2017 FAD Feedback

2017 FAD Feedback

For a list of all the FAD reports from this year and previous years, see here.


Lebanon 25 February

On the 25th of February I attended the Lebanon Field Associative Debate (FAD), a country with 3 different Operational Centres (OCs): Paris, Geneva, and Brussels. This associative event was quite unique, gathering MSFers with varying amounts of experience, from newcomers to others working in the country for ten years or so! The event clearly drew a lot of interest with over 90 participants, 5 moderators (from OCB, OCG, and the IB), not forgetting our International president Joanne Liu who joined us for the day! The two main topics on the agenda: “Accountability towards beneficiaries” and “Principled approach versus pragmatism”.

Accountability towards beneficiaries generated an interesting discussion on who exactly MSF is accountable to. There was broad agreement that we are accountable to our patients but also the communities they belong to, communities we ought to interact with as stakeholders in their own right. FAD participants reflected on the theme through the lens of a project cycle. They highlighted specific aspects of their context, like the often delicate relationship between the hosting country and the different nationalities it hosts, touched upon our professionalism as an organization engaging with its stakeholders, but also discussed the responsibility of our beneficiaries. Some of our shortcomings as an organization were also mentioned especially in terms of our communication (both internal and external) when engaging or disengaging from in-country activities. Key words we came up with: Mutual responsibility, respect and dignity. 

The “Principled Vs Pragmatism” theme as we called it was split in two sub-discussions, one on administrative hurdles and corruption, and one on Termination Of Pregnancy (TOP) in Lebanon. The first sub discussion was extremely rich, bringing together staff well acquainted with our MSF rules and regulations, people with experience in different environments and similar contexts, and staff discovering how MSF deals with such obstacles through its procedures and way of working. 

The TOP discussion was more delicate in light of cultural considerations, but also in light of what is perceived as the legal frame around the procedure in Lebanon. The discussion started with a clarification of MSF’s positioning on the topic, and then the discussion looked at the specifics of providing choice and access to safe abortion, while also exploring Lebanese specifics of what is heavy regulated as opposed to being illegal. However the most interesting aspects came up when discussing the reality in Lebanon with many practitioners offering to perform the procedure illegally (and no guarantees of safety), the stigma society associates with the procedure, and how more traditional communities address TOP in Lebanon.

TOP in Lebanon, and more generally in the Middle East warrants further attention, with some participants not at ease with the "Western discourse" used when presenting and communicating our TOP positioning. One voice in the assembly said “we want to offer it, not brag about it” highlighting a utilitarian approach, yet a different one than our usual discourse. It remains to be seen how many were uncomfortable with our position itself rather than with our communication around it: Is it time for us to reflect on how we communicate on TOP within our organization, and adapt the discourse to our different audiences?   

Overall the FAD was a great day, showcasing how vibrant our associative life is in Lebanon, and how relevant the inputs were for wider associative debates to come. Moreover, it was heartwarming to see our association play such an important part in debating our presence in country, and contributing overall to improving our response to the patients we care for…and the communities hosting us. No motions put forward this year…2018 anyone? Inshallah!  

  - Mario Stephan, OCB Board member

Here you can read the full FAD report


Egypt 14 March

The Egypt Association may be relatively young but it sure knows how to organise a great event. I had the privilege to participate in the FAD in Cairo on 14th March, which was a well-attended FAD with lots of multifaceted discussions and debates reflecting the complex issues being addressed in the projects here. OCB runs projects in Maadi providing care for victims of sexual violence and victims of torture, as well as a migrant project in a detention centre in Alexandria. In addition, Cairo is one of the MENA hubs in the region, collaborating with other MENA networks.

The main topics for the FAD were chosen during the local pre-FADs held a few weeks prior and included the following topics; whether or not MSF should improve the conditions of the detention centres for the sake of the detainees; whether or not MSF should provide medicines for chronic disease for unregistered-undocumented migrants; and whether or not MSF should buy the buildings it is renting considering perceived increasing inflation in Egypt. The following discussions ensued:

‘Should MSF improve the conditions in the Detentions centres for the sake of the detainees?’

This subject raised strong emotions among the members. Some described the highly insufficient hygiene levels, clean water supply and lack of electricity, while others described how densely packed the rooms were, how this made cohabiting very difficult for the detainees and aggravated psychological distress. In general there was a desire to optimize the work for the detainees however, many pointed out the institutional limitations on MSF in working in detention centres.

‘MSF should provide medicines for chronic disease for unregistered-undocumented migrants?’

It was highlighted that currently nobody is providing medical care for undocumented migrants, and MSF already provides similar services for chronic disease patients. The discussions revealed a general agreement and desire for MSF to intervene for this group of patients. However there was an acknowledgement that the project coordination and cell could look into the issue in more depth to assess what MSF could do for these patients.

‘Should MSF buy the properties it is renting to save money in the long run considering fast increasing inflation in Egypt?’

Some members highlighted the trend of rising living costs and suggested there is a financial argument for procuring the properties to save money. Some suggested that by buying the properties it is renting, MSF can demonstrate to the community that it is here to stay, hence benefitting perceptions of MSF as a committed organisation. Counter-arguments such as ‘what if MSF discontinues the project’ were met by suggestions that in that case, purchased properties could be resold or donated to appropriate local healthcare agencies. In the context of economic inflation, some members had questions regarding salaries and bench-marking. These concerns were answered by the members of the coordination, but highlight a need to develop a more in-depth understanding of the purpose of the FADs.

At the end of the FAD day, a new Associative Committee was elected including an Associative Coordinator.  During the coming year this relatively new association would benefit from associative visits to strengthen the commitment already shown by the association in Egypt and to develop more understanding of the associative framework and create links with other associations within the OCB. I have enjoyed attending the FAD in Egypt and want to thank the team for their hospitality and their passionate engagement in MSF.

  - Sohur Mire, OCB Board Section Representative (MSF Denmark)

Here you can read the full FAD report.


Pakistan 16-18 March

This year’s FAD in Pakistan took place in Islamabad, and gathered 85 people from 3 OCs: Amsterdam, Paris and Brussels. MSF has worked in Pakistan since 1986, and activities are particularly focused around services targeting women and children. OCB currently runs three projects in the country, focusing on Hepatitis C treatment in Karachi, providing access to healthcare for vulnerable populations in Bajaur, close to the Afghan border in northern Pakistan, and supports the district headquarters hospital in Timergara in emergency, obstetric and neonatal care.

Pakistan has a vibrant associative, with highly engaged and vocal members. Some of the FAD participants had worked for MSF for more than a decade, whilst others had recently joined the organization. This created an excellent environment for lively debates around key challenges in the field, but also with great relevance to the movement at large.

We started out by debating how the use of social media can have consequences for operations, and the associated possibilities and risks. Should our team members’ social media accounts be monitored more closely, is this feasible, and more importantly, what about the ethical implications? In the end it was clear that the opportunities outnumber the risks related to social media. But as controlling content is neither feasible nor desirable, we need to inform and educate our staff on responsible use. Trainings and guidelines should be accessible to all staff, but more important than the actual rules is simply raising awareness about the potential risks. After having highlighted the numerous possibilities of social media, we finished the session by finally launching the MSF Pakistan Facebook page. This will enable better information sharing regarding MSF activities, raise awareness on the struggles we are facing, and facilitate connection with our colleagues in various locations.

The second topic focused on access to advanced medical technical equipment in our projects. What are the main constraints hindering us to obtain and utilize such devices, and how are priorities made? As activities in Pakistan are particularly centered around maternal and neonatal care, some expressed a desire to introduce more advanced equipment, such as ventilators or incubators, to enable a higher standard of care. At the same time, it was clear that such equipment increase demands on HR and budget, and maintenance capacity is often limited. There may also be important risks associated with inappropriate use and lack of qualified staff. The participants agreed that advanced technology should be implemented based on operational needs and clear objectives, not for the sake of it. A cost-efficiency and risk-benefit analysis should also be done prior to decision making. Finally, a request for a clarification on the criteria for obtaining advanced medical technical equipment was brought forward to the coordination. This would increase understanding of the priorities made, and the reasons behind the limitations that we are facing.

Our last debate was concerning the use of implementing partners in situations where MSF does not have direct access due to security reasons. To what degree should this possibility be used, and what are the risks and benefits associated with such an approach? Following another lively discussion with various inputs, there was broad agreement that such collaboration should be limited to extreme situations, where the use of an implementing partner is the only possibility to reach highly vulnerable populations. In such cases, one needs to make sure that MSF principles are respected to the highest possible degree in the project, as these are fundamental for our identity as a humanitarian organization. Advocacy and negotiations for increased access need to be continued simultaneously, and monitoring efforts have to be put in place. Currently such an intervention is not relevant in Pakistan, but there may still be situations in the future where this approach should be considered.

After having finished 2 days of lively and respectful discussions, allowing all participants to share their reflections, we finished off by enjoying a day at the Khanpur Dam outside Islamabad. A big thanks to all the inspiring, dedicated and skilled colleagues in Pakistan who contributed to making this event happen!

  - Karine Nordstrand, OCB Board Section Representative (MSF Norway)

Here you can read the full FAD report.


Cambodia 24 March

The common perception of the OCB mission in Cambodia is one of a unique, malarial research oriented project, unlike any we have in operations. Having the privilege and opportunity to visit the field myself, and taking the time to speak with many of the staff involved in the mission, I would like to correct this perception.

The mission is very much operational as it involves a lot of outreach in remote villages, health promotion, motivation of people to get tested, screening tests for malaria, counselling on the treatment, treatment on site, contact tracing, screening of contacts and treatment as necessary, exhaustive follow ups and, last but not least, the data collection and analysis. The mission is small yet big in commitment, heart and passion. Everyone, from the drivers to health promoters to nurses, is aware of his/her importance in the project and understands fully the essence of team work.

The MSF associative concept and life is more evident in this year’s FAD and we have 4 official members joining us. We owe our gratitude to the hard work, patience, awareness and foundation laid down by the Cambodian mission over the years to achieve today’s result.

The Asian culture is one where we need to take time to warm up and gain trust. Yet once the bond is formed, the loyalty is much cherished and indestructible. The pride of our Cambodian national staff in wearing the MSF T-shirt is something you have to see for yourself to believe how committed they are to the MSF cause and work of our mission in Cambodia.

  - Nason Tan, OCB Board Section Representative (MSF Hong Kong)

Here you can read the full FAD report.


Guinée 24-25 March

Cette année je participais au FAD en Guinée, le pays qui était bien dans le collimateur les dernières années pour sa lutte contre l’épidémie d’Ebola. Après la clôture du projet post-Ebola et celui d’OCG récemment, OCB reste seul avec son projet VIH en capitale dans un contexte de relativement basse prévalence SIDA. L’association MSF sur place est très active et comprend 90 membres en tout. Leur comité avait opté pour des thèmes à relevance national notamment :

Quelle stratégie de couverture ARV et rétention à mettre en œuvre dans la prise en charge du VIH en zone rurale dans un contexte de basse prévalence ?
Dans quelle mesure les débats Associatifs peuvent influencer la qualité des projets ? Dans quelle mesure l’Associatif peut influencer la perception sur MSF dans la communauté ?
Dans quelle mesure l’Associatif peut influencer la perception sur MSF dans la communauté ?
MSF en tant qu’organisation humanitaire  internationale intervenant dans de situation d’urgence. Que peut-il faire pour pérenniser les acquis obtenus lors de l’intervention après son désengagement ?

La relevance des thèmes est sortie dans les discussions très engagées en petit groupe: une très faible couverture de pris en charge de patients VIH en zone rurale ; la fermeture du projet SIDA à Gueckédou, décidé encore avant l’épidémie d’Ebola mais certainement accélérée par celle-ci avec le résultat qu’apparemment 600 patients sous traitement ARV sont restés dans la cohorte, qui comptait 2000 auparavant.

La perception de MSF comme acteur humanitaire au sein de la population dans le pays reste vague, malgré son engagement récent. Il a été noté un amalgame entre MSF et la Croix rouge notamment (2 logos en rouge), probablement lié aussi au fait que la Croix Rouge était en charge de la sensibilisation lors d’Ebola alors qu’MSF a géré l’action. La campagne de vaccination rougeole qui est planifiée pour le 5 avril, est une bonne opportunité de sensibiliser les gens via nos actions.

En général le FAD a été une bonne opportunité de débattre le rôle de l’associatif dans la mission et celui de MSF dans le pays avec des bonnes propositions et un ferme engagement à le mettre en œuvre.

Il n’y a pas de motions, qui sont sorties.

  - Peter Firmenich, OCB Board Section Representative (MSF Luxembourg)

Here you can read the full FAD report.


By: Emmeline Kerkvliet