Friends of MSF - National AGM Report - 2009

AGM Report | February 2009

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Report on the FoMSF

Annual General Meeting 2009

Friends of Médecins Sans Frontières | UK and Ireland

February | 2009


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Contents ……………………………………………………………………………………………………………………………………………………………………………

Title Page Number

Introduction - 3

AGM Agenda - 5

New Initiatives and Communication channels - 6

National Committee Elections - 5

“MSF Crisis Response” Plenary session - 8

Workshops

“Témoignage” - Marc DuBois - 11

“Security first, humanitarianism second?” - Paul Foreman - 13

“Without Borders“ - Jacob McKnight - 17

Joint events workshop - Peter Scolding - 21

Panel discussion - 23

Feedback - 25


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Introduction ……………………………………………………………………………………………………………………………………………………………………………

Dear Friends of MSF,

Welcome to the report on the 2009 Annual General Meeting (AGM) for the Friends of Médecins Sans

Frontières (FoMSF) in the UK and Ireland.

The 3rd

FoMSF AGM

This was the third FoMSF AGM and by far the largest, with more than 120 people attending,

representing 20 different universities from across the UK and Ireland.

To give you an idea of the ‘scaling-up’, the attendance has risen from around 40 people from 10

universities in 2008, and less than 20 people from just a handful of universities at the first AGM in

2007. Quite some growth!

Agenda

The layout has also developed this year. Whilst still packing everything into the Saturday, this year’s

AGM was very much a day of two halves.

The morning focused on ‘Friends Business’, looking at and discussing what the groups and the

National Committee (NC) had done over the past year, and electing a new NC for 2009-10.

The afternoon was about MSF itself, dealing through a number of talks, workshops and a panel

discussion, with various realities and choices with which MSF is faced in its work. A ‘Joint Events’

workshop ran in parallel with the MSF workshops, and was attended by a member of nearly all

current FoMSF groups.

Contents

In this report you will find information on the new initiatives and communication channels

developed over the past year, the NC elections, and notes from the “Crisis Response” plenary, the

Joint Events workshop, the MSF workshops and from the panel session following these. In addition,

all of the comments and suggestions we received through the feedback questionnaire are included.

These are extremely useful in tailoring next year’s AGM, so thanks to those who took part.

Workshops

The workshops themselves are presented here in as full a format as possible, with supporting

information and background scenarios, along with reports of the proceedings of each workshop. We

would like to encourage groups to use these as the basis for further discussion, and hope in the

future to develop them further for use as workshop templates which can be run at the local level, if

possible in the presence of someone with experience of working with MSF.

Thanks and photos

Thanks to everyone who made notes on the different sessions and to all those MSF staff who gave

up their time and energies to take part. Photos of the day are available through our Facebook page

(Friends of Médecins Sans Frontières | UK and Ireland), and on our Flickr account

(www.flickr.com/photos/friendsofmsf_uk_ireland/).


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The ‘Take-home-message’!

We hope that everyone enjoyed the day, and, like us, were in equal parts inspired and challenged by

the different sessions. Everyone will have their own memories of the day, but we would like to

encourage you to remember all those you saw, met and talked to throughout the AGM, and to try to

stay in touch with all this throughout the following year through any of the available channels, for

example the Google Groups, Friends of Médecins Sans Frontières|UK and Ireland Facebook, email

and the forthcoming FoMSF e-newsletter.

We thank you all for making the 2009 AGM such a success and look forward to hearing from you

over the coming year.

Peter Siordet Scolding

President, Friends of MSF National Committee 2009 -

Søren Kudsk-Iversen

President, Friends of MSF National Committee 2007-09


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Agenda for the day ……………………………………………………………………………………………………………………………………………………………………………

09:40 Registration opens

10:00 Welcome and introduction to the day

10:15 Friends of MSF Group Updates

11:50 National Committee Updates

12:00 New Initiatives

12:20 National Committee Elections

12:50 Lunch

13:45 Hand in election slips

13:55 National Committee 2009-10 announced

14:00 MSF presentations on topics with particular interest to Friends of MSF:

“Friends of MSF web pages” Pete Masters, Web Editor MSF-UK

“MSF Speaking Out Collections” Polly Markandya, Marketing and Communications MSF-UK

“Access to Essential Medicines (AEM)” Oliver Moldenhauer, AEM Coordinator MSF-

Germany

14:40 “MSF Crisis Response” Marc DuBois, Executive Director MSF-UK

15:30 Workshops

“Témoignage” Marc DuBois

“Security First, Humanitarianism Second?” Paul Foreman

“Without Borders?” Jacob McKnight

“Friends of MSF Joint Events” Peter Siordet Scolding

16:25 Workshops presented back to AGM

17:00 Panel of Workshop Facilitators: Your questions answered

Chair: Lucy Clayton, Head of Communications MSF-UK

17:35 Closing remarks

17:45 End of the AGM


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Reports ……………………………………………………………………………………………………………………………………………………………………………

Group Updates and National Committee updates

For the Friends of MSF (FoMSF) Groups’ and National Committee (NC) updates please see the FoMSF

Annual report 2008|2009, available at www.msf.org.uk/Friends...

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New Initiatives and Communication channels

Over the past year several new initiatives and channels of communication have been made available.

These include the following…

- Events Coordinator – on the FoMSF NC – whose role it is to help develop and execute joint

FoMSF events; to follow up on successful events to see if they can be used by other groups; to

develop ‘Event Templates” based on these events for use by all FoMSF groups; together with the

president, to find ways the Friends of MSF can assist MSF-UK at different larger events (e.g. MSF

Scientific Day)

- FoMSF Coordinator – a part-time volunteer position at MSF-UK, currently held by Rachel Francis.

Their role is to co-ordinate things from MSF-UK’s side, and to be the point of contact for

enquiries from Friends groups about MSF, available MSF resources such as posters, collecting

tins and anything else specifically related to MSF-UK.

- FoMSF Handbook – developed by the NC over 2008-09 – the handbook has many different

sections, including the FoMSF constitution, a guide to getting started, putting on speaker events,

fundraising ideas and much more!

- Memorandum Of Understanding – all FoMSF groups sign the MoU, introduced at the AGM. It

outlines the relationship between FoMSF groups, the FoMSF NC and MSF itself.

- Website - http://www.msf.org.uk/friends.aspx - all FoMSF groups will be aiming to have their

own pages on the MSF-UK website. This is an increasingly important public interface as students,

members of the public and other interested parties would like to know more about the Friends

and what they are doing. For help with setting up and maintaining your page please get in touch

with the Pete Scolding – [email protected] or MSF-UK’s web-editor, Pete Masters –

[email protected]

- Google Groups – A new forum – FoMSF Forum - created over the last year for the FoMSF to raise

any questions and discuss any issues arising either from the practicalities of running groups or

more general questions about MSF and humanitarianism. Any FoMSF group or individual is able

to sign up and join in with what goes on - http://groups.google.com/group/fomsf-forum?hl=en-

GB


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- A second Google Group has also been set up – FoMSF Alerts – for a more streamlined

communication of any important messages or updates directly from MSF itself; for example

details of MSF campaigns, events or situation updates from places such as Sri Lanka. Again, any

group or individual can sign-up to this group to receive these alerts

http://groups.google.com/group/fomsf-alerts?hl=en-GB

- Facebook – Friends of MSF is on facebook! Just look for Friends of Médecins Sans Frontières |UK

and Ireland. Become a fan and you can post photos, links to events and help to spread the word!

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National Committee Elections

Background

The FoMSF NC was first formed and elected at the 1st FoMSF National AGM in 2007. Initially

composed of five members, the positions have been evaluated and elected annually ever since.

Voting

Applicants for each post must present themselves and then participate in elections each year. Each

FoMSF group casts one vote per post, and the candidate with a majority of votes assumes the

position for the next year.

The NC aims to:

1) Support and facilitate the activities of individual FoMSF societies

2) Encourage and support the formation of new groups in the UK, Ireland and abroad

3) Act as mediator between FoMSF and MSF

4) Work to consolidate and continue FoMSF’s progress and development as a movement

New National Committee 2009-10

President – Peter Siordet Scolding (University College London)

New Groups Officer – Julia Neely (University of Cambridge) Events Coordinator – Ayame Tanaguchi (Imperial College London)

Speaker Liaison – Tom Adams (University College London)


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Reports ……………………………………………………………………………………………………………………………………………………………………………

MSF Crisis Response – Plenary Session

Marc DuBois - Executive Director MSF UK

Notes by Mathew Sheridan - Sheffield FoMSF

MSF’s purpose is often held to be emergency medical relief for populations in crisis. Within this, we

see the purpose of MSF is to save lives and alleviate suffering and to protect human dignity and

restore the ability of people to make their own decisions.

This is a massive undertaking, which can be achieved through 2 forms of action:

- Medical aid (provision of which can become an end in itself)

- Witnessing; the concept of Témoignage.

There are many ways in which we can ‘just’ help people, so why does MSF focus on populations in

crisis? This is because crisis areas are those in which you can save lives and alleviate suffering the

most.

A crisis can be considered “an extraordinary event” often in which there is high, usually excess

mortality (and this situation forms the root of operational policy). A crisis may also be considered a

“departure from equilibrium” a “spike/outbreak/outburst” or an “abnormal period of suffering”.

Bearing these definitions in mind, we can see how crisis response enables the ability to save lives

and alleviate suffering to be maximal.

Considering crises as extraordinary, abnormal and departures from equilibrium, we see where MSF

responds.

Iraq is a middle income country with a relatively high standard of living and decent hospitals. In

2006, the infant mortality rate was 48 deaths/1000, the 64th

highest in the world. In Sierra Leone, a

newborn has the lowest chance of surviving in the world. Mortality in childbirth in Sierra Leone is 1

in 8, compared to 1 in 48000 in Eire.

The mortality rate in Sierra Leone is 270/1000. This is far higher than in Iraq. However, MSF has 5

operational centres in Iraq. It has only 1 in Sierra Leone.

War demands core humanitarian action. Yet how does one define and measure need?

In crisis zones, there’s not just medical need, but overlapping layers of need. The value of treating an

acute medical need when war has ripped everything else apart is something that must be debated.

Indeed, this is an area continually debated in MSF, which is now a very fluid organisation.

Always, we must remember our will to SAVE LIVES AND ALLEVIATE SUFFERING. Yet how to act on

this is difficult. Consider our role in treating Cholera in Zimbabwe.

International Red Cross - a close ally, though they’re mandated by international law to do certain

things.


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When there are high levels of need and other actors aren’t prepared to fill that need, we must

remember our need to save lives and alleviate suffering. Cyclone Nargis gives a good example of

MSF’s crisis response.

Cyclone Nargis was rapid onset with high mortality (approximately 146000 deaths). 2 missions, OCA

[Operational Centre Amsterdam] and OCG [Operational Centre Geneva] had previously been

operational in the area affected, and OCA had had massive capacity. However, due to the Cyclone,

this was now a highly restrictive environment and though not a conflict environment, in the impact

area there were constraints on expatriates.

MSF made functional responses by addressing

- Operational teams

- Human Resource Management

- Communications

- Fundraising

Operational teams:

Operational centre Amsterdam had massive HIV/AIDs and healthcare operations in the area and

within 48 hours had shifted staff into the (affected) delta areas.

OCG scaled up its expats, while emergency desks coordinated with the OPS team. Consequently,

there developed a split from mission activities.

OCA only moved expats “under cover” into ‘the delta’ and so relied upon local staff to administer the

basics: healthcare, mental health, food and water. This was a huge logistical exercise and

necessitated “bearing witness” (being critical of what was seen) to be held in the high regard. In

addition, consideration had to be given to the impact of the removal of 125 staff from clinics which

had been administering HIV/AIDs education to 420, 000 people, while still also considering the

following:

Human Resource Management:

Extreme difficulties with permission to enter for expats.

OCG drew sharp lines with the government.

Communications:

Very difficult to obtain quality information.

Few expats on the ground, therefore causing extreme pressure on teams.

Coordination of messages was difficult.

Lack of English speakers.

UK team coordinates for major media outlets based in the UK e.g. BBC, Al Jazeera.

Yet despite this adversity, in villages where everything had been wiped out, in Burma, extreme order

was still maintained.

Fundraising:

International coordination (post-Tsunami) was required.

Questions arose over the ability to absorb the funds donated – indeed, absorption of funds on this

scale is limited when providing emergency medical care and must be used for crisis, not exploitation.


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Decision to launch fundraising appeal, which was very successful in the UK, amassing approximately

£650 000, which was added to the DFID funding of £1,100,000.

Impact (2 months on): over 30, 000 medical consultations, and mental health counselling is being

provided. Rice, beans, tinned fish and special therapeutic food have been provided as well as plastic

sheeting.

In conclusion, Nargis showed the response of National staff was more rapid and highly accountable,

but less specific than the response of International staff.

Communication lines and information flow are essential, but often problematic and must be

improved in crisis response. However, intersectional cooperation was good and the integration of

mental health services into the response is to be highly valued.


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Workshops ……………………………………………………………………………………………………………………………………………………………………………

1: Témoignage Facilitator: Marc DuBois - Executive Director MSF UK

Notes by Patrik Bachtiger – University College London FoMSF

Background reading:

“Civilian protection and humanitarian advocacy: strategies and (false?) dilemmas” – Marc DuBois -

www.odihpn.org/report.asp?id=2917

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Report

Marc gave out a double sided piece of paper, with one side featuring an actual press release from

MSF about rape and sexual violence in Darfur and the other side featured a copy of a falsified article

about the same issue. As a group, we took it in turns to read out a sentence and then discuss the

elements of it that could be interpreted as bias, skew or simply expressing an opinion that could get

MSF into trouble.

Some of the key dilemmas that came up were:

- How to respond to rape?

- How do you diagnose it? Many of the women would have been raped at gun point, and would

thus not have been able to resist.

- Did MSF witness the actual rape? In nearly all cases, no. This questions MSF’s philosophy to only

report on what they see with their own eyes.

- Credibility of witnessing rape as a claim of government forces’ brutality?

- Does witnessing rape in one area of Darfur make it applicable in the whole region?

- CONFIDENTIALITY of those MSF treats; mental health patient’s accounts can’t be used to further

MSF’s institutional agenda, as this would both be breaking confidentiality and consequently the

safety of the patient e.g. political reprisals.

- How do you define witnessing? If you have no evidence for what you saw, can it be used in a

press publication? What counts as témoignage? Is it always appropriate?

Mark’s sound-bite of the work shop was definitely that there is an “inherent value in the truth

coming out”. It is a duty of MSF to report on what they see, even if this sometimes may present

problems to the organisation. We concluded that witnessing is incredibly difficult, as it not only

needs to be fully supported with evidence but must also prevent any subjects of this evident falling

victim to any harm. Witnessing needs to be a secondary agenda to the care and treatment of those

who need MSF’s skills the most.


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Feedback from participants

Some of its best features were described as…

“The use of a real life example”

“Getting pre-readings so you knew the background”

“Really interesting discussion around the article - it was amazing to have the discussion lead by

Marc du Bois as it gave us a good insight into the real issues MSF face regarding this topic.”

“I found the issue really interesting.”

Possible areas for improvement included…

“There was a general consensus that more time would have been useful.”

“Hard to plan for the worst case scenario, but it was very disruptive having to move half way

through and having 9 new people join our group, in stages.”

“Smaller number of people”

“More time; fewer people would make for more in depth exploration of the topic. Maybe focus it

around several scenarios, not just one.”


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Workshops ……………………………………………………………………………………………………………………………………………………………………………

2: Security first, humanitarian assistance second?

Facilitator: Paul Foreman – Member of MSF-UK Board of Directors

Notes by Kate Pitt – UCL FoMSF

Background reading:

“Iraq case study” (see below) – Paul Foreman

Iraq case study In order to frame some of the dilemmas of managing MSF operations in insecure environments and

to give the discussion some context, here is a brief summary of the main operational challenges

faced by MSF in Iraq and some past management decisions in response to these challenges.

It became clear in 2002 that Iraq was going to be involved in another war, and therefore that MSF

should try to design a response to this potential humanitarian need. As usual, MSF was faced with

the dilemma of not wanting to spend on ‘strategic placement’, but also needed to accept that MSF

capacity and local knowledge in Iraq was minimal. MSF had been active in the Kurdish region in 1988

(Iraq’s attacks on their Kurdish population) and again in 1991 when the first US coalition Gulf war

(GW1) occurred. But on both occasions had withdrawn soon after, mainly due the politicised nature

of operations and the capacity still in place for a quick recovery (assuming the will was also present).

In 2002, initial approaches to the government of Iraq were met with numerous political obstacles.

There were certainly humanitarian needs associated with the UN-administered blockade; there was

a rising nutritional crisis, un-catalogued but reportedly significant re-emergence of Kala Azar (visceral

leishmaniasis), cancer clusters allegedly associated with use of depleted uranium in GW1, etc. The

Government of Iraq wanted MSF to look into these situations, but often the degree of political

control demanded compromised impartiality unacceptably. However, as the wind-up to GW2

became inevitable in early 2003, MSF gained access to main population centres of Iraq and managed

to establish credible medical programmes in relevant locations just as the needs emerged.

The first phase of the war was relatively quick and, as wars go, involved relatively few civilian

casualties. MSF was independently active for most of the time supporting Iraqi hospitals, but refused

to ‘embed’ with the advancing coalition forces for obvious reasons. Prior to the commencement of

hostilities the US government had issued calls for proposals from NGOs asking for, among other

things, provision of medical care for tens of thousands of war wounded including nuclear, biological,

chemical wounded and provision for refugee & IDP services for millions of war displaced civilians.

Even though most of these services were not taken up, the relationship between the USG and NGOs

that was established in the preparatory phase formed a pattern for the duration of the conflict. Thus

NGOs were viewed largely as contractors, as opposed to independent (humanitarian) organisations.

In the immediate aftermath of the war MSF suffered a degree of indecision. It was clear that the

looming humanitarian catastrophe predicted by many had not occurred, and so there was a move to

leave Iraq quite quickly, as relatively little had been achieved or established during the acute phase


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of the violence. However, it was also clear that the public health system was in complete disarray

and that the removal of the entire Iraqi governmental system would not lead to early improvement.

Therefore, some capacity remained in the country, working independently of all coalition and UN

mechanisms, mainly on preventative and primary health initiatives. This project was well positioned

to react swiftly to the humanitarian needs that escalated as the resistance to the occupation, and

the coalition response, grew steadily more violent. For a few months, MSF provided vital

humanitarian assistance.

The violence grew rapidly in intensity and spread to many sectors of society. The ICRC headquarters

building in Baghdad was bombed, followed by the UN headquarters, leading on both occasions to

significant loss of life. Political kidnap for ransom became commonplace, and sectarian violence

increased dramatically. Civilians were routinely targeted for their social standing, wealth, political

affiliation, religion; even lowly occupations were specifically targeted (e.g. refuse collectors &

bakers). Political extremism mixed with pure banditry made Iraq an extremely dangerous place in

which to operate, and there were many incidents involving the kidnap or murder of western

personnel. Following the kidnap and subsequent murder of Margret Hassan, country director for US

NGO Care International, many NGOs including MSF were forced to reconsider their positions. Some

weeks later MSF withdrew completely from Iraq.

Fast forward twelve months to the latter part of 2005 and it is clear that the conflict zones of Iraq

are becoming a humanitarian catastrophe, but with no MSF presence at all. MSF makes contact with

former stakeholders in our operations and begins the dialogue that will eventually lead to re-start of

emergency operations in Iraq. During the course of 2006, against a background of continuing and

escalating urban warfare, MSF develops two models for addressing the most severe humanitarian

needs resulting from the conflict:

• A facility for maxillofacial & orthopaedic reconstructive surgery is opened in Jordan, where

‘cold’ cases are given treatment unavailable in Iraq and essential to reinstating a reasonable

quality of life

• Remote support consisting of training and provision of surgical supplies is given to large

hospitals in the heart of the conflict, frequently dealing with daily influxes of wounded in their

tens and, occasionally, hundreds.

Both of these programmes were developed in some secrecy by liaison with former MSF staff and

doctors who previously worked alongside us. The process has continued since then.

The challenge of re-establishing MSF in Iraq was enormous because, in an operating environment

where any western presence was automatically attacked, all the usual avenues of approach were

unavailable. Ultimately, we relied on Iraqi nationals, who volunteered to facilitate the gradual

increase in operational presence. As we speak, it is still dangerous to visit many parts of Iraq, and we

continue to be severely constrained by security.

It is interesting to hypothesise, what would have happened if MSF had ‘gone underground’ in

October 2004, retaining national staff on the programmes and working very carefully with visiting

management as security permitted?


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MSF refused to embed with the coalition, but had to negotiate with the government of Iraq to retain

/ regain access – where does the compromise to independence start and finish?

The risks that were unacceptable in 2004 were far greater at the height of the conflict in late 2006,

when MSF had already re-engaged with both operational models. The difference was the level of

humanitarian need, which had increased exponentially. What constitutes an unacceptable risk, and

against what is it measured?

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Report

The workshop focused on the potential conflict, when working in dangerous environments, between

protecting staff and delivering care. The case study was the re-launch of remotely –supported

operations in 2006 in Iraq.

Paul ran the workshop in three stages. Firstly, he described the security challenges of re-launching

MSF operations in Iraq. Secondly, he invited participants to debate the broader issues raised for

MSF’s operations in dangerous environments. Thirdly, he identified strategies that had protected

the safety of MSF staff and volunteers in Iraq.

Workshop participants raised several questions for debate, which included:

• How is risk measured?

• What is an acceptable level of risk?

• Who should determine what level of risk is acceptable? Field staff? MSF management? Both?

• How do you balance meeting immediate humanitarian need with the long term viability of

working in an area?

• Should dangerous operations be curtailed to minimise the risk of adverse events undermining

MSF’s reputation?

• How do you balance the safety of MSF staff with the duty to fulfil MSF’s objectives?

• Is it morally justified to put the lives of MSF staff and volunteers at risk?

• Is risk unavoidable in order for MSF to fulfil its objectives?

Paul Foreman provided examples of the methods by which risk was minimised during the Iraq

operation. These included using staff without British or American passports, delivering aid without

the MSF logo, working in partnership with Iraqi clinicians, and building trust over time.


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“It was good to meet someone with experience in the field. Debating the issue and swapping

ideas among the group was fun and threw up some interesting points.”

“Relaxed informal manner.”

“Good to hear people's view points and what it is like in real life.”

“The workshop raised several interesting dilemmas for debate.”

“Speaking to someone with real experience.”


“We got into debating very quickly but I would like to have heard a bit more from the speaker

before we started as I felt that with all his experience he would have had a lot to say.”

“Lacked specific focus. Perhaps the scenario could have been a role play situation where we

were to pretend to have been placed on site, under siege. Going on to discuss different

aspects with regards to safety etc.”

“It was often the same people talking so perhaps more of a structure would be needed to

help everyone give their ideas. There was also a lot of wasted time while people were 'shy'

and not talking. More direction from the lead would have been good.”

“More time.”

“It took a while to really get interesting, so maybe brief the speaker a bit more with a starting

statement.”


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Workshops ……………………………………………………………………………………………………………………………………………………………………………

3: Without Borders Facilitator: Jacob McKnight – MSF Field Logistics expert

Background reading:

“Somalia case study” (see below) – Jacob McKnight

Workshop Case Study

As any broadsheet will tell you, Somalia has been without an effective government since 1991. Some

academics make the very reasonable point that it never really had a government and suggest that to

consider the fall of Siad Barre’s regime as the loss of statehood is misguided. Regardless, Somalis

have been on their own for quite some time: without a government, struggling with very harsh

environmental conditions, divided by their unique clan system and suffering the legacy of failed

interventions, drug addiction and the mass proliferation of small arms.

At the same time we must remember that Somalia is homogenous and united in all manner of ways.

Somalis have one language, one religion and largely, a shared culture and belief system. Until 2006,

Somalia had active trade nationally and internationally, a growing telecoms sector and despite not

having a national bank, the country had its own, mostly stable currency.

MSF have managed to maintain projects in Somalia with greater continuity and larger scale than any

other NGO. How do they do this? Contrary to what you might imagine, it’s not by abseiling out of

helicopters to save small children while bullets fly overhead. Every step MSF takes in Somalia is hard

won and the decisions that are made day-to-day edge them further forward allowing access to

desperately needy patients, or further back, to ‘remote-control’ projects and watching from Nairobi.

Some of these decisions are made in European headquarters, others are made at the country office

in Kenya but most are made in the field.

The following case study is a real example of a situation that occurred in a project based in South

Central Somalia in 2006. In considering what might be the correct course of action, we need to

remember:

• Clan tension and rivalry

• Complete lack of resources

• Intense competition for jobs

• The ever present possibility of violence directed towards ex-pat staff

• The even greater possibility of violence directed towards national staff


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The Project

The project in question was started in 2002. Although the services offered at first were sparse, the

project grew and by 2006 it had approximately 200 patients in the Hospital proper, a TB sanatorium,

capacity for a cholera outbreak, several isolation units and a very active outpatient department. The

work done with Kala Azar is especially important to MSF and the busy ward usually has at least one-

hundred child in-patients.

The National Staff Involved

Dr Abdi is the most senior Somali medic in the project. Long before MSF arrived, he was offering all

manner of medical services through the pharmacy that he owns – everything from penicillin to

amputations. Given the dearth of medics in Somalia, Dr Abdi is a very well respected man. He has

four wives and many children, manages a pharmacy and several shops, and as a doctor, earns a

relatively lucrative wage each month. He is about 65 years old and belongs to clan A.

Mohammed is a competent young nurse. He is well liked by the national staff and is beginning to

garner some real respect from the ex-pats who recognise in him an intelligent and thoughtful

clinician – someone who if given the chance, would shine. The acknowledgement that he was slightly

more efficient than his peers has however, made Mohammed a little arrogant. He is around 25 years

of age and belongs to clan B.

The Situation

Security rules on the project demand that the ex-pat staff are not allowed to leave their compound

after dark. The hospital is instead run by the Somali staff and the two Somali medics work on

rotation to answer any emergencies that arise. One night, a member of staff calls the ex-pat

compound to inform them that there has been a ‘big problem’…

…The MSF driver responsible for driving Dr Abdi revealed the ‘big problem’. During the night, Dr Abdi

had been called to answer an emergency in the hospital. The condition of a child in the Kala Azar

ward had rapidly deteriorated and Mohammed, the nurse on duty, had called Dr Abdi to the ward.

There was a disagreement about what should be done, and it came to blows. The nurse,

Mohammed, had beaten Dr Abdi in front of other staff and patients and the guards hadn’t known

what to do. The call came late at night from a distressed diver (of the MSF car which had picked up

Dr Abdi) who informed the ex-pat team that the situation was now relatively stable but that Dr Abdi

was badly bruised and shaken in one part of the hospital while Mohammed continued to work in the

Kala Azar ward.

What should the ex-pat team do?


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Part 2

The team decided that it would be best for the driver to take Dr Abdi home and let Mohammed

finish his shift. At first light, the project coordinator drove to the hospital to interview Mohammed.

The nurse was candid and said that Dr Abdi had blamed him for not calling him earlier to help the

child. The child had died. The conversation had become heated and Mohammed described how Dr

Abdi had accused him of being a bad nurse and gesticulated near to his face causing him to lash out.

The project coordinator put Mohammed on immediate suspension.

He then went to interview Dr Abdi who largely supported this version of events, saying that he had

been picked up by the driver, had found the patient to be in a bad condition and had told

Mohammed that he should have been called earlier. After the patient died, Dr Abdi spoke forcefully

with Mohammed and this resulted in a fierce argument and Dr Abdi had been assaulted

unexpectedly. He had a bruised face and a suspected cracked rib and was unable to work for the

next two shifts.

Given that the stories largely matched, the project coordinator discussed the matter with the

Nairobi office and decided that there was no excuse for the physical attack. It was felt that to

discipline Mohammed through suspension or other means would be to condone violence and so the

decision was made to terminate his contract.

A meeting was held with Mohammed and he was allowed a representative from his clan to also be

present. Despite a passionate defence, and demands that Dr Abdi was in the wrong and that he had

provoked Mohammed, the judgement stood and Mohammed was fired with immediate effect.

Over the coming days, the projector coordinator was inundated with calls and visitors from

Mohammed’s clan. Some of these people were suppliers to the hospital, others were senior

members of staff, and some were local businessmen and clan elders. A great deal of pressure was

put on the project coordinator and he was told repeatedly that it was not fair to show clan

favouritism. The pressure built to such an extent that the project coordinator became aware of a

threatening tone in the appeals. Traders, businessmen and senior staff all said that this could

‘damage the project’.

The project coordinator called the Nairobi office and the MoH co-ordinated a visit to tie in with a

meeting to discuss the problem with Mohammed and the clan leaders in question. Unexpectedly, Dr

Abdi and senior representatives of his clan turned up for the meeting saying they had been invited

by Mohammed’s clan. The gathered group told the MSF team that a decision had been made,

Mohammed had apologised to Dr Abdi and that the situation was now ‘fine’ and as such,

Mohammed should be allowed back to work immediately. Dr Abdi showed no sign of coercion and it

did appeal to the ex-pat medical team in that Mohammed was a skilled nurse and it was difficult to

find good staff.

What should the MSF team do?


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Part 3

The decision was made that despite Dr Abdi’s forgiveness, the situation was not acceptable to MSF

and that Mohammed must be made to pay for the assault lest this type of behaviour be seen as

acceptable. Seeing however, that Mohammed must have a great deal of capital with his clan and

that to uphold the decision would likely result in a serious threat to the project, the decision was

made to reduce the punishment to a 6-month suspension.

As it turned out, the same powers put relentless pressure on the project team throughout this

period and Mohammed was eventually allowed back after just a 4-month suspension.

Key points:

Somalia and other countries like it are extremely resource poor. Car rentals, staff wages,

employment practices and payments of every kind are of critical importance.

The clan system is extraordinarily complex. Rather than ‘chaotic’, the Somali system ensures that as

an outsider you are extremely unlikely to be able to see all of the details of any given ‘deal’.

Hence, given the above, Mohammed’s monthly salary probably had an effect on a lot of people’s

lives, some who probably had good links to Dr Abdi’s clan. It was very important for them to broker

some sort of deal to recover this lost income.

Flexibility - while we needed to ensure that the incident was punished, to hold the strict rule of law

in this instance may have threatened the project.

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“Discussion and then seeing how things were actually done and how the two differed.”

“Although sixty years old, I always enjoy the articulate and challenging input by young people.”


“No suggestions. Just enjoyed a day out and learned a lot about MSF.”


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Workshops ……………………………………………………………………………………………………………………………………………………………………………

4: Joint Events Workshop Facilitator: Peter Scolding – Speaker Liaison, FoMSF National Committee 2008-09

Notes by: Peter Scolding - UCL FoMSF and FoMSF NC

Phil Campbell – UCL FoMSF

Report

The joint events workshop contained a representative from nearly all FoMSF groups, alongside some

observers from MSF. We started with a brief round of introductions, reflection on the group updates

and suggestions for events and focus points for the year ahead.

Particular events re-mentioned included the Battle of the Bands series, raffles, balloon race, fun run

and workshops and speaker events.

Some of the issues and points for thought raised were

- how to harness the ‘people power’ which is definitely there to be used;

- how to channel messages and awareness-raising through all different events e.g. fundraising;

- how to improve fundraising;

- how to improve campaigning;

- the value of interaction and collaboration, both within universities – with other societies – and

between different FoMSF groups;

- how to broaden participation and membership beyond the current pre-dominance of medics

- how to increase integration nationally as a movement

Some suggestions for 2009-10 included collaborating in at least one joint event nationally, and

staging of another conference and careers fair.

The workshop then separated into two breakout groups, one with representatives from FoMSF

based in the south, and the other with representatives from the North.

South

We want to scale up the UCL Regents Park fun run that has taken place for the past couple of years,

which has raised around over £9000 for MSF. The run is usually over 10km but for a combined event

perhaps a significant distance could be selected, e.g. the distance a person had to walk to a

treatment centre (symbolism). The runners may also be able to wear t-shirts with slogans, such as 'I

am a pregnant women' etc.

As for fundraising, perhaps healthy competition between the universities would create much more

in terms of cash. A local celebrity to start the race was also suggested as this would mean press

involvement and so therefore help raise awareness as well!

A social event after the race would also be great to give people an incentive to come from further

afield to take part and would be excellent end to the day! Could announce prizes for winners of

fastest time, most raised etc.


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A provisional date was the 6th March 2010. Issues that need to be sorted are insurance, booking

Regents Park, publicity and recruiting people, as well as finding prizes.

North

The possibility of staging various events was discussed, including hosting the National AGM at some

point in the future. We also discussed the possibility of a Northern Fun Run and a regional

conference (possibly on consecutive days) and both with a social attached. A regional conference

might for example be staged in Manchester.

Summary session

Both North and South break-out groups re-assembled, and provided a very quick summary to the

whole workshop, unfortunately there wasn’t enough time to properly discuss the ideas arising.

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“Direct interaction/brainstorming with other groups - very fruitful for plans for next year!”

“Direct interaction between the groups - some really exciting ideas and more practical

discussions about something really happening.”

“Everyone had a chance to introduce themselves and participate in the discussion of the

proposed event.”

“Getting new ideas”


“More time, and perhaps email those involved beforehand with details of how it will work etc.

And, perhaps send around a list of email addresses to all those who were in the joint events

workshop so contact is made easier afterwards?”

“Definitely more time, and probably a bit more preparation re. template given to participants

earlier and email exchange.”

“Longer time is definitely needed. Ideas can be shared beforehand by email submission if

possible and discussed at the workshop.

If each FoMSF has any good suggestion of events they could possibly prepare a brief presentation

about their event and propose the joint event using their ideas.”

“Having more time”


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Panel Discussion ……………………………………………………………………………………………………………………………………………………………………………

Chair: Lucy Clayton – Head of Communications MSF-UK

Panellists: Marc DuBois - Executive Director MSF UK

Paul Foreman – Member of MSF-UK Board of Directors

Jacob McKnight – MSF Field Logistics expert

Oliver Moldenhauer – MSF Access to Essential Medicines Co-ordinator – MSF Germany

Notes by Claire Shaftoe – Sheffield FoMSF

Q. Currently there are no opportunities for students to work with MSF on their medical

electives, is there a future role for students within MSF as part of their electives?

A. Not on a practical level. There is usually only a small MSF presence in one area and supervising

students would take doctors attention away from the job they are there to do. It is not necessarily

appropriate for students to be in the sort of environments MSF works in and raises questions of

professionalism. There are many other organisations that students can organise electives through in

developing countries.

Q. What do you need to become a logistician? Who do you need to target?

A. The people to target are those working in supply/delivery/management, and not just in the

medical field. Also civil and general engineers; a base level of engineering experience augmented

with other experience, e.g. language skills, is needed to work in logistics.

Q. Why doesn’t MSF work with destitute asylum seekers in the UK?

A. The level of need of destitute asylum seekers is not high enough to justify MSF input, based on an

assessment of access to healthcare. There are other organisations working in this field, e.g.

Médecins du Monde.

Q. What is MSF’s response within populations exposed to conflict with regards to mental

health? Are these acute problems or long term?

A. Violence produces sexual, physical and mental trauma. There are many traumatised and grieving

people, and the aim is to use low resource interventions to get people to a healthier situation and be

able to function again. Long term mental health programmes significantly decrease non-specific

medical presentations.

Q. Continuing ART

A. This is a difficult issue. Is it the right thing to start ART knowing that the treatment will have to

stop? Ideally, build handover partners to take over the treatment once MSF has moved out and

provide assistance to other organisations (funds?). There are no concerns regarding drug resistance


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following the termination of treatment and life expectancy is increased, even after the treatment

has been stopped. Sustainability is not necessary for all actions.

Q. Is it that the name is in French that is causing poor recognition of MSF?

A. The UK is the only section to not use the local language and the name has been used for over 15

years, so it would be a big overhaul to change it. There is already confusion amongst

journalists/media, to change the name would just make that worse. Perhaps it would be better to

explain ourselves better. People think that MSF and DWB are two separate organisations and it has

not been proven that it is the name that is the problem.

Q. Is there too much bureaucracy and not enough publicity?

A. How much money should be spent on publicity and how much on field work? There needs to be a

balance. There is also an issue with image, MSF doesn’t want to be seen as harassing people for

money and needs to be responsible with its money. There is no point in spending money to generate

more money, because, in the long run it doesn’t work. People give money to MSF knowing that it

will be used properly, not spent on paper or leaflets.

Q. Would MSF consider going back to a country that it has already pulled out for, e.g.

Afghanistan, 5 murdered.

A. We need to investigate and understand why workers were targeted, and if this is an ongoing risk,

or ignorable. MSF tries to mitigate risks as much as possible.

Q. Are deaths in the field an unavoidable consequence? Or can steps be taken to reduce

the risk?

A. Yes, it is dangerous and workers may also have to deal with the death of colleagues. MSF doesn’t

just accept it and doesn’t want thrill seekers, but looks for genuinely caring humanitarians. It is a

difficult balance but if there is significant risk of loss of life, liberty or limb then operations are

curtailed.

Q. Could MSF use students to go into schools for education?

A. YES! It would be great to have students spreading the message, but the method of getting

information into schools needs to be looked at. It is easy to do a talk in an assembly, but integrating

information about MSF into the curriculum is difficult, needs lots of effort from national MSF in

terms of organising and arranging.


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Feedback ……………………………………………………………………………………………………………………………………………………………………………

Overall there were 27 respondents to the Feedback questionnaire.

Registration

How satisfied were you with the event's registration process?

No. of

people

1= Very dissatisfied

5= Very satisfied

How could the registration process be improved?

“On the day, there was a bit of confusion about where to go and felt that more signs to the lecture

theatre could have been good.”

“Whilst the majority of the team were great and very helpful, there were one or two committee

members who didn't appear to be pulling their weight with directing people and making them feel

welcome.”

“Making more use of the online forms would be useful, and possibly allow for online payment as

well (through the Google payment system maybe?) would allow it to be smoother.”

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Location

How satisfied were you with the event's location?

No. of

people

1= Very dissatisfied

5= Very satisfied


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…………………………………………………………………………………………………………………………………………………………………………… Future AGMs

How likely are you to attend a future event?

No. of

people

1=Very likely

5= Very unlikely

Considering the layout of this AGM, with the morning for FoMSF and the afternoon for MSF, how

would you prefer the layout for next year's AGM?

- 4% - More focus on Friends of MSF, sharing

of ideas, and developing joint events!

- 32% - More focus on MSF, their dilemmas,

and our questions answered!

- 64% - It was just about right this year.

How would spreading the AGM over two days affect you?

- 67% - (18) I would be less likely to attend

- 11% - (3) I would be more likely to attend

- 22% - (6) It makes no difference to me

“The set up was very good. I think that an extra day could be good but depending on the timing it

could make it more difficult to attend. It happened to fall for us the weekend before our biggest

exam of the year so far and although we could just about take one day off, two would not have

been possible. That said, if it happened to be a better weekend two days would be great!”


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2009 AGM - Overall

What did you like the most about the event?

“As a very new group just starting out it was great to hear from all of the other FoMSF groups.

Hearing how successful everyone else had been was very encouraging for us and gave us some

great ideas. I also felt that attending the event reinforced what we were doing and made us

aware of the fact that our group is part of something much bigger.”

“The inspiration gained by meeting lots of other FoMSF groups and hearing about events they've

had.”

“Relaxed informal manner. Very well organised. Opportunity to see what other universities have

been up to and share successful ideas.”

“Meeting other people with similar opinions and sharing ideas.”

“Organisation. Perfect mix of FoMSF and MSF material. FoMSF info was very useful”

“Meeting Marc DuBois”

“Meeting other FoMSF groups and exchanging great ideas”

“Sharing of events ideas (at a good pace!), and good direct interaction with MSF representatives

to ask specific questions and learn more about the organisation as a whole.”

“I was there as an observer looking into the possibility of a FoMSF at my local hospital. I was also

the old man amongst about 100+ medical students.

It was great to see so many young articulate and challenging young people, they often are the

makings of any event. Also they treated the "old man" very well.”

“The talk from Oliver Moldenhauer on widening access to essential medicines, how this can be

achieved and statistics to demonstrate progress. Also Marc DuBois's talk on ethical dilemmas.”

“Excellent organization and use of time (except the events workshop which was way too short)

Everyone had a good chance to discuss their updates for each FoMSF and the updates from the

national committee were very clear.”

“The chance to meet other people who have been having the same difficulties as we have! Doing

it over two days would be cool, but accommodation and cost could be a problem. though it might

mean more time for socialising which would be nice”

“The discussion and engagement of all the FoMSF.”

“I really enjoyed the speakers from MSF. It put everything into place and a target that we can

help people to achieve. They are passionate and I felt that the talk by Marc DuBois was

extremely well done, giving everyone a real drive to make the best of our time in Friends of MSF.

It was good to hear what other Friends of MSF groups have done and some of their ideas."

“I found the talk by Marc DuBois excellent as well as the group updates. Where the former was

motivating in terms of where we're heading, the latter was inspiring with regards to how our

group could be running.”

“The questions answered session with the panel was brilliant - we should have had more of this!”

“I enjoyed the talks, and giving each other ideas on what to do.”


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“Balance between practical ideas for FoMSF and inspirational talks by staff.”

“To see all these motivated people”

“I liked it all but the MSF Speakers were particularly interesting and I like the panel format for

asking questions.”

“"The talk by Marc Dubois”

What can we do to improve future events?

“The workshop was good but short (I know there were timing issues at the end of the day) - it

would have been good to have more time to get into it.”

“Perhaps having the workshops on a rotation so everyone gets to go to all of them, time

allowing?”

“Work on the Workshops. With more focus, perhaps role play. May allow discussion to flow more

freely and be better directed.”

“More about MSF works, more talks like the one given by Marc”

“Have lunch at the venue so different groups have more of a chance to mix”

“Host them closer to the middle of the UK”

“It was very good”

“There wasn't quite enough time spent in the seminar groups due to a lack of time, so perhaps

work on that.

Slight overkill on the Logo, it was important but I thought too much time was spent on it.

Otherwise it ran perfectly from start to end and managed to be both informative and enjoyable.”

“Greater time for workshops.”

“More information about how to actually get involved with MSF in future and exactly what to

expect from the experience. Advice on what we can do in the meantime to prepare ourselves for

such experiences.”

“It would be ideal to shorten the day to half a day but that is quite difficult, considering there are

many issues to discuss...”

“More time with the MSF speakers as these are the people for whom Friends of MSF are

ultimately working and having a good understanding of what everyone does and the things that

people go through really help us to focus why we are in the group. “

“The review of each society’s achievements at the beginning was useful but quite repetitive. It

might be good to compress this part - or make it into a workshop for sharing event ideas instead.”

“Mingling over food might be a good idea.”

“Just deliver something of the same quality!”

“I would spend less time talking about things like logos.”

“Increase the time available for the workshops”


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Is there anything different you would like to see at future events?

“Have you thought about having a social after to really give all the groups the chance to mingle

and swap ideas and get to know each other? Wouldn't have to be anything flash - just a local pub

after or a pizza somewhere?”

“Again more talks by members of MSF and people who have worked for them. Perhaps across

two days.”

“Some socializing and ice breaking for those who are interested, if time permits. Opportunity to

know FoMSF from different university and exchange contacts?”

“Maybe lunch....!??”

“More time for the workshops.”

“Maybe a film / slide show of field work?”

“Maybe a bit of a careers fair, because most of us are interested in working with MSF in the

future, so perhaps a little bit of an explanation of how to get into it, what different paths there

are and so on.”

Overall, how satisfied are you with the AGM?

1 - Very Dissatisfied - 0

2 - 0

3 - (1) - 4%

4 - (7) - 26%

5 - Very Satisfied (19) - 70%

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Attendance

Are you from a university with a Friends of MSF Group?

Yes - 89%

No - 11%

If Yes: Are you in the committee of this group?

Yes - 60%

No - 40%

Friends of MSF - National AGM Report - 2009

Documents

Transcript of Friends of MSF - National AGM Report - 2009