Interview with Christian Captier, General Director of Doctors without Borders/Medecins Sans Frontieres (MSF) in Switzerland

2 January 2009
Interview with Christian Captier, General Director of Doctors without Borders/Medecins Sans Frontieres (MSF) in Switzerland

If you haven’t heard about them… I’m sure you will not have to wait long. They are the "enfants terribles" among the Humanitarian Health NGOs, always there to denounce unjust cases or the pharmaceutical industry, neglected diseases etc.

What started in 1971 as a protest against the inertia of the international community and the Red Cross and in particular by French Doctors during the Biafra crises has now grown into a major humanitarian medical organization. The organization is now present in more than 80 countries worldwide.

The organization also gained a lot of respect during the tsunami as the only NGO who went out to the media telling people to stop sending funds, because they had enough funds to cover the emergency and highlighting the needs in forgotten contexts. We wanted to know more about what they do and why they are so engaged and dedicated. So we met with Mr Christian Captier, the Director of M?decins Sans Fronti?res.

Q: Could you tell us about your organization?
Our organization was set up more than 30 years ago. The history started in Biafra with medical Doctors who started to work with the Red Cross. In the 80s the movement evolved quite quickly into becoming highly visible among NGOs in terms of its efficiency, its size, reputation and notoriety. From a structure that initially was French, today it has become an international organization with 5 operating centers (Paris, Amsterdam, Brussels, Geneva and Barcelona) and a whole network of cooperating centers which provide the human and financial resources, communication, medical assistance etc... Altogether there are 19 sections all over the world - MSF USA, Japan, Hong Kong, Norway etc.

Q: I think you are even in Taiwan?

We do not have an office in Taiwan, but we do have some contacts. Historically, what happened was that Doctors, who worked with MSF in the field, went back to their home societies and willing to continue their commitment, started different initiatives, which contributed to the development of MSF worldwide in the 80s.

Today it’s an organization with a budget of more than 500 million Euros. It is a true associative structure, something that makes it somehow also different from most major humanitarian organizations. The association is a fully fledged part of Doctors without Borders. So we have members which are elected in the Board of Directors, who supervise, control and make broad strategic decisions in order to respect the social mission of the MSF charter. All are volunteers to the exception of our President.

Then we have the executive branch, which I belong to, where we propose and execute. So there is an equilibrium between the executive and the executing powers that exists only in the associative environment.

In May each year, the General Assembly of MSF Switzerland takes place; it’s for the all members of MSF Switzerland. We have about 300 members. Each MSF structure is an association and all are linked by the Charter of MSF and the principles of Chantilly which defines a common frame and references.

Q: So you have a kind of umbrella over all these associations?

Yes, Doctors Without Borders/M?decins Sans Fronti?res (MSF) has sections in 19 countries. Five of these sections are also ’operational centers’, meaning that they directly supervise and manage field projects that decide when, where, and what medical relief is necessary and eventually, when to terminate aid. These sections are: Belgium, France, Holland, Spain, and Switzerland.

The remaining 13 MSF sections are ’non-operational’. The primary functions of a non-operational section are to recruit volunteers, to raise funds for field projects, to provide specific medical expertise or operational support and to do public outreach and education projects on behalf of populations in danger. Those sections are located in: Australia, Austria, Canada, Denmark, Germany, Greece, Hong Kong, Italy, Japan, Luxembourg, Norway, Sweden, the UK, and the U.S. MSF has also UN Liaison Offices in Geneva and New York City; and an office in United Arab Emirates.

So each section has a President, who is a Member of the International Council, which elects an International President. The international Council has a Secretary General and a staff of around 30 people who will coordinate the actions of the MSF movement. The international office was based in Brussels, but since 2004 it was transferred to Geneva in order to be closer to our main partners, and after all Geneva is the Humanitarian Capital of the world.

Q: It has been said that MSF is a rebellious organization. What do you think of that?

I have nothing against that image, but we are always ready to discuss with our partners. We do not just sit there grumpy in our corner and criticize the others; we discuss with our other partners how to solve a problem, how to face an issue. The fact is if there is a reality in the field or a problem, then we need to speak out. Sometimes we have a two-to-two dialogue just like you and me; sometimes we go out to the media. What is critical is that our only aim is after all to improve the access of the populations to humanitarian assistance.

We are a medical and humanitarian organization. The humanitarian side of our activity takes us to work in conflict regions and we are quite well-known for that in Darfur, Iraq, Somalia and Afghanistan, before we left the country in 2004 after the killing of 5 of our staff. On the medical side we do a lot of projects, for instance in the field of HIV/AIDS. We were the first ones to administer anti-retroviral treatment drugs in Sub-saharan Africa at a time when people said it was impossible. And today this has become a recognized standard, however yet unaffordable for too many patients. You have to take risks at certain times to show that it was possible to do so at that time.

The problem is that this treatment was very expensive. It was about 10, 000 USD/per year, per patient. Now it is down to around 300 USD a year. This is due to the lobbying made by groups of patients and by organizations like MSF. Today MSF is only one of the many actors active in the field of HIV/AIDS in Africa, but years ago we were almost the only ones. MSF Switzerland for instance started up a project in Cameroon in 2001, and we continue as the problem is still there.

Today the problem is the scaling up and simplification of treatments. For instance we have started to reflect upon whether or not following up with the patients can be done by nurses instead of medical doctors while maintaining the necessary quality. This would bring it closer to the community, imply a lower cost of the treatment and thereby reach out to a bigger number of AIDS patients. We also reflect on more technical problems. Today the majority of these patients are treated with the first generation of anti-retroviral drugs, but there has been a development of resistance. If the treatment becomes inefficient, you have to use the second generation of antiretroviral treatment. So we need to do the same type of work as we did for the first generation and contribute to make them cheaper. It is essential for a growing number of patients. We have a serious problem with pediatric treatment for children with HIV/AIDS but also with the development of tuberculosis linked to AIDS, and therefore the mix of AIDS/tuberculosis treatment is very critical.

We are trying to focus on these specific problems and leave it to other actors to handle the health systems, starting with Ministry of Health and international organization like the WHO. Today with Global Fund etc., there are several ways to get funding for these diseases, but our role has evolved to always assist the population at risk, the most vulnerable ones. That’s part of the impartiality.

We will look for the most vulnerable people and not be satisfied with launching projects and waiting for people to come to us. Those who come are not the most vulnerable ones because they have access to information. Therefore we always have this dynamic aspect in our projects, to find the most vulnerable ones. So we try always to have a rethinking and a dynamic force in all our projects.

So, on the medical front there is malaria, AIDS and tuberculosis, neglected diseases, epidemics, etc.

We treat patients but we also try to evaluate and improve the medical sciences we use. In fact our teams are facing some problems in the field, and we try to assist them to be able to respond to this challenge. Sometimes this problem requires operational research; and when no one else is willing to do it, for example because there is no market incentives for private actors to invest, we are ready to use our own resources, up to several millions for the whole MSF movement, for this kind of essential operational research. The need always comes from the field. For example, one of our focus is on the neglected diseases such as the sleeping sickness, and there is no adequate medication, so what we are trying to do is to stimulate the research.

We have a center in Paris called Epicentre, another one here in Geneva called Campaign for Essential Medicines plus another one started by MSF
called the Drug for Neglected Initiative which is a joint venture between MSF, Universities and the private actors for the development of new treatment and tools for neglected diseases because there is no market, and too little investment. We are in contact with this reality and we consider that the means developed by the states, starting with the rich ones, and the World Health Organization are very insufficient and that there we are very critical to these practices. We are trying to respond to this emergency. It is quite an ambitious project, although it’s not a typical MSF project, we support this initiative strongly.

Q: How many people work in MSF Switzerland?

Here in Geneva we have 130 persons and about 3,300 staff in the field, amongst whom 300 international colleagues. Our national colleagues are the ones carrying the bulk of the work with a tremendous commitment throughout our projects.

Q: What does the international staff do?

Either they are the surgeons who do the work directly or the supervision. As much as possible we work with national colleagues, which we provide some training and support because we consider that they are the best ones to work in relation with their own people.

However in Darfur, the case might be a little different. There are very few available qualified national staff - as either its local doctors or nurses, so in this case we have to send an important contingent of international staff or Sudanese colleagues from other parts of the country. In other countries, like Cameroon, on the other hand, the level of medical qualification is high and personnel relatively available. In some other countries, like in Austral Africa, the situation is very difficult since there is a huge shortage of medical staff.

We need both national and international staff, working together as a team with the same objective. For example, MSF Switzerland is running around 60 projects altogether in 20 countries. Of these 60 projects we have about 30 % emergencies. Our operational budget here in Geneva is about 80 millions CHF for the field. As I said 30 % of these are for the emergencies and the rest are for the other projects. We work foremost on the diseases. Here in Geneva we work on a special theme - and that’s violence, and in particular - sexual violence. We have worked quite extensively in Congo but also in Latin America on this issue where we have worked on the medical aspect of the sexual violence whether it’s in a war situation or more domestic. So we also have the physiological aspect of the medical treatment.

We also have important projects on nutrition in Niger, Somalia and Sudan where you have the peak of malnutrition. In Niger we have assisted more than 20,000 children yearly. This is an extremely difficult situation for the children, in particular for those younger than 5 years old. We have implemented new strategies where we use a special nutritional pack, ready-to-use-therapeutic food. The medical results are much better. This has given us the possibility to reach out to a bigger number of children than in the past since treatment for many children is taken at home. The treatment for each child is more effective and lasting. The idea is scale-up this innovative practice and therefore we launched an international campaign in order to promote these strategies, which are more effective for these children, and these are important critical operations.

What was initially going to last for 30 minutes actually took more than an hour. And leaving the MSF office at 19h, there were still lots of people working... In fact, the MSF staff is not only working, they have adopted a unique humanitarian life style. As the Director said when we left him: when I’m here I do not have the feeling of being at work"…

For further information about the MSF work, you can have a look at their website