Saving Lives at the Front

It’s been a big year for the international medical charity Médecins Sans Frontières (MSF, Doctors Without Borders) and not just because it turned 40 this winter.

"We chose not to celebrate our birthday", said the President of MSF’s Austrian office Reinhard Dörflinger, speaking at the regional headquarter's annual review on 10 May, "but to use it as an opportunity to see what we can do better." Entering middle age in self-critical mood, MSF is mulling over the fraught issue of the price of neutrality – whether it's always justified to co-operate with the men in power in human rights abusing regimes in order to gain access to the powerless.

MSF is certainly getting many things right. Founded on 21 December 1971 in Paris by a group of idealistic medics, the organisation was a response to the horrors of the Biafran Wars in Nigeria, where medical care was dependent on tribal or political identity. The group in Paris saw the need for an organisation that would be trusted to work across political and religious boundaries to provide impartial medical aid to all victims of wars or natural disasters.

Since then, Médecins Sans Frontières has grown to one of the most recognised humanitarian aid agencies with an international taskforce of 2,500 volunteers. Awarded the Nobel Peace Prize in 1999, MSF has built up a robust reputation for being one of the first humanitarian aid groups to arrive at the scene of any conflict or catastrophe, and very often being the last group still helping when all other aid agencies have fled difficult conditions.

The group claims to provide direct medical help to 8 million people per year, and from its headquarters in Paris it has now expanded to open offices in places as disparate as the United Arab Emirates, Hong Kong and Australia.

The Austrian office

Europe still provides the main thrust. The Austrian office was opened in 1994 and last year, from its headquarters on Vienna's Taborstraße, it sent 116 volunteers from Austria or Central Europe on 165 different missions in 36 countries.

Due to its belief in political and religious independence, MSF is largely reliant on donations from private sources from which it receives 80-90% of the funding, with grants from national governments making up the rest.

In Austria, the charity has received no public funding. On 10 May, director Mario Thaler announced that the group was withdrawing its accreditation from the governmental agency, the Austrian Development Agency (ADA), from which he said it had received not a cent of funding since 2008 and which he described as "totally without credibility on humanitarian issues." He accused ADA of being overly bureaucratic and slow to respond to crises. Nonetheless, Thaler announced, despite the financial crisis, 2011 was a record year of fundraising for MSF Austria, which received a total of €19.7 million exclusively from private donors or firms.

"It’s a sign that Austrians really recognise the good work that we do", he said. "They know that to a large extent their money goes directly to the operations in the field, where it is so badly needed." For MSF, the annual review is a chance to show donors that this is the case. Only 4% of donors' money was spent on administrative needs, Thaler pointed out, and €14.9 million was spent directly in the field.

Money and medics on the ground

For example, €1.8 million went to help the victims of cholera in Haiti. Thirty-year-old Tyrolean nurse Priska Bedner was among the Austrian medics flown in to help fight the outbreak of the disease known as the "Blue Death" because it dehydrates victims until their skin appears almost translucent. This was Bedner’s first mission, and it came as a culture shock. She arrived at a makeshift treatment centre in a giant sports hall in Cap Haitien where a hundred cholera patients were lying on the floor, their drips attached by string to a sort of washing line pulled through between the walls of the hall. Her six years of nursing experience had been in the sterile and orderly environment of the urology ward of Innsbruck’s University Clinic. She remembers thinking "What on Earth am I supposed to do?"

Buoyed by support of her more experienced colleagues, Priska contributed to two further difficult missions in 2011. After surviving the risk of kidnapping in Haiti, she stood up to gun-toting militiamen in the war-scarred Ivory Coast, and, finally, she helped with a malnutrition crisis in Chad.

"Throughout my time at MSF, I was pushed to my limits and beyond. I did loads of things I never dreamed I could do", admitted the delicately-built Tyrolean. But she hopes to return to the front line of humanitarian intervention soon: "It’s the challenges you face, the people you meet," she said. "The positives far outweigh the negatives."

A further €900,000 of the money donated in Austria went to power operations in the world’s newest nation, South Sudan – a country so bereft of infrastructure that only a third of the population has access to the most basic medical care. Thomas Rassinger, who recently returned from the region, described a desperate situation in which, instead of supporting the health services, MSF found itself acting as the sole provider of medical care in many regions. In Agok, south of the border region Abyei, Médecins Sans Frontières runs the only hospital in the region and the international medical team found themselves stretched to capacity: "We were dealing with sick children, victims of tuberculosis and HIV", said Rassinger. "We were carrying out operations and helping women give birth."

The situation in South Sudan was made worse by security fears, fueled by interethnic fighting within the country, as well as by increased tension with North Sudan. There are also only a few tarred roads in South Sudan's capital Juba, but otherwise there are only mud tracks, which have become impassable with the dawn of the rainy season in May. Rassinger was based in Nasir, a small town in the Upper Nile state.

"Every ten days, a plane arrived on which we had to transport everything – personnel, medicine and even construction material. But when it rains the landing strip is under water. It is a race against time to help these people."

Healing with risk and turmoil

Work under these circumstances can be frustrating, the Austrian volunteers admit. The lack of infrastructure, time pressure, precarious security and funding mean compromises every day. In the Ivory Coast, for example, Bedner ran out of surgical gloves and she had to replace bandages with bare hands in a region where the infectious diseases HIV and hepatitis are endemic.

"While we were waiting for the new batch of gloves I did have a really uneasy feeling", she admitted. Despite the long hours and huge efforts, you don’t often see any big changes in the situation. Missions can resemble the never-ending labours of Sisyphus. Still, Rassinger agrees with Albert Camus that Sisyphus was happy: "Every day we can be there and help someone is a good day", he said.

This winter highlighted the risks undertaken by MSF volunteers. In December, two medics, Philippe Havet and Andrias Karel Keiluhu, were shot dead in Somalia’s capital, Mogadishu, while working on a project to fight malnutrition. This came two months after two female Spanish MSF workers were kidnapped in Dabaab refugee camp, just over the Somalian border in Kenya. They remain missing. By any definition, these volunteers are heroes.

Yet in this jubilee year, MSF is eschewing self-congratulation. The Austrian wing has been touring the country with first-time director Mark N. Hopkins’ 2008, warts-and-all MSF documentary Living in Emergency, which lays bare the logistical difficulties and tensions within stressed-out operational teams. Veteran project coordinator, Marcus Bachmann described the often-harrowing film as a "realistic portrayal". And the organisation marked the anniversary date by publishing a highly self-critical book called Humanitarian Negotiations Revealed. The collection of essays, written by MSF veterans, describes bargaining for access to victims, which often resembles a dance with the devil.

To operate in Somalia in 2009, for example MSF was "asked" to pay a $10,000 registration fee per project to the al-Qaida-linked al-Shabaab militia, which also exacted a 5% tax on the salary of all MSF employees and forced them to employ male-only staff. The alternative would have been to leave needy patients untreated. But should donor money be given to a murderous militia? And did this money contribute to prolonging the conflict?

As MSF Austria President Reinhard Dörflinger puts it: "We have to weigh up the question: can we provide effective help here and save lives or is our presence here actually strengthening the men in power?