on immediate humanitarian assistance can
give it a different perspective on the Comprehensive Approach
from NGOs who undertake development work (or a mix of development
and humanitarian work) and may thus receive funds from UK Government
or the wider international community for the purposes of building
up local/governmental capacity. MSF does not engage in capacity-building
as an objective in itself (although in stable settings it can
be a by-product of our action).
If MSF is to be well-placed to meet the needs
of people caught up on both sides of a conflict, and maintain
the safety of its staff, it must be independent of governments
and be perceived by local people to be independent, neutral and
impartial. To maintain its independence, neutrality and impartiality,
MSF limits its contact with governments taking part in a Comprehensive
Approach. As a matter of policy, and in order to preserve independence,
MSF relies on private funding for the majority of its income.
It generally does not take government funding in areas of conflict
(eg Afghanistan, Pakistan, Somalia, Iraq), particularly not from
governments who are undertaking military operations (including
peace keeping operations) in a country where MSF is operating.
The application of the Comprehensive Approach
by the international community, and the inclusion (real or perceived)
of NGOs in that Comprehensive Approach, can make it more difficult
for MSF to deliver humanitarian aid in environments that are already
hard to operate in. In Afghanistan, for example, there are large
numbers of western NGOs who have close links with western governments
and undertake activities that could be perceived as part of a
state building agenda. With NGOs being generally perceived as
a fairly homogenous group, the (real or perceived) association
of some with a western state-building agenda leads to increased
risks for all (including MSF staff who are operating in-country).
Until 2004, MSF operated in Afghanistan. MSF
closed its operations after the Afghan authorities responded inadequately
to (and were even implicated in) an attack in the west of the
country which killed five MSF employees. MSF are now looking to
return to Afghanistan.
MSF initially operated in Iraq after the 2003
invasion but withdrew because of the security risks faced by its
staff. MSF is now again present in Iraq and plans to expand its
activities.
MSF are also operating in a number of other
countries where there are conflicts including Sri Lanka and Columbia.
Theme 1. From a UK perspective, what does
your organisation understand by the term "Comprehensive Approach"?
UK Government sees the Comprehensive Approach
as coordinating and unifying all UK Government departments and
non-government bodies (ie private sector organisations as well
as NGOs) under a single overarching foreign policy objective.
Theme 2. Has the MoD and/or the UK Government
effectively communicated what it understands by the Comprehensive
Approach and the merits of such an approach?
The UK Government has provided information on,
and some opportunity to discuss, the Comprehensive Approach. MSF
gave two examples:
— NGOs were invited to the launch of
the Stabilisation Unit;
— Via the UK's NGO-Military Contact
Group. MoD, FCO and DFID attend these meetings.
However, implications of the Comprehensive Approach
and specifically how to ensure that space exists outside of it
for independent humanitarian action, need continual discussion
and attention.
Theme 3. Does your organisation see the Comprehensive
Approach as an effective way of addressing international crisis?
From the perspective of the UN or UK Government,
the logic of bringing together different instruments (eg defence,
diplomacy, development) into a cohesive whole is understandable.
But the Comprehensive Approach can compound the difficulties MSF
face trying to operate in a conflict zone, and can make it more
difficult for MSF to carve out the space necessary for it to provide
independent humanitarian, medical assistance to those most in
need. For example, in Iraq humanitarian NGOs were seen by many
as part of the wider western military effort and were presented
by the US military as such.[57]
This false representation of humanitarian action as part of the
military effort increased the security risks faced by NGO staff
operating in the field and, as a result, MSF and many other humanitarian
NGOs withdrew from Iraq. If MSF, and similar organisations, are
squeezed out by the Comprehensive Approach, the population is
deprived of life-saving assistance in its hour of greatest need.
As an alternative the military will undertake relief activities,
not only for altruistic purposes but also for the benefits of
hearts and minds, but only in the areas under their direct control,
which may result in large numbers of the civilian population receiving
no support. And a withdrawal of NGOs will only increase the length
of time that the military needs to undertake this direct provision
of relief.
The Comprehensive Approach can also increase
the militarisation of civilian settings or facilities, such as
hospitals, in the host country. Many armed private security providers
are being used to protect DFID staff working in Afghanistan. The
presence of armed security providers in civilian facilities can
turn the facilities, and the Afghan users, of those facilities
into targets for belligerents. In Afghanistan, the UK Government
has described armed private security providers as armed civilians,
which risks militarising the "civilian status". Under
the Geneva Convention civilians are individuals who take no part
in hostilities.
Theme 4. Has the MoD and/or UK Government
worked effectively with the international community to adopt a
Comprehensive Approach?
MSF is not in a position to comment on this
question.
Theme 5. Has the MoD and/or the UK Government
built the UK's capacity to engage in a Comprehensive Approach
to a crisis? What more could be done?
MSF is not in a position to comment on this
question.
Theme 6. What are the challenges faced by
NGOs in engaging in the planning of a Comprehensive Approach to
a particular crisis? How might the MoD/UK Government assist NGOs
in addressing these challenges?
MSF does not get involved in the planning or
the delivery (see Theme 7) of the Comprehensive Approach as i)
it does not have the same objectives as UK Government or other
governments and ii) thus it wishes to maintain its independence
from their efforts. The UK Government wishes to resolve conflict
in a way which best suits the interests of the UK. MSF does not
share that objective and maintains its complete independence from
it, wishing only to provide impartial humanitarian assistance
to civilians caught up in a conflict situation regardless of which
side of a frontline they may reside
Theme 7. What are the challenges faced by
NGOs in engaging in the delivery of a Comprehensive Approach to
a particular crisis? How might MoD/UK Government assist NGOs in
addressing these challenges?
MSF does not engage in the delivery of the Comprehensive
Approach (see Theme 8).
MSF's objective to provide impartial humanitarian
assistance based on need could put it at odds with governments
seeking to apply the Comprehensive Approach. MSF gave the example
of a country which was partly controlled by the host government
and the international community (both of whom were seeking to
apply the Comprehensive Approach) and partly controlled by belligerents.
To assist the stabilisation of the whole country, the host government
and the international community may wish to see NGOs involved
in the Comprehensive Approach, helping to provide "hearts
and minds" assistance to people living in areas controlled
by the host government and international community. In such a
situation, however, MSF would wish to provide services according
to need and thus it may wish to also provide assistance to civilians
living in areas controlled by belligerents. However, by providing
humanitarian assistance in parts of the country controlled by
belligerents, MSF would be demonstrating that the international
community and host government did not have a monopoly on aid or
service delivery and thus undermine the "hearts and minds"
strategy. It is also likely that, to provide humanitarian assistance,
MSF would need to have (direct or indirect) contact with belligerents.
The host government and international community might judge such
contact as inappropriate.
MSF see the UK Government, and the international
community more generally, making greater use of private sector
to deliver aspects of the Comprehensive Approach. MSF noted that
there can be limits on the locations where the private sector
can and would be willing to operate. For example, contractors
do not work impartially—they are driven by profit—and
thus would generally not be willing to provide services in areas
of Afghanistan not under the control of the international community.
Theme 8. What are the challenges faced in
moving between different stages of a Comprehensive Approach, for
example from stabilisation to reconstruction?
MSF is not in a position to comment on this
question as it does not engage in the Comprehensive Approach.
However, MSF emphasised that the application of the Comprehensive
Approach in Afghanistan post 2001 had made it difficult for MSF
to separate itself from the wider state building agenda which
a large number of NGOs were perceived to be involved in (see Theme
7).
Theme 9. How can local ownership for a Comprehensive
Approach be established?
MSF is not in a position to comment on this
question.
Theme 10. What lessons have been learnt from
the application of the Comprehensive Approach in Iraq, Afghanistan
or other countries?
The conflict in Iraq left no space for humanitarian
NGOs, such as MSF, to operate in a safe way. NGOs in general were
seen by many as part of the wider western military effort, and
thus there was limited recognition that individual humanitarian
NGOs could be independent of, and have different objectives from,
western governments. MSF generally proves its adherence to humanitarian
principles (independence, neutrality, impartiality) through its
work. But where initial distrust is high, it is very difficult
for MSF to negotiate a way in so that they can deliver services
and prove their strictly humanitarian character to local people
by the way they operate on the ground.
57 For example, prior to the invasion of Iraq, Colin
Powell called on NGOs to act as "a force multiplier for us...
an important part of our combat team". Back
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