Archive: GA 2016 (Oslo)

Agenda 2016 General Assembly




The following were elected to the MSF Sweden Board of Directors: 

Anna Bergström, regular member (replacement election) (2016-2017)

Katrin Kisswani, regular member (2016- 2019)

Mikael Mangold, regular member (2016-2019)

Jessica Svefors, regular member (2016-2019)

Andreas Häggström, alternate member (2016-2018)

New Statutes: 

2015 Annual Report

Nordic Progress Report

Report back on Motions

GA 2016 Minutes


Session 1: MSF and Migration - Is MSF transforming?

MSF is more and more seen as a political actor within Europe on the migration issue but what is happening with our patient-centered approach providing quality medical care? 

Introduction: In light of the migration challenge in Europe, is MSF transforming? Do we have a healthy balance between the assistance we give to refugees in Europe and those in other parts of the world? A reflection on diversity and scalability of operations and quality of care by Loris de Filippi, president of MSF Italy and former Head of Mission for the MSF projects in Italy. 

Delér Shakely (M.D. Ph.D.) worked at Lesbos last year with MSF, but he also worked with MDM clinic in Sweden providing health care to undocumented migrants and he has been active with the Red Cross youth organization in Sweden. Delér will share his experience with MSF, being able to communicate with many of the beneficiaries directly in Arabic, Kurdish, Farsi and Dari. He will also give a reflection on the medical data collection and how MSF uses it. 

Kaz de Jong (Behavioral Science, Health Psychology, Clinical Psychology Ph.D. and Mental Health Advisor at MSF) will help us to see where MSF is today with providing mental health support to displaced people. How do we keep mental health as an agenda in an increasingly politicized landscape? Mental health seems to be a common denominator for how MSF has managed to remain at least somewhat medical in a very political agenda on refugees. Do we not risk using mental health as a justification for intervention where the physical health needs are low? Kaz de Jong will share his experiences from Holland and try to help to see if they are applicable in a Scandinavian context. 

Meinie Nicolai (Nurse and President of OCB) will reflect on what we learned from search and rescue in the Mediterranean in 2015 and how we apply this in 2016. Has MSF maintained enough medical profile in our support to migrants? One can argue that MSF have saved thousands of lives by rescuing migrants before they had to chance to sink and as such reduced the mortality. Critics may say that MSF has gone too far in taking on the role of lifeguards and that our collaboration with authorities at times has become uncomfortably close. How do these actions fit with the mandate that we traditionally have given ourselves? 

Moderator is Ulrika Hedberg, MSF long-timer and soon to be Medco in Myanmar.

Session 2: Speaking out globally, but how does that translate into our home societies

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Introduction: Should we be equally politically active in the destination countries as we are in the reception countries? This questions is important as it translate into choices we make in our home societies. We confront and criticize our governments. We ask them to support independent investigations, we demand “safe passage” for migrants. Are those donors who suspend their financial support because they believe MSF is becoming “too political” completely wrong?
How do we see the role of MSF in advocacy evolving? Is our current level of engagement our “new normal”? A reflection on MSF positioning globally and at home, safeguarding our medical identity while engaging politically, and the measures we take to make sure our positions are heard loud and clear. 
Loris De Filippi (President of MSF Italy and former Head of Mission for the MSF projects in Italy) will talk about the Italian experience. 
Lindis Hurum (Emergency Coordinator OCB) will reflect on what it means to speak out in Norway as a fieldworker.
Frida Lagerholm (Head of Communication MSF Sweden) and Jonas Hågensen (Communication Adviser MSF Norway) will provide an insight on how it is to be implementing MSF communication, often being between the associative and the operational line management.
Moderator is Erwin van’t Land, GD of MSF Norway and with extensive experience from communication in MSF since the late 90´s.



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Given the increased work load of the President, we mandate the Board to investigate the relationship between a reasonable workload and level of remuneration, taken into account the newly approved statutes making it possible to remunerate 2 Board Members and thus potentially sharing the workload. We ask that the Board reports back to the Association before a change is put in action.

Jon Gunnarsson Ruthman, Rebecca Cederholm, Sheila Bore 

Motion 2: Motion on accountability of Operations - GA DECIDED TO ADD THE MOTION TO THE AGENDA, MOTION DID NOT PASS

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The Association asks the Board to follow up and proactively push for the second Roadmap deliverable “The International Associative will foster a culture of accountability throughout the movement and hold the International Executive accountable”, keeping the beneficiaries in focus. This could include: Use of resources, Management, and Quality. The Roadmap deliverable should be translated at the level of the MSF Sweden partnerships. By: Clearly reporting back to the General Assembly how money raised in Sweden is spent throughout the movement. A higher level of transparency is required in order to understand how the resources from Sweden are used with particular emphasis on the relationship between social and non-social mission costs.

Motion brought up by Adam Thomas, Eugene Bushajiya

Recommendation: We do not start projects when we do not have the staff. In other words, limit the number of projects to the number of staff we have - RECOMMENDATION WAS NOT ADDED TO THE AGENDA 

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MOTION 1: Humanitarian ethics: MSF’s commitment to ethics reflection, discussion, and concrete measures to improve our humanitarian action and to reduce moral distress - MOTION PASSED

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Motion Sponsors: Gunnhildur Arnadottir; Kristina Bolme Kuhn; Anneli Eriksson; Gunnar Hagström; Stefan Liljegren; Angelique Robert; Johan von Schreeb

Destination: To the Board of MSF Norway and MSF Sweden, with next destination of the International General Assembly (IGA)

Motion text: MSF Norway and MSF Sweden acknowledges the profound moral challenges inherent in humanitarian action. These challenges have repercussions for the people we assist and result in moral distress of our field workers. Therefore, the Association requests the Board to commit to reflections, discussions, and concrete measures that will promote ethics dialogue for our humanitarian action, with the goal of (1) making fair and open decisions towards those we thrive to serve, and (2) reducing the moral distress of our field workers.

Argumentation/evidence: Humanitarian ethics is a distinct and evolving field of inquiry and practice, and ethical challenges are experienced within all roles and at all levels of MSF.

Ethical issues are pervasive in humanitarian action in general and in medical humanitarianism in particular. Too often, medical and non-medical humanitarian aid workers find themselves in unfamiliar contexts, vulnerable and isolated in making difficult – and sometimes impossible – decisions about right or wrong courses of action. Usual sources of ethics guidance, such as biomedical ethics or professional codes of conduct, do not sufficiently address or capture the full complexity of humanitarian situations where ethical challenges arise. New circumstances, values or constraints have to be taken into account. Furthermore, when disputed or challenged, outcomes of difficult ethical decisions tend to be seen and judged through the perspective of “misconduct”, reflecting a very narrow interpretation of ethics.[1]

Attention to ethical challenges should be an integral part of the humanitarian ethos of MSF.

When improperly addressed, ethical challenges can cause operational dysfunction, job attrition, reputational harm, hardship for our beneficiaries, and moral distress for our field workers. Therefore, MSF, from the local association to the International General Assembly, should acknowledge the range and significance of humanitarian ethical challenges, and commit to making humanitarian ethics one of MSF’s priorities through reflections, discussions, and concrete measures that will mitigate ethical challenges, improve our humanitarian action, and reduce moral distress.

Examples of ethical challenges:

While ethical challenges are experienced within all roles and at all levels of MSF, here are illustrative examples in specific contexts:

Infectious disease outbreaks: During the West Africa Ebola crisis, there were multiple ethical dilemmas in decision-making. Examples include: the balance between coercive public health measures and patients’ autonomy; the balance between public health and clinical management priorities; inequalities in treatment options between expatriate and national staff (e.g. possibilities of medical evacuation or access to experimental treatments); the lack of pre-established scheme for clinical triage when hospitalisation capacities were exceeded.

Violent contexts: Experiences such as in the Middle East/South Sudan/CAR see ethical dilemmas in decision-making regarding: levels of "acceptable" risk for staff, working or not with ISIS, working in environments where our facilities and local populations are bombed and massacred with impunity, and working where there is diversion and misappropriation of aid, witnessing discrimination or violence against victims, etc.

[1] Philippe Calain (2015, April). Syllabus: Preparing for ethical challenges in humanitarian medicine. Facilitator’s Manual 1st Edition. UREPH: MSF.

MOTION 2: Promote Disability Inclusion in MSF - MOTION PASSED

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Motions sponsors: Patrice Vastel

Destination: OCB Gathering, IGA 

Motion text: 

Recognizing that persons with disabilities are often the most in need in regions where MSF works and that their exclusion  may hamper our humanitarian identity and impartiality,  MSF should:

  • Initiate actions to develop its awareness on this risk of exclusion of persons with disabilities,
  • Develop dialogue with organizations of persons with disabilities where/when possible,
  •  Take in account accessibility to persons with disabilities of our facilities and of our communication materials.

Argumentation / background: 

Around 15% of the worlds population, or estimated 1 billion people, live with disabilities (source 2011 WHO World report on disability[1]). They are often among the most marginalized of the poor. 80% of persons with disabilities live in developing countries (Source UNDP). However disabled persons are rarely or seldom included in development or humanitarian projects.

The report 2014 from Handicap international and Helpage, “Hidden victims of the Syrian crisis”[2] shows that 22,4% of surveyed Syrian refugees in Jordan and Lebanon have an impairment.

Organizations of persons with Disabilities have been and are continuing to be active to provoke changes in their society in developed countries like in developing countries for persons with disabilities to have equal access to basic services. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD)[3] has been ratified by 162 countries.

Several organizations have started to work on the issue. In the references hereunder are some documents related to the work done or in progress.

We consider that MSF should emphasize its awareness on inclusion of persons with disabilities in its action. MSF personnel should be made aware that persons with disabilities, while representing a significant number, are at risk of being excluded from our projects for various reasons including often their invisibility.

It may be argued that the 2013 Germany GA motion on Gender and diversity, endorsed by the IB, may already cover the present issue. We believe “Diversity” is very broad, and a motion addressing too broad issues delays MSF response by adding complexity. Identifying more precisely who we are talking about (Persons with disabilities) will allow MSF to have a faster and more adequate response.




Motion 3: MSF's humanitarian principles in relation to the nationality of Head of Missions - MOTION RECEIVED AFTER THE DEADLINE, THE GA DECIDED TO NOT ADD IT TO THE AGENDA

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Motion sponsors: Jonas Hågensen and Sebastian Stein

Destination: International 

Motion text: “To further protect our independence, impartiality and neutrality, MSF should ensure that Heads of Mission may not be a citizen in the country of their mission, nor have a strong personal link to that country.”

Argumentation / background: 

Independence, neutrality and impartiality stands as the core main principles of MSF`s social mission and firmly guides our operational decisions. One of the main ways that MSF implements these principles in practice is to use international staff in our missions. This is done to ensure loyalty to our charter and to prevent that someone with strong personal interests in the country have the final decision. And it also avoids the organization of being accused of lacking such independence, neutrality and impartiality.

However, it is not written anywhere (at least to our knowledge) that the Head of Mission in all missions should be international staff. And we know of a few examples of national HoM in Italy, Niger, France and Greece.

This begs the question of whether we can be regarded as completely living up to our own principles. A Head of Mission working in her own country might be accused by outsiders of favoring her own family, clan or religious or political group, for instance. Working too close to home can also realistically cloud anyone’s vision and analysis that in turn affects operational decisions. National staff HoMs can also become subject to real pressure from other nationals in the same country, more so perhaps, than international staff. If nothing else: the ongoing debate about the movement`s response to the current situation in Europe shows how easy it is to be dragged into something where an international staff`s perspective could be beneficial. Why not have a Sudanese HoM in our mission in Italy? We don’t claim that it is impossible for a HoM to work according to the charter in her own country, but it is certainly a complicating factor and external perceptions of our implementation of the humanitarian principles might be distorted.

Of course, no rule should be absolute – especially not in MSF – so it should not be interpreted as a rule that cannot tolerate exceptions. Emergency situations, for example, could justify national HoMs or EmCos, but the objective should always be to find an international colleague to fill the position as soon as possible.

Motion received after the deadline: 

MSF’s humanitarian principles in relation to the nationality of Heads of Missions (presented by the motion sponsors Jonas Hågensen and Sebastian Stein) - the GA decided not to add the motion to the agenda

The motion sponsors explain that it is not written anywhere that the head of mission should be international staff. Working close to home can cloud anyone’s judgement, and an international head of mission is always positive. No rules should be absolute, and this can tolerate exceptions, for example in a crisis. The objection should however be to always find an international head of mission. The audience comments that it is unclear in the motion who judges what constitutes a strong personal link to a country, and this could complicate things. It is mentioned that the decision of who will be head of mission is taken in the operational centers and by the line managers, and that they should judge what is preferable. Some state that in some cases, it will be better to have a local/national head of mission, as it can create less difficulties with working with local organizations and national staff. Many see the value of the motion and like the spirit behind it. Many believe who will be a head of mission needs to be decided on a case by case basis



By: Rebecca Cederholm