Admit complexity: a few takeaways from MSF’s “Humanitarian Negotiations Revealed”

I snagged a free copy of a recent volume published by Médecins Sans Frontières (aka Doctors Without Borders). Humanitarian Negotiations Revealed: The MSF Experience is a series of case studies from a range of humanitarian contexts, combined with a few essays that take broader looks at how MSF’s approach has evolved over the years.

The value of this book stems from the willingness of current and former MSF leaders to take a critical look at how they’ve dealt with incredibly difficult situations over the years. Here’s the meta-lesson I took away from it all:

Admitting failure is for sissies. Let’s admit complexity instead.

Much of the complexity discussed in the book arises from the politics of delivering aid. The case studies cover various conflict settings like Sri Lanka, Afghanistan, Somalia and Gaza Strip, where provision of humanitarian aid — like almost any other activity — becomes immediately embroiled in the politics of the existing conflict.

Even logistics gets political. Describing the re-launch of their programs in Somalia in 2007, one interviewee said:

If getting a car is that hard, imagine what happens when you start providing medical care.

The book delves into how MSF has responded to the increasingly confused boundary between civil/humanitarian organizations and military action. Of course, this is especially prominent in the chapters on Afghanistan and Pakistan. In the latter, MSF stopped referring to itself as an “NGO” — a term that has connotations of US/UN funding and faith-based groups. But there is no way to be apolitical:

(Emphasis mine.)

Other complexity is more mundanely about operations, such as how to allocate resources in Somalia without reliable indicators on existing health problems or outcomes, or how to ensure quality care in the face of high staff turnover in Afghanistan. Cultural issues come into play as well, as consumption of alcohol by expat staff in Palestine became a point of contention with Hamas.

The closing essays put the case studies in a broader framework. They describe how MSF’s thinking has evolved over the years, in response to fierce internal debates as well as geopolitical shifts. The epilogue draws three broad categories around the choices that MSF has made over the years: realism (playing the game), confrontation (challenging the game), and abstention (refusing to play).

MSF has used each approach in varying measures, sometimes even within the same country. The case study on Myanmar illustrated this. MSF-France withdrew from the country in 2006, citing the “unacceptable conditions imposed by authorities” on its activities. The Dutch section, on the other hand, took an approach of realism. Using the Dutch acronym (AZG) to distance itself from MSF’s other activities, it served populations that had been forcibly displaced by the government:

These tensions exist throughout the case studies. “Collaborating” might support an unjust system, but the alternative is to create a parallel health system that undermines local capacity, or to leave a group without care at all. There’s no right answer that will serve all contexts. Nor is there necessarily a right answer for a given context. There are simply people trying to use their best judgment to do the most good they can.

That’s the real reason I appreciated this book. As I said, it admits complexity rather than simple failure. The lesson of failure is: do A, not B. That’s incredibly helpful if you plan to scale your solution or tackle the same problem again. But in complex situations, the next scenario will never look enough like the last one for you to apply the previous lessons directly. We can’t say: A worked then, so we should do A again. Case studies help us understand the previous scenarios, the choices those actors faced, the reasons behind their decisions, and the results of their actions. If we’re lucky, we’ll be able to retain that much complexity in our minds and use it to inform our own decisions.

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Where to get it:

• You can buy a paper copy from Amazon or just get the electronic version free from MSF.
• If you want to read it (or anything else) on a Kindle, I highly recommend Klip.me’s Send to Kindle app. Install the extension in Chrome/Safari (or the bookmarklet on any browser), give it your Kindle email address, and then you can send any text on the web to your Kindle with a single click. The text will show up on your Kindle the next time you sync, just like any book you’ve bought.