"Nationals" and "expatriates": Challenges of fulfilling "sans frontières" ("without borders") ideals in international humanitarian action

Health and Human Rights

Volumn 10, Issue 1, 2008, Pages 109-122

  Shevchenko, Olga ^a   Fox, Renée C ^b,c  

^a WILLIAMS COLLEGE   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

^c The Wellington   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EQUITY; HUMAN RIGHTS; INTERNATIONAL ORGANIZATION; PHILOSOPHY; SOCIAL JUSTICE; TRADITIONAL KNOWLEDGE;

EURASIA; RUSSIAN FEDERATION;

CULTURAL COMPETENCE; ETHICS; EUROPE; HEALTH; HEALTH CARE DISPARITY; HEALTH CARE MANPOWER; HUMAN; HUMAN RIGHTS; INTERNATIONAL COOPERATION; ORGANIZATION AND MANAGEMENT; POLITICS; POVERTY; PROCEDURES; PUBLIC HEALTH SERVICE; RUSSIAN FEDERATION;

CULTURAL COMPETENCY; EUROPE; GLOBAL HEALTH; HEALTH MANPOWER; HEALTHCARE DISPARITIES; HUMAN RIGHTS; HUMANS; MEDICAL MISSIONS, OFFICIAL; POLITICS; POVERTY; PUBLIC HEALTH ADMINISTRATION; RUSSIA;

EID: 57049139446     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/20460093     Document Type: Article

References (39)

1. Médecins Sans Frontières, Chantilly Document (1997). The text of the Chantilly Document is available upon request from Doctors Without Borders/Médecins Sans Frontières, 333 Seventh Avenue, 2nd floor, New York, NY 10001.
2. For more on the origins, history, and structure of MSF, as well as the dilemmas that arise in the course of its humanitarian work, see P. Dauvin and J. Siméant, Le Travail Humanitaire: Les Acteurs des ONG, du Siège au Terrain (Paris: Presse de la Foundation Nationale des Sciences Politiques, 2002)
3. R. C. Fox, "Medical Humanitarianism and Human Rights: Reflections on Doctors Without Borders and Doctors of the World," Social Science & Medicine 41/12 (1995): pp. 1607-1616
4. P. Redfield, "Doctors, Borders, and Life in Crisis," Cultural Anthropology 20/3 (2005): pp. 328-361
5. P. Redfield, "A Less Modest Witness: Collective Advocacy and Motivated Truth in a Medical Humanitarian Movement," American Ethnologist 33/1 (2006): pp. 3-26
6. F. Terry, Condemned to Repeat?: The Paradox of Humanitarian Action (Ithaca, NY: Cornell University Press, 2002)
7. O. Weber, French Doctors: Les 25 ans d'épopée des hommes et des femmes qui ont inventé la médecine humanitaire (Paris: Robert Laffont, 1995).
8. This process of organizational self-examination, initiated in November 2004, resulted in the drafting of the so-called "La Mancha Agreement," which was approved by the International Council of MSF in Athens on June 25, 2006. The Agreement was intended to be "complementary to the Charter and the Chantilly Principles." The name "La Mancha" was given not only to the Agreement, but also to the entire process of self-scrutiny, self-criticism, and debate from which it resulted. "La Mancha" intentionally connected the organization and its members with the chivalrous escapades and battles of Don Quixote, the hero of Cervantes' romance. As such, it expressed both MSF's ardent dedication to humanitarian ideals and its characteristic self-directed and ironic wit about the exalted nature of those ideals, as well as its supposed nobility in pursuing them.
9. RCF was an observer at this meeting.
10. Although nationals make up such a huge percentage of MSF's personnel, compared to the number of expatriates, the total funds spent by the organization to cover the salaries, transportation, per diem expenses, and other forms of support for the nationals roughly equal the entire amount spent on compensation for the expatriates. This suggests that, taken as a whole, the international volunteers "cost" on average about 10 times as much as do local employees - a detail that no doubt introduces additional complexity to MSF's efforts to achieve equity for the latter.
11. This is excerpted from Article 1.3 of the La Mancha Agreement. As in the case of the Chantilly Document, the text of the La Mancha Agreement can be obtained from MSF on request. See note 1.
12. M. Buisssonnière, "La Mancha Here We Come!" La Mancha Gazette (MSF Internal Newsletter, May 2006): pp. 2-3.
13. U. von Pilar, "Sharing Knowledge! The La Mancha Training Center," La Mancha Gazette (MSF Internal Newsletter, May 2006): p. 12.
14. Along with MSF-Belgium, the operational sections of MSF include MSF-France, MSF-Holland, MSF-Spain, and MSF-Switzerland. The other 14 sections of MSF are called "partner" sections. Their primary functions are recruiting MSF personnel, raising funds, and disseminating information about MSF's mission and action.
15. Our interviews and observations were conducted primarily in the MSF-Belgium office, with shorter field trips paid to the Moscow offices of MSF-Holland, MSF-France, and MSF-Switzerland, and also to the office of Doctors of the World in St. Petersburg. While we drew both implicitly and explicitly on information and insights gathered in all these locations, the MSF-Belgium mission in Moscow was the primary source of our ethnographic data.
16. African societies number among the top 10 countries in which MSF has invested the largest amounts of operational funds; in 2004, Sudan, the Democratic Republic of Congo, and Angola alone absorbed more than 34% of MSF's operational expenses.
17. To protect the anonymity of our field informants, we quote their observations here and at several other points without detailed attribution.
18. Although MSF does not have, and has never had, an official common language, English has gradually supplanted French as the lingua franca of the organization.
19. The most common medical problems affecting the Moscow homeless were trophic ulcers and infected wounds, due to exposure to the elements, poor living conditions, and lack of access to medical care. One of the significant results of the care delivered by MSF was to drastically reduce the incidence of lice and scabies among the homeless persons treated.
20. The Russian acronym "BOMJ" is a pejorative term that has been widely used in Russia to refer to the homeless. The term originated in police reports and made its way into wider, everyday usage. Literally, it means "without a fixed place of residence," but in colloquial language, it carries the connotations that homeless persons are vagabonds, beggars, robbers, criminals, dirty disease spreaders, and "good-for-nothings" who deserve their lot. MSF has achieved a certain success in reducing the frequency with which "BOMJ" is used in official and public Moscow contexts, and in furthering its replacement by the neutral word "bezdomnyi," which simply means "homeless."
21. MSF-Holland and MSF-Switzerland have operated more extensive programs in this North Caucasus region than MSF-Belgium.
22. In terms of gravity and scope, military operations in Chechnya fully deserve to be classified as wars. However, because the conflict was internal to Russia, those displaced by it were not granted the status of war refugees and thus had no access to whatever rights and privileges this status entailed.
23. The two most publicized kidnappings of MSF personnel have been those of Kenneth Gluck and Arjan Erkel. Gluck, a US citizen associated with MSF-Holland, was working as Head of its North Caucasus program. He was abducted on January 9, 2001, while traveling in a humanitarian convoy near the village of Starye Atagi in Chechnya, and released on February 3, 2002. Erkel, a Dutchman, was Head of MSF-Switzerland's mission in Dagestan when he was abducted in Makhachkala on August 12, 2002, by gunmen who kept him in captivity until April 11, 2004.
24. At the time of our field visits to the Moscow office, women filled all three of these positions. We found no evidence in the Russian context or in any other MSF milieu with which we have had contact, that any discrimination on the basis of gender exists. Furthermore, MSF membership as a whole seems to be equally divided between women and men.
25. Lieve V. and Nikolai S. are pseudonyms, as are all the names used in this article.
26. Nikolai attributed this oversight to the Health Department bureaucrats' lack of familiarity with social work, which was a relatively new profession in Russia. He also pointed to their uncertainty about how to handle the fact that, from an administrative point of view, social workers would have to report to a different set of people and be paid from a different budget source. Instead of confronting and resolving these problems, they simply dropped social workers from their list of personnel for the Medical-Social Center.
27. Nikolai never broached the topic of these persistent disparities in his status-role with us.
28. The formulas used by MSF to arrive at salary figures for the local staff are quite intricate and include, among other things, a detailed assessment of the complexity and responsibilities of the jobs, the number of supervisory responsibilities the positions entail, and the salaries offered for comparable services by employers other than MSF in the countries where they are working.
29. The situation is changing as more nationals become expatriates and as awareness grows within the organization that (in the words of an MSF-Holland member) "national staff... are well positioned to manage expats, and especially nervous new young doctors." Nevertheless, the transfer of national staff members to expatriate positions and assignments is still limited and most often seems to occur when a national of one African country is sent to an MSF mission in another African country.
30. In the earliest years of its history, MSF was principally engaged in relatively short-term, emergency missions in which they responded with immediacy to critical situations due to armed conflict or natural disasters. In a second phase of its history, MSF became involved in dealing in a more sustained way with the predicaments of internally displaced persons and refugees. At present, they continue to carry out both of these kinds of humanitarian action. Increasingly, however, MSF is also undertaking more long-term, development-oriented projects, such as those in Russia, under circumstances that they describe in their La Mancha Agreement as "crises with medical consequences that are not armed conflicts, but can often be... catastrophic" - situations in which the "numbers of people affected and the type of specialized care required... has been beyond the capacity of local health structures." A major precipitant of this shift in MSF's work is the emergence of "new" and "old" infectious diseases on an epidemic and global scale since the last quarter of the twentieth century. Among such diseases, HIV/AIDS, TB, and their concomitance figure prominently.
31. Chantilly Document (see note 1).
32. Ibid.
33. The problems and dangers that particularistic relations can pose for MSF are especially serious in societal settings where primordial, violence-accompanied conflict exists among clans, tribes, and ethnic and/ or religious groups. These dangers also exist in societies where power is held by fundamentalist political regimes that autocratically and militantly enforce beliefs, thought, structures, and behavior on the basis of religion, gender, kinship, and tribal and ethnic affiliation.
34. This trend has two potential repercussions. On the one hand, it could augment the already grave deficit of health professionals and facilitate their migration from the countries where they received their education. On the other hand, by confining their mobility to assignments within the African continent, it may provide a counterweight to what a Joint Learning Initiative report identifies as the "fatal flow" of nurses and doctors from poor African countries to Europe and North America. See C. W. Dugger, "Africa Needs a Million More Health Care Workers, Report Says," The New York Times (November 26, 2004): p. A27.
35. Russia ranks 11th among the world's 22 countries with a high tuberculosis burden. Rates of tuberculosis have always been high in the countries that made up the Soviet Union. However, whereas before 1990, the incidence of TB in Russia was gradually declining, since 1992, it has been on a sharp upward trend. Russia's epidemic of drugresistant tuberculosis is considered to be one of the worst in the world.
36. Chantilly Document (see note 1).
37. Influenced in part by MSF-Holland, which has always stressed the importance of a comprehensive staff development program and policy, other sections of MSF have been incrementally moving in that direction.
38. La Mancha Agreement (see note 6).
39. Ibid. (Article 2.13).