'Ending Need' Indeed?

An interview with Médecins Sans Frontières India General Director Martin Sloot reflects upon the contentious approach to humanitarian aid at the recently concluded World Humanitarian Summit at Istanbul, and examines humanitarian aid. as tendered by Doctors Without Borders and other organizations in light of the 'ending need' and a largely overarching developmental approach to state and non-state responsibility.

An Interview with Martin Sloot, General Director, Médecins Sans Frontières (MSF) (Doctors without Borders India

Martin Sloot is the General Director of Doctors Without Borders / Médecins Sans Frontières (MSF) India. He has been with MSF since 2000 and worked with MSF in different countries to support MSF’s medical work in the country.

 How does large scale displacement affect those who are under the age of 30? What kind of rehabilitation programs do the children affected by conflict require?

In general, women and children normally are most affected by conflict and displacement since they are the most vulnerable in such situations. While MSF does not run rehabilitation programs itself, it is in touch with other organizations that do so.

How do you think is the international aid community faring in dealing with the refugees and IDPs pouring out of the Middle Eastern crisis?

The world is facing one of the greatest displacements of humanity in decades. Over 60 million people have been forced from their homes by war, misery or oppression from countries like Syria, Afghanistan, Somalia, Iraq or Eritrea. A percentage of these desperate people have risked their lives on overcrowded boats and knocked on Europe’s front door. Faced with this crisis, European leaders were given a choice – to work together to provide asylum and help those in need, or push people out of sight to other countries. They chose the latter. Signed in March, the EU-Turkey deal compensates Turkey financially and politically to block people from Europe’s shores and accept deportees from squalid prison camps in Greece. For MSF, this dirty deal marks a historic abdication of Europe’s moral and legal responsibilities to provide asylum to those in great need and a failure by the EU to uphold Refugee law.

The first ever World Humanitarian Summit is underway in Turkey. The UN claims the reason behind organizing the summit is to bring about improvement in the global humanitarian system. Why is the humanitarian system failing? What changes do you think will this summit bring about?

One reason for the poor international response of recent years is the extent to which humanitarian aid has been placed at the service of national security interests. When security imperatives dominate, expect to see more people washed up on the shores of Europe, more hospitals bombed in warzones, and an even slower international response to epidemics. And as states pursue their security agendas, they leave a constrained and partially co-opted humanitarian aid system to cope with the consequences of their decisions.

The past year has seen more than 100 medical facilities in Syria, Yemen, Afghanistan and South Sudan forced to close, because their buildings have been destroyed or their medical staff killed, resulting in the interruption of vital emergency treatment as well as routine health services. Even when medical facilities continue to function, their targeting has left many people fearful of seeking medical care. In this context, humanitarian aid is needed more than ever. However, providing humanitarian aid is becoming increasingly difficult, due to both internal and external factors.

Response to epidemics and other health emergencies are being sidelined. Partly this is because of the international community’s stated desire to ‘end need’ and refocus on development. But it is also due to the lack of political will and incentive to declare epidemics and to respond to them in a timely and effective manner, as we saw with the initially lethargic response to the West Africa Ebola outbreak in 2014.

While the humanitarian system has shown itself capable of mounting an effective and timely response to natural disasters, mainly through mobilizing local and regional actors, its response to epidemics, refugee crises and in conflict zones are seriously lacking. These are the real challenges, which MSF does not believe the World Humanitarian Summit will be able to address. This underpinned our decision in early May to pull out of the process.

As already mentioned, the humanitarian system is now being asked to become part of the UN’s efforts to ‘end need’. It proposes incorporating humanitarian assistance into a broader peace-building, development and resilience agenda. Development and state-building are vital tasks, but not suited to humanitarians, particularly in contexts where power is being fought over. Focusing on the longer-term development challenges will inevitably come at the expense of those people caught up in the most urgent crises.

MSF has withdrawn from the summit and has called it a ‘fig leaf of good intentions.’ Why do you think so?

(1) One of them being the blatant disregard for the refugee law which has led to one of the largest displacement of our times.

(2) The continuing violation of the international humanitarian law by attacking vital medical facilities by both States and non-state actors

(3) Apart from this the UN Secretary-General’s report for the WHS, and the draft responsibilities and commitments, contain fundamental contradictions: they reaffirm humanitarian principles, while simultaneously proposing a convergence between humanitarian action and development aid. MSF is very concerned about the call for humanitarian action to become part of ‘ending need.’

(4) Lastly, health issues hardly featured in the WHS and as the ebola crisis has shown, the world is woefully unequipped to handle an epidemic of that scale again. As a medical humanitarian organisation, epidemic response is a priority area for MSF and much more needs to be done to address the system’s deficiences.

In short: We believe that the WHS process does not address the weaknesses in the humanitarian system’s response to current crises. Rather than focusing attention on acute humanitarian crises the WHS’s emphasis was on longer term development objectives. As shocking violations of international humanitarian law and refugee rights continue on a daily basis, WHS participants were pressed to a consensus on non-specific, good intentions to ‘uphold norms’ and ‘end needs’.  This is why MSF thinks that the summit has become a fig-leaf of good intentions, allowing these systematic violations, by states above all, to be ignored.

Summit participants, whether states or UN agencies or non-governmental organisations, were asked to declare new and ambitious “commitments”. But putting states on the same level as non-governmental organisations and UN agencies, which have no such powers or obligations, the Summit will minimize the responsibility of states. In addition, the non-binding nature of the commitments means that very few actors will sign up to any commitments they haven’t previously committed to.

MSF, in its report, ‘Where is everyone?’ has remarked that the UN has been at the heart of the dysfunction of the humanitarian aid system. The report also points out that the role of the UN agencies as donor, coordinator and implementer is causing conflicts of interests. Could you explain what do you mean by this?

The UN was at the heart of dysfunction in each of the cases reviewed (see report ‘Where is Everyone?’) which included the crises in South Sudan, DRC and Jordan. There, historical mandates and institutional positions have created a system with artificial boundaries (for example, between the coordination roles of UNHCR for refugees and OCHA elsewhere), to the detriment of those needing assistance and protection. Further the triple role of key UN agencies, as donor as coordinator and implementer caused a conflict of interests, especially in recognizing and correcting mistakes. Funding systems, in particular, are problematic, slow, cumbersome and not fit for emergency situations.

Many believe that out of the total aid money that is received, very little is passed over to the beneficiaries. Why is this?

We cannot comment on other organizations and their spending. However, we believe in financial control and transparency towards our donors as an important responsibility. We have the support of more than 5.7 million individual donors around the world who provide some 89 per cent of our funding. This helps to ensure operational independence and flexibility. The remaining funds come from institutional donors.

When we work in contexts where there are many parties to a conflict and humanitarian assistance is at risk of abuse, we rely solely on private donations to fund our activities. We allocate more than 80 per cent of our resources to our humanitarian activities. The remaining 20 per cent is spent on management and administration, and reinvested in fundraising. We maintain reserves that allow us to respond immediately to a crisis without having to wait for fundraising. The use of MSF funds is tightly controlled and the audited financial reports of all our national offices are publicly available. Every year, we put out the audited MSF International Financial Report which provides a transparent global overview of MSF’s work. It defines the different categories of income and expenditure and shows how funds are raised and spent.

How effective will the summit be with many world leaders and INGOs such as MSF giving it a miss?

MSF has been significantly engaged in the WHS process over the past 18 months, including preparing briefing note on various themes-a sign of our willingness to be involved. The WHS did an admirable job in opening up the humanitarian sector to a much wider group of actors and leading an inclusive process. However, Summit participants, whether states or UN agencies or NGOs have been asked to declare new ambitious commitments. However, putting states on the same level as NGOs and UN agencies, which have no such power or obligations, the Summit will minimize the responsibility of states. In addition, the non-binding nature of commitments means that very few actors will sign up to any commitments they haven’t previously committed to. We, at MSF, therefore felt the platform wasn’t effective to address the massive needs and challenges facing the humanitarian sector.


The nature of conflict has changed in that we now encounter non state actors as the main parties to conflict rather than state actors. In such a scenario, how do international aid agencies go about peace building measures? How do you go about convincing non state actors to honour international humanitarian law?

Note: MSF doesn’t engage in peace-building measures.

MSF’s principles of neutrality, impartiality and independence help us negotiate with all sides of the conflict and in delivering medical assistance to those who need it the most. We reinforce our principles everywhere and this helps us in convincing non state actors to honor international humanitarian law most times. MSF’s principles of neutrality, impartiality and independence help us negotiate with all sides of a conflict. In the context of armed conflict, neutral, impartial and independent action is essential in order to negotiate access and to advocate for people to be able to reach assistance. Working in conflict requires flexible funding and nimble response structures, including strong logistical and security management, robust operational capacities and skilled emergency teams.

MSF has criticized the UN Security Council for its involvement in the military strikes carried out on health care workers and health facilities. Do you think that the doctrine of humanitarian intervention and Responsibility to Protect (R2P) are smoke screens hiding the real political agendas of countries that provide military support and aid?

Of the four out of five permanent members of the UNSC have been associated - to varying degrees - with coalitions that have destroyed health facilities in the past year.  But it is not just these four. Many other States and non-State actors fail to protect, or outright destroy, healthcare services as we most recently have witnessed with the killing of MSF’s staff in CAR, or the destruction by Boko Haram of the MSF health post in Yebi (Niger), which serves a population of about 20,000 people. 

Today, many politicians have made statements to re-assert their commitments to the protection of medical facilities and health workers in conflicts. Countries are also re-committing to upholding existing norms (inc. IHL & others elements found in R2P) pertaining to protecting civilians, medical services and respecting the obligations of doctors to treat everyone, regardless which side they may be fighting on. This includes the UNSC Resolution voted on May 3, 2016 on the protection of civilian and medical services.

However, the contrast between words and actions; commitments and their application is particularly striking. On ground, the reality is yet to change on the ground. Civilians continue to bear the brunt of conflicts, as do local health workers. The national security interests of States are used to justify wars without limits. Patients are being crushed in the anti-terror narrative’s wake. Humanitarian Aid is welcomed when it serves national security interests and restricted or attacked when it does not.

Oxfam chief executive Mark Goldring has called the summit, ‘an expensive talking shop.’ Perhaps there is truth in his statement. Can the world afford to spend millions of dollars organising a summit when this money could have been better spent in delivering much needed aid?

MSF is always aiming to increase its impact on the ground, for the benefit of our patients. However, this does not mean that MSF dismisses conferences and summits which aim to contribute to this. Important is that the conference should be really aiming at the improvement of the situation and result in meaningful commitments which are respected.

It seems that the criticism that MSF levels at its peers is also directed at itself. What, in your opinion, can MSF and the larger Humanitarian Aid community do differently?

MSF reflects continuously on the challenges we face as a humanitarian organization. We are constantly trying to improve activities based on our experiences. Working at the frontline of delivering humanitarian aid, we at MSF are acutely aware of the limitations and deficiencies of the international aid response to crises. Some good work is taking place, and lives are being saved, but much more can, and should be done, to reach those people most in need. In my opinion, reflecting on how we have reacted and continue to react with regard to ongoing crises is an important step forward.  


Posted Date: 09 Jun 2016 | Views (1454)