Doctors with Borders: Challenges in Humanitarian Aid

by J. R. Reed

On Wednesday afternoon, the Yale International Relations Association presented “The Instrumentalization of Aid and the Challenges of Negotiating Space for Humanitarian Action” with U.S. Executive Director of Doctors without Borders (Médecins Sans Frontiéres), Sophie Delaunay, who outlined the difficulties her organization faces in providing medical aid in the twenty-first century.

Delaunay, who has worked on MSF projects in Thailand, Rwanda, China, and Korea during her 20 year career in the organization, lectured to an overflowing crowd of students in WLH. She explained the challenges the group faces in negotiating space in certain regions for their humanitarian action and ensuring authorities don’t manipulate MSF aid to advance their own agendas. As a result, MSF focuses on providing medical care to those trapped in poverty and war torn regions, while maintaining political distance in the process. Delaunay added that because of increasingly shrinking operational space, MSF faces significant limitations.

“Because we’re acting in the space with a different agenda (than other groups), there’s assumed to be a blurring of lines between us and those who don’t operate by humanitarian principles,” Delaunay said. “We have to spend days and months convincing communities that we are humanitarian actors.”

In the past decade, according to Delaunay, MSF has faced a series of dramatic restrictions on aid, including being expelled from Niger in 2009 because the government believed the organization provided too much exposure to the country’s malnutrition problem.

Due to such restrictions, MSF representatives have been forced to accept compromises, such as limited access to certain regions, maintaining a low profile on the ground, or even promising to remain completely silent about their efforts. For example, in Iraq, although MSF has addressed medical issues, they haven’t been given access to certain regions with military activity.

“These compromises show just how complicated negotiations are,” Delaunay said. “If we think the intervention could be life-changing, we’re going to compromise, but, if we don’t think we can have a significant impact, we won’t (give up) the reputation of the organization.”

Delaunay added that these restrictions also pose significant ramifications because of the number of patients MSF treats on a regular basis. She explained that twenty years ago, when crossing the border between Pakistan and India, the organization helped treat around twenty patients, but know they’re treating thousands of patients each month.

“We have so much to lose now,” Delaunay said. “You know people are starving, you know the costs, and you know the inability to act is heartbreaking.”

In addition to losing potential work space, MSF representatives face challenges ensuring they are independent, humanitarian actors, who do not help support particular political agendas.

She admitted that, in the past, MSF has been forced to close operations and withdraw from regions after realizing their assistance helped move a certain agenda. In one instance, MSF workers realized they were helping cure prisoners who had previously been tortured, so that they could be tortured again. In addition, Delaunay explained that humanitarian aid has been instrumental in keeping the North Korean regime alive, while those suffering in the region have not garnered significant support. MSF representatives withdrew from North Korea in 1988 and have since been unable to negotiate with the government to assist citizens.

Delaunay’s penultimate discussion was on the ambiguous feelings governments harbor toward MSF’s work. She said that governments realize the organization challenges them and the status quo, but, at the same time, when there is a major crisis, they “recognize that we are quick to respond and generous in our response”.

Delaunay concluded by explaining the security measures MSF takes to decide whether to send a team into a particular region. She said that MSF representatives are sent into “dangerous” places only if they have sufficient guarantees from factions that doctors won’t be targeted. Another criteria is to make sure the doctors have an evacuation route, especially in military zones such as Afghanistan.

Still, Doctors without Borders perseveres in overcoming diplomatic and infrastructural obstacles—one border at a time.

J. R. Reed is a freshman in Silliman College. Contact him at