MSF: Evolution of an International Movement

Associative History 1971-2011

Ever since Médecins Sans Frontières (MSF) was founded in 1971, there was both an international and associative organisation. International because it wouldn’t have made sense for France on its own to have gone to the aid of threatened populations around the world and associative because civil law in France, especially the 1901 law governing charitable bodies, was perfectly suited to MSF’s guiding democratic and selfless precepts.

Yet, MSF’s development from a small, purely French organisation into an international associative movement was never carefully planned and never was particularly smoothly. It was the result of various compromises between the movement’s leaders, with their individual agendas, and integrating fait accomplis whenever necessary. The evolving modifications were discussed at length to ensure that concerns raised were legitimate and that there was agreement for decisions made. The nature and the validity of MSF’s leadership were regularly challenged, as was the question of how MSF should grow while remaining true to its approach to humanitarian aid.

Episode One of this study - a summary of which you will find below - covers MSF’s first three decades (1971-2000). Episode Two is about the challenges of the early 21st century. 

► The full study, factsheets, timeline, reference documents is available online! 

An International Movement…
MSF’s founding charter stressed an international vocation and the founders’ successors maintained this vision for years. Further, the founders believed that new MSF entities created outside of France should remain under the control of MSF France. The idea behind this control was to avoid putting MSF principles at risk. A solid structure was necessary before growth could take place.

In the early 1970’s attempted launches of MSF in the United States and in the Netherlands never got off the ground. First steps towards internationalising legal statutes failed as well.

In the early 1980s, Belgian and Dutch returned volunteers attempted to open MSF offices in their home countries: Belgium in 1980 and The Netherlands in 1984.

MSF France supported these initiatives, but insisted on retaining control of new entities, the MSF trademark and name, in particular.

In 1985, MSF Belgium took a first step towards independence from MSF France by opposing the creation by MSF France’s newly formed Liberté Sans Frontières (LSF), a think tank focused on ‘third-worldism,’ the political view that the First world’s relations with the Third world were skewed. MSF Belgium considered LSF to be overly political for a medical emergency organisation. They also refrained from supporting MSF France after their expulsion from Ethiopia as a result of denouncing the abusive regime. MSF France sued MSF Belgium in court to forbid the use of the MSF name in Belgium, but lost the case.

MSF Switzerland was created in 1981 to improve access to the various Geneva-based funding institutions and in 1983, became an independent organisation from MSF France, freely run by Swiss volunteers.

In 1986, after a last stand against the creation of MSF Luxembourg and MSF Spain, MSF France had no choice but to accept the existence of five other international, independent MSF entities. However, MSF France did succeed in requiring MSF Belgium to integrate MSF Luxembourg’s operations into its own operations.

At the end of the 1980s, after the reconciliation of the six national MSF entities, they began to meet regularly to formalise common rules and coordinate more coherent activities around the world, in the name of Médecins Sans Frontières.

In 1987, a moratorium on the creation of any new entities was instituted. Although the moratorium was renewed in 1989 and 1993, MSF France, MSF Belgium, and MSF Holland continued to create a number of new entities including delegate and international offices. The role of these offices was to increase funding and human resource opportunities for operations.

In the case of some countries like Switzerland, Canada, and Greece, returned volunteers wanted to create home country entities, in line with the new sourcing approach from the three big operational centers. Thirteen delegate offices in total were created: MSF USA in 1987; MSF Greece in 1990; MSF Canada in 1991; MSF Japan and MSF Sweden in 1992; MSF Italy, MSF UK, MSF Denmark in 1993, MSF Germany ; MSF Hong Kong, MSF Australia, and MSF Austria in 1994; and MSF Norway in 1996. An MSF France’s Antenna was set up in the UAE in 1995.

The first six MSF associations, which were considered to be founding associations, formed a movement, first as MSF Europe (in parallel with the EEC at the time), and later as MSF International. This federation, which was formed in 1991 as an association under Belgian law, was run by a board of directors, known as the International Council. It brought together the presidents or general directors of the six original entities. A secretary-general headed the international office, or Brussels based secretariat

The International Council, comprised of the Presidents of the various entities, was assigned duties including designing the movement’s rulebook, updating the charter, supervising the use of the trademark and logo, and overseeing public statements and witnessing, and overseeing accounting.

By 1991-1993, internal operational and political disagreements spilled over into approaches to the conflicts that engulfed ex-Yugoslavia and soon after, the genocide of the Rwandan Tutsi 1994. These challenges forced MSF to consider whether it was truly a community of culture and practice, something that is described as sharing a common ‘identity.’ Between 1994 and 1996, a series of conventions and workshops, with MSF association members, the executive, and the International Council, were held to examine these questions.

In 1995 and 1996, two international conventions were held in Chantilly, France and the resulting ‘Chantilly principles’ were outlined. These basic principles define the MSF community of culture and practice.

... With an Associative Character
The Chantilly meetings reflected on the associative character of all of the entities as a whole, and of each of the entities individually. Until then, this associative aspect was accepted without question because the founding associations started in countries where civil law provided necessary legal frameworks for MSF’s democratic and not-for-profit approach.

For delegate offices, an associative legal structure was more complicated because they were created in countries under common law, such as the United States of America and the United Kingdom. Although common law statutes could integrate the non-profit character of MSF, they did not have laws regarding democratic governance. The members of these boards, for instance, were not elected by a general assembly, but coopted. Further, volunteers hired by delegate offices, who wanted to participate to the organization‘s governance had to be members of a founding association, which was often not in their country of origin.

Delegate offices wanted a more associative method of governance that would allow them to maintain connections with volunteers after they had returned from a mission for a number of reasons, including support, future recruitment, or press interviews.

In January 1997, the International Council agreed upon major structural reform including rules of governance.

The 19 delegate offices became partner sections, but were still not operational. Like the six founding sections, each partner section had to be backed by an association, even in countries that did not have those particular legal statutes. The 19 presidents and their associations were given equal voting rights in the International Council. The International Council became a discussion platform that included an advisory role to the executive regarding questions related to culture and practices.

MSF received the Nobel Peace Prize in 1999 and launched in 1999 its first wide-ranging, strategic, international campaign, the Access to Essential Medicines Campaign. That same year the MSF movement for the first time officially sanctioned a member entity. MSF Greece was expelled after long negotiations and three near-unanimous votes in favor of the expulsion. This expulsion was a movement-wide penalty for organising an exploratory mission in violation of MSF operational principles in Kosovo. Nonetheless, the process for reintegrating Greece was launched in 2002, and was successfully concluded in 2005.

By: Göran Svedin