TEFKAP Archive

The 2019 TEFKAP was cancelled due to movement-wide budget constraints

In 20196 the TEFKAP was cancelld due to budget constraints. 

The PowWow formally changed name to TEFKAP (the Event Formally Known as the PowWow)

MSF has a long history of assisting and protecting refugees and people who are internally displaced. The last few years, operations have moved increasingly close to our European home societies.  Apart from our operations with SAR and on the Balkans, OCB has started a project on mental health among asylum seekers and refugees in Sweden (the Götene project), and also had ambitions to start a project directed towards undocumented migrants in Norway. Having projects in our home societies in Europe is nothing new to MSF, however the resources (financial and HR) invested in such projects are unprecedented. Still, the vast majority of the world’s displaced population reside outside our European borders – far away from the attention of the media. Their uncovered humanitarian and medical needs are often far more critical than what we witness in our European projects.
Our operations directed towards migrants, including speaking out and advocacy activities, come with a risk in terms of reputation, access (particularly in settings such as Libya and Myanmar) and support from donors. When speaking out we are now often portrayed as a pro-migration and political organisation in traditional and social media. At the same time, most humanitarian crisis, including epidemics, are due to political failure in assisting populations in need. When MSF speaks out about such crisis in Yemen or CAR, it is no less political. The difference in the current situation is that we are addressing the governments of our home societies and their inability to protect those in need of refuge and a safe passage. Our decision to suspend PIF following the EU-Turkey deal resulted in a significant loss of private donors. However, this was to some extent balanced by new donors supporting our actions. Equally, our search and rescue operations on the Mediterranean has resulted in an increasingly critical public opinion towards MSF in Italy, and a loss of donors that has not been balanced to the same extent. The same criticism is also reflected, although to a lesser extent, in the public discourse in the home societies of our Nordic partner sections – sometimes expressed in a clearly hostile tone.
It seems humanitarian values are at stake in today’s political environment. A rhetoric of us and them is increasingly pushed by leading politicians, and many feel protectionism and tribalism is becoming a virtue not only among politicians, but also huge segments of the population in our home societies.
How do our operational efforts in and around Europe fit with our responsibility as a global medical humanitarian actor? Have we become too Euro-centric? How we set our priorities? Has our identity, or at least our image, changed? How far do we go in our public positioning in home societies and elsewhere to defend humanitarian values, and at what risk?
Morten Rostrup, medical doctor, MSF-Norway, former MSF international president
Stefano Argenziano, operations coordinator Cell 2 OCB (Italy, Egypt, Mauritania, Greece, Algeria, Serbia, Tunisia)
Arjan Hehenkamp, general director OCA 2011 -Sept. 2017, key to driving OCA's ambition and direction on migration
Asil Sidahmed, humanitarian advisor for MSF in the Middle East and North Africa (MENA)
Itta Helland-Hansen, logistician MSF-Norway, recently returned from her mission on Prudence / SAR
The Nordic MSF sections have been on the forefront in bringing topics such as harassment and discrimination to the table in our governance bodies. Inclusion, disability, gender, sexual abuse – all these issues have been on the agenda in our associations over recent years. One aspect of such discrimination is racism, which we know is an important concern among many of our staff. At the same time, few of us would recognize ourselves as racists. Are we blind to our own shortcomings, as individuals and as an organisation? Does our understanding of racism sufficiently take into account a broader comprehension of what social power dynamics look like? Are we certain we are able to recognise contemporary forms of racism and privilege - both in society at large and within our own organisation? These are some of the questions we will be asking ourselves during this year’s PowWow. Our experiences from other dossiers related to discrimination have taught us valuable lessons, including the importance of having a common language to deal with these issues. We need to identify and acknowledge the problem in order to address it and take action. 
FacilitatorMario Stephan, MSF field worker and OCB board member, founding director of Arabian Perspectives.
External expert: Dr Lene Auestad, philosopher and writer, focusing her work around prejudice, hate speech and social exclusion.
You can find the final input from the audience on what racism means to each of us here and our expert Lene Auestad's full text of her presentation here.
You will have a chance to contribute to MSF’s ongoing thinking on crucial medical topics. The medical speed dating concept allows you to choose four (out of six) subjects on which you share your ideas.
6 parallel sessions, each lasting 25 min, will be held on different medical topics. There will be a brief introduction of each topic, followed by group discussion. After each session, participants will then move immediately to the next session of their choice.
See the outcomes of the discussions on each topics in the below word clouds.
The 6 topics are:
  • Medical retention - Karin Fischer Liddle, nurse, MSF Sweden
Retaining experienced medical expatriates for coordinating positions is a global challenge in MSF. Only about half of the medical fieldworkers do more than one assignment in the field, despite various initiatives over the past years to improve training and retention. What are the reasons behind this, and how can we improve the statistics?
  • MSF & cancer treatment - Erlend Grønningen, medical doctor, MSF Norway
At this year’s OCB gathering, a motion was passed asking MSF to take up the fight to provide cancer care for our patients. But what does providing cancer care mean in practice – is it feasible in the settings where we work? If engaging in such care, should we aim at cancer care in general, or rather focus our ambitions on prevention (mainly through vaccination; cervical cancer and liver cancer) or cancer types that are most easily detected and treated (the low hanging fruits)?
  • Mental health Helena Jónsdóttir, psychologist, MSF Norway/Iceland
In 1998, MSF formally recognized the need to implement mental health and psychosocial interventions as part of its emergency work and we proudly state that in MSF our MH services are and should be integrated into our medical activities.  Now, what does that really mean? And how do we support and ensure this integration?
  • Maternal and neonatal care in humanitarian crisis – can we do more? - Mats Blennowpediatrician, MSF Sweden
Although “Under 5 Mortality” (U5M) globally has reduced significantly, mortality during the first month of life remains unacceptably high. Neonatal mortality accounts for 44% U5M, 17% die during their first day of life. Measures needed include improved organization of maternal-neonatal care, better collaboration in neonatal resuscitation and implementation of the WHO Helping Babies Survive program.
  • Medical ethics: Quality vs. Quantity – Evy Dvergsdalnurse, MSF Norway
We all share the same ambition and goal - to provide quality medical care to our beneficiaries in order to reduce morbidity and mortality among vulnerable populations. But how do we strike the balance between quality and quantity to reach this goal? Can we accept compromises in the quality of the services provided or the safety of our patients in order to reach more people? Is it always better to do something than doing nothing? 
  • MSF’s responsibility towards our beneficiaries – Annlaug Selstø, nurse, MSF Norway
In emergencies, our support to the populations we serve often include more than medical services. MSF also provides shelter, water and sanitation services, and other items that are essential for people in order to secure their health. But how far does our responsibility as a medical humanitarian organization go? In certain countries we have been working for more than a generation, and established long-lasting relationships with the population. Do we then have a responsibility to move beyond medical relief and consider how we can contribute to improve the determinants of health in that population?
We held 2 MSF Talk presentations during the PowWow, both held on Saturday Nov 11th.
The first MSF Talk was presented by Jon Gunnarsson Ruthman, from MSF Sweden and the topic was "The power of Association?" 
You can find Jon's presentation here. Feel free to contact Jon directly should you have any question: Jon Gunnarsson Ruthman: jon_ruthmangunnarsson@hotmail.com 
The second MSF Talk presentation was an introduction of the Mentoring & Coaching Hub and its scope of activities catering to the whole MSF movement, by Alan Lefebvre, MSF Norway Mentoring and Coaching hub Coordinator.  You can view Alan's presentation here. Feel free to contact him should you have any question: alan.lefebvre@legerutengrenser.no

Friday February 5, 19:15 - 21:00
Moderator: Katrin Kisswani, President MSF-Sweden
Speakers: Helene Lorinquer, Senior Advisor at OCB & MSF Sweden Board Member; Françoise Bouchet-Saulnier, Legal Director OCP; Nils Mørk, Director of Communications MSF Norway
Iron roofing and rubble litter a corridor in the MSF Kunduz Trauma Centre as the facility lies destroyed following the 03 October aerial attack which killed 22 staff and patients in northern Afghanistan. The bomb blasts were so strong that the corrugated iron roof caved in here in the blood laboratory corridor, and elsewhere in the hospital building. (c) Andrew Quilty/MSF 2015
At this year’s PowWow we are fortunate enough to have a group of expert speakers with us to share their insights on the highly relevant and current topic of International Humanitarian Law (IHL) and the myriad ways that it impacts our ongoing MSF projects.
Perspectives from MSF’s ongoing Medical Care Under Fire (MCUF) project will also be shared. The overall objective of MCUF is to improve patients’ safe access to healthcare and the security of patients and staff in healthcare structures by using evidence-based, context-specific, targeted advocacy to promote respect of the principles of independence and neutrality of the medical mission.
Here we have compiled a brief primer on IHL as well as a few resources we found to be particularly helpful, to provide a bit of context for the upcoming PowWow discussions.
The Geneva Conventions comprise four treaties, and three additional protocols, that establish the standards of international law for the humanitarian treatment of war. These Conventions are rules that apply only in times of armed conflict and seek to protect people who are not, or are no longer, taking part in hostilities; these include the sick and wounded of armed forces on the field, wounded, sick, and shipwrecked members of armed forces at sea, prisoners of war, and civilians.
Today, almost all countries are bound by the Geneva Conventions. The Conventions of 1949 were supplemented by two treaties; two additional protocols were added in 1977 that relate to the protection of victims of armed conflict.
The first convention deal with the treatment of wounded and sick armed forces in the field. The second convention deal with the sick, wounded, and shipwrecked members of armed forces at sea. The third convention deal with the treatment of prisoners of war during times of conflict; the conflict in Vietnam greatly contributed to this revision of the Geneva Convention. And the fourth convention deal with the treatment of civilians and their protection during wartime.
Dr. Joanne Liu, MSF’s International President, phrased it like this in her statement at the Palais des Nations, Geneva, Switzerland, after the US attack on our trauma hospital in Kunduz, Afghanistan.
“These Conventions govern the rules of war and were established to protect civilians in conflicts – including patients, medical workers and facilities. They bring some humanity into what is otherwise an inhumane situation.
The Geneva Conventions are not just an abstract legal framework – they are the difference between life and death for medical teams on the frontline. They are what allows patients to access our health facilities safely and what allows us to provide healthcare without being targeted.
It is precisely because attacking hospitals in war zones is prohibited that we expect to be protected.”
Through the ages, societies engaging in war have always been governed by rules—be they vague or precise—pertaining to the outbreak and end of hostilities, as well as how they are conducted. (ICRC)
Over 500 cartels, codes of conduct, covenants and other texts designed to regulate hostilities have been recorded since the inception of warfare to the advent of today’s humanitarian law. The 19th century saw the beginnings of the universal codification of these rules and in 1949 the Geneva Conventions, the primary origin of modern IHL, came into being.
There are other international protocols and conventions prohibiting the use of some military weapons and tactics, or protect certain categories of people or goods. These measures are particularly enacted by the:
IHL encompasses both international treaty law and customary IHL. Treaty law is governed by formal written conventions which are agreed upon between states, whereas customary IHL exists independently of treaty law and is a collection of unwritten rules derived from “a general practice accepted as law.
Customary IHL is considered to be essential to modern armed conflicts as it “fills gaps left by treaty law in both international and non-international conflicts and so strengthens the protection offered to victims.” (ICRC) There are two ways in which customary IHL proves particularly relevant in modern day conflicts:
  1. States are bound by the rules of customary law regardless of whether they have ratified treaty law
  2. Treaty law is relatively weak in terms of governing non-international armed conflicts, which makes the use of customary IHL essential given that most modern armed conflicts occur within the boundaries of one country
You can read more about the details of customary IHL here.
The duty of treating the wounded and sick, and the correlating protection of medical personnel and facilities, has been at the core of international humanitarian law since its inception in 1864. The protection of medical services in war zones is also part of International Humanitarian Customary Rules (see previous section) and is reflected in the domestic law and military code of all countries around the world. (MSF)
These rules bind States and non-State armed groups. In situations that do not reach the threshold of armed conflict only international human rights law (IHRL) and domestic law apply. In principle, IHRL applies at all times, unless States decide to derogate from it. Though less specific than IHL, IHRL contains several rules protecting access to health care. (ICRC)
The following is a brief introduction by MSF to the mail principles guiding the protection of medical services under international humanitarian law.
Grave violation of International Humanitarian Law
A targeted attack on a medical facility is a violation of IHL and can constitute a war crime if it was:
  1. Intentional,
  2. due to negligence stemming from a failure to properly verify the military or civilian nature of the target,
  3. a disproportionate response to the identified military threat, or
  4. undertaken without advance warning of an imminent attack. (definitions of war crimes, ICRC)
Protection of the Wounded and Sick
The Geneva Conventions stipulate the imperative to protect the wounded and sick, without discrimination and in respect of the rules of medical ethics.
Under IHL, as soon as a person is wounded, they are protected, no matter how they were wounded, nor if they participated in hostilities on any side. A combatant who is wounded and ceases fighting can no longer be considered a combatant. The wounded must be collected and given medical care with the minimum delay possible.
The Obligation to Give Medical Care
Under IHL, medical personnel are obligated to treat all patients without discrimination. Patients are not registered according to their ethnicity, politics, religion, or participation in prior hostilities. They are triaged only according to their medical needs and the urgency with which they need to be seen.  Withholding care or providing care in a discriminatory fashion is strictly prohibited – it is a breach of medical ethics as well as the Geneva Conventions, and can amount to a war crime.
Protection of Medical Personnel and Medical Ethics
Medical personnel are protected under IHL to ensure that they are able to resist military interference and act with independence and autonomy according to medical ethics only. In other words, medical personnel must be free to treat patients based on medical need alone and cannot be compelled or give priority to treat one side or the other. Medical personnel may not breach doctor-patient confidentiality and cannot be punished for carrying out medical activities, regardless of the profile of the patient.
Medical personnel must defend the ethical, neutral, and impartial character of medical structures, units, and activities.  They are responsible for maintaining the medical and neutral nature of the facilities. In MSF facilities, a weapons-free policy is strictly implemented.  All weapons are collected at the entrance and stored until the patient is discharged.
Protection of Medical Facilities and Precaution in Any Attack
Medical facilities and transports must be respected and protected at all times and cannot be attacked.  They are afforded a special protection as a medical facility, while also retaining the general protections applies to civilians and civilian structures. It is mandatory for warring parties to take all precautions to ensure medical staff and facilities are not attacked.
Distinction: Parties to conflicts are only allowed to attack identified and legitimate military targets.  Before attacking, all parties to conflicts must make every attempt to ascertain their proposed target’s civilian or military nature.  If there is any doubt, armed forces must presume that it is civilian and refrain from attack.
It is prohibited to strike a building without knowing what it is.  Attacking a structure without knowing what it is constitutes a violation of IHL.
When a Hospital Loses its Protection
A hospital can only lose its protected status if it is used outside of its medical purpose to commit acts harmful to an enemy—i.e. as an active combat position. Treating wounded combatants does not meet this standard (and, as noted, failure to treat wounded combatants would be the violation of IHL), nor would instances during which unarmed people seek refuge inside a hospital. What's more, protection ceases only after due warning has been given to evacuate civilians and this warning has gone unheeded.
The proportionality test: If a hospital loses its protected status, armed forces can only attack after issuing the warning, and only in proportion to the threat. For example, if a gunman is firing from a hospital, the other warring party could respond, but only against the gunman, not by destroying the entire hospital. Any direct expected military advantage gained by such an attack must also be weighed against the potential loss of civilian life. The means and methods of the attack must been chosen to avoid or minimize civilian deaths.
Read More:
Medical Personnel exclusively assigned to medical duties must be respected and protected in all circumstances. They lose their protection if they commit, outside their humanitarian function, acts harmful to the enemy.
Numerous military manual recall the obligation to respect and protect medical personnel.  Under the legislation of many States, it is a war crime to violate this rule.
Punishing a person for performing medical duties compatible with medical ethics or compelling a person engaged in medical activities to perform acts contrary to medical ethics is prohibited.
Medical units exclusively assigned to medical purposes must be respected and protected in all circumstances. They lose their protection if they are being used outside their humanitarian function, to commit acts harmful to the enemy.
Directing an attack against a zone established to shelter the wounded, the sick and civilians from the effects of hostilities is prohibited.
The abhorrent attack on our hospital in Kunduz, Afghanistan on the 3rd of October 2015, which killed at least 42 people and demolished northeastern Afghanistan’s only trauma center, highlighted how crucial questions of IHL are to MSF’s operations as well as the magnitude of devastation that can be incurred when these rules are not respected. However, the attack in Kunduz does not stand alone as a tragic example of disregard for these essential laws, as recent the multiple airstrikes against MSF hospitals continue in Yemen and bombings of medical facilities (including MSF supported facilities) in Northern Syria threaten our ability to continue operations. 
Read more about these ongoing challenges in the recently published article in The Gaurdian by Vickie Hawkins, executive director of MSF UK. 
For further reading please check out http://guide-humanitarian-law.org --an excellent resource by Françoise Bouchet-Saulnier (one of this year's PowWow speakers).
All members can propose motions to the General Assembly (check the bylaws of your section to see what the time frame is to propose motions).  A motion presented at the joint Nordic GA or the MSF-Denmark GA, can be directed to the home association, the OCB Gathering, or the International General Assembly, depending on whether it is an issue that pertains to the movement as a whole or not.

Motions should be used to push issues you strongly believe in at level of the missions, your association and/or the movement.  A motion should address the associative and is about the fundamentals of the movement, its identity, aspirations, responsibilities, principles and its mandate.  If a motion is adopted by the members at General Assembly it is then followed-up by the Board who has a responsibility to report back to the members on the progress of the motion.
Motions are a useful tool to provoke changes in MSF and/or put an issue on the agenda of the Association as a whole. This is why motions should have a ‘wide’ scope: meaning they should not be limited to one country of operations but be applicable to several contexts, deal with MSF's long-term orientations and/or propose something ‘new’ – a different approach, a new strategy, a fresh ‘impetus’ etc.
Motions are also a tool to change the governance of the section, for instance changes to the statutes will be presented as a motion.
In Denmark some further distinctions have been made as follows (for full document click here):
A Motion is a proposal presented to the AGM by voting members regarding MSF-Denmark, OCB, and/or IGA related issues that involved identity, aspirations, responsibilities, principles and/or mandate.  As such motions aims at challenging the organization and is worded positively and constructively.
A recommendation is a suggestion presented to the AGM by voting members regarding MSF-Denmark, OCB, and/or IGA related issues that involve practical executive or operational issues that aims at improving the organization and is worded positively and constructively.
  • All debates do not have to end with a motion or recommendation! The writing of a motion should only be considered if it brings a new spirit to the associative like new ideas that could make things move.
  • To avoid wasting time: motions that have already been approved by a previous GAs/OCB Gathering, or that refer to policies that have already been accepted and/or applied should not be written, unless you wish to re-emphasize a motion you feel have not been implemented. (past MSF-Denmark Motions; past MSF-Sweden Motions; past MSF-Norway Motionspast OCB Gathering Motionspast IGA motions - log in: msf; password: iga)
  • Avoid writing motions you are not ready to defend.
  • If you have a proposal to make and think it qualifies to become a motion, try and gather support of other members/MSFers around your proposal. You do not need to wait for the General Assembly to rally people around your idea.
  • Refer to the motions checklist (link) to make sure that what you are proposing meets the ‘requirements’ to be considered as a motion. For example, does your proposal speak to MSF’s identity, principles or responsibilities to our patients? Does it apply to other contexts beyond yours? Have you checked that there is not yet a policy in place on the same topic? Is it proposing something new?
  • Use the examples of previous motions to help you word and present your motion.
  • You can get the help of Board Members or the Association Coordinator if you have questions.
You need to be a member of the Association to present a motion. Practically this means you need ot be a voting member of MSF-Denmark to present a motion at the Danish GA.  You need to be a member of either MSF-Norway or MSF-Sweden to present motions at the joint Nordic General Assembly. 
  • A title that clearly indicates what is the subject and to whom the motion is directed
  • A short background / argument in favor of  the change asked for
  • A request, i.e. the text that the assembly will vote on (the shorter and the more concise it is, the bigger the chance that it will pass) 
Once a motion is submitted to the General Assembly it will be debate and voted on.  If the motion passes the Board is responsible to follow up and report back.  If the motion is meant for the OCB Gathering and/or the IGA it will also be submitted to those platforms.  Due to the sheer volume of motions submitted to the international platforms, both the OCB Gathering and the IGA use Motion Committees to decide which motions will be brought to a vote by the members.  They often combine motions of similar nature to cover as much ground as possible.  You can read more here about the work of the OCB Motion Committee here.
MSF-Denmark: Please find the framework for the motion process here
Joint Nordic GA:  Though we are moving towards one Association, for legal reasons some motions will have to be voted on separately by MSF-Norway or MSF-Sweden respectively.
Therefore the motions session is divided in two parts so that motions only pertaining to one section (motions regarding the statutes for instance) will be handled during the national GA:s, while motions addressing the greater movement will be addressed to the Nordic, OCB or the IGA and voted on jointly.
Though the motions process is extremely important when it comes to influencing the movement and how we work, it is important to remember to that motions can sometimes not be implemented for a number of reasons.  By submitting a motion that is accepted to the General Assembly you guarantee that the issue is debated and that there will be feedback from the Board on why or why not a motion was implemented.  Hold the Board accountable by asking questions!
If your motion is approved you will receive feedback at the different stages of the process: following the General Assembly through the Nordic Newsletter, the Nordic Facebook page, InsideOCB and during following General Assemblies. 
Medical Challenges: Ebola Evaluation Outcomes.
The 2014 Ebola outbreak in West Africa (Guinea, Liberia, and Sierra Leone) was unprecedented in its size and scale with 28,636 confirmed cases and 11,315 deaths. The situation was exacerbated as it took place in the border areas between the three countries, where movement of people between countries is regular and often not controlled. Mali, Nigeria, and Senegal were also affected, though on a substantially smaller scale.
What is Ebola?
Ebola is a virus (first detected in 1976) that is transmitted through direct contact with body fluids like blood and vomit from infected people.  Although its origins are unknown, bats are considered the likely host.  MSF has intervened in almost all reported Ebola outbreaks in recent years.
The West African outbreak
On March 21, 2014 the Ebola outbreak in Guinea was laboratory confirmed and MSF rapidly dispatched experienced teams to initiate. MSF’s usual approach in an Ebola outbreak, consisting of  six elements:
  1. isolation and supportive medical care for cases, including laboratory capacity to confirm infection
  2. safe burial activities in case management facilities and in communities
  3. awareness raising
  4. alert and surveillance in the community
  5. contact tracing
  6. Access to healthcare for non-Ebola patients, including protection of health facilities and health workers
By July 2014the virus had spread to Liberia and Sierra Leone. Both WHO and the Guinean government downplayed the outbreak and disregarded MSF’s warnings of the severity of the outbreak.
It was only on August 7th that WHO Director General Margaret Chan designated the outbreak as an international health emergencyand more than a month later at the UN Security Council passed Resolution 2177During the meeting MSF warned that we were “losing the battle against Ebola” and denounced “a global coalition of inaction”.
MSF's Jackson K.P. Naimah´s statement
Incidentally, the international help deployed to control the outbreak reached West Africa at a late stagelate.  A recent report stated that the number of cases could have been halved had beds been available 1 month earlier.
From October onwards, other actors began arriving and setting up projects in the three affected countries.  The number of cases gradually decreased both in Liberia and in Guinea (in Liberia the decrease started even before the bulk of international organization except MSF arrived), yet a sharp increase was observed in west Sierra Leone. Furthermore, trials started in two countries for treatment, vaccines and diagnostic research.
In March 2015, marking the anniversary of MSF’s involvement and criticizing the slow international response the MSF report was released: Pushed to the limit and beyond.
Cases in the area continued to gradually decrease throughout the year and only just last week WHO declared the end of the Ebola outbreak, though warning that flare-ups were highly possible. Only a few hours after the declaration a new case was reported in Magburaka, Sierra Leone, a flare-up that so far has resulted in one more case. Since then MSF has been reinforcing screening procedures, increasing isolation capacity, reinforcing infection protection and control measures, and making sure that all protocols are in place.  The patient had been travelling through several districts and over 100 contacts have been identified, of those 29 are deemed high risk.  The WHO has asked MSF to take the lead in ring vaccination, but since the vaccination has not been approved yet, the campaign will have to be done within a study-setting.  Many discussions are currently ongoing between the government of Sierra Leone, the WHO, and MSF.  The ring vaccination should start as soon as possible. (information as of January 18, 2016).
All in all, MSF played an exceptional and decisive role during the outbreak. Not only was MSF critical in detecting the outbreak, they were the first in the field and through training and support enabled many other actors to intervene.
The OCB Ebola review
The OCB management commissioned an extensive multi-sectorial critical review of its Ebola intervention. This was the largest review ever done in MSF. Nine sub-reviews covered medico-operational issues, human resource management, water and sanitation, supply, logistics, construction, communications and advocacy as well as governance.
The review is focused on the appropriateness of the chosen strategies and an analysis of the effectiveness of the intervention. It identified key learning areas based on examples of good and bad practice and made recommendations for possible future best practices. The time period reviewed ranges from the 1st March 2014 to 31st March 2015.
The pow wow session will focus on the medico-operational part of the review, including the aspects of patient care.
Additional reading:
Liberia: The boy who tricked Ebola (16 September 2014)
Sierra Leone: Race against time to control the Ebola outbreak (21 July 2014)
Saturday Feburary 6, 11:15 - 13:00
Moderator: Helena Frielingsdorf, MSF-Sweden Board Member
Speakers: Manica Balasegaram, Executive Director MSF Access Campaign; Otto Cars, Chairman of the International Secretariat and Executive Director of eAct; Fredrik Rücker, Infectious disease specialist with experience in Ebola, HIV, and MDRTB
In sight of ever increasing AMR around the world doctors are running out of options to treat common infections.  This results in higher costs and death or disability of individuals who could have otherwise continued a normal life.  Without effective anti-infective treatment, many standard medical treatments will fail or turn into high risk procedures. Currently, there are estimated 700,000 deaths from AMR and projections predict that by 2050 the number will rise to 10 million.  AMR is a public health emergency and a serious threat to MSF programs- death from infectious illness is twice as likely if the pathogen is resistant to the antibiotic. Thus, without urgent action the world is heading towards a ‘post-antibiotic era’.
What is driving AMR?
Irrational use of antibiotics is the main driver for development of antibiotic resistance: globally more than 50% of all prescriptions are unnecessary or incorrect. There is a positive correlation between outpatient antibiotic use and AMR, antibiotics are used when they are not needed and drugs have been exhausted and developed resistance.
What is the role of MSF in AMR? A cross-sectional study using routinely collected data in Ahmad Shah Baba hospital, Kabul speaks loud and clear: we are overprescribing. Results showed that 50% of patients were receiving an antimicrobial in winter and over 60% in summer- the WHO target stands at 30%. The high prescription rates accounted mostly for conditions which are often viral such diarrhea and URTI or which may not require antibiotics (dental conditions).
What to do now?
Last May at the World Health Assembly the 194 member countries adopted global action plan against AMR.  The five strategic objectives are
  1. Improve awareness and understanding of AMR.
  2. Strengthen the knowledge and evidence through surveillance and research.
  3. Reduce the incidence of infection through effective hygiene an infection prevention measures.
  4. Optimize the use of antimicrobial medicines in human and animal health.
  5.  Develop the business case for sustainable investment that takes account of the needs of all countries, as well as the need for investment in new medicines, diagnostic tools, vaccines and other interventions.
In order for the adopted global action plan to be effective, a great political global will is needed to advocate for a new framework. But also to coordinate and integrate worldwide research as well asincentivises and stimulates new antibiotics development.  
Additional Reading:
Antibiotic Resistance: Major Setback- exploring Middle East and Haiti as one of the many areas affected by antibiotic resistance (30 Jul 2015)
Could Antibiotic Resistance Threaten Public Health? (24 Jun 2015): “More than fifty years after the introduction of antibiotics on a large scale, could it become possible to die of simple pulmonary infection?”
The World Health Organization published a report on resistance to antibiotics -the first of its kind (23 Jun 2014): The World Health Organization published a report on resistance to antibiotics at the end of April. The first of its kind, it sounded the alarm on this insufficiently documented issue where infected wounds won't heal despite treatment. MSF had already observed the phenomena, notably in its surgical program in Amman, Jordan where, three quarters of patients from Iraq have infections due to resistant bacteria.
Also check out this recent series in the Lancet (18 November 2015) which gives a multidimensional view of the complexities surrounding this issue, it is well worth a read!
Saturday February 6, 15:00-16:00
Moderator: Sohur Mire, Vice President MSF Denmark
Speakers: Rachel Kiddell-Monroe, International Board Member; Karsten Noko, Vice President MSF Southern Africa

In the beginning there was the Charter[2], followed by all MSF sections, though interpreted differently. In time there were questions of whether we wanted to be an international movement, of our independence and neutrality, the role of the associations, our medical act, advocacy, and about growth and governance. In 1994 the so called Royamount attempted to address the governance and identity issues.  At the time there was significant tension and mistrust in the movement, especially within the operational sections[3].  The sections agreed to an “active pause”, which implied that operations were continuing, but that the sections took a one year pause from each other in order to reassess and reflect on the collaborations within the international movement[4].  The Chantilly Document followed after the “active pause” in 1995/96 and was an attempt to find coherence and reconfirmed the Charter and our principles, the central role of the medical act AND témoignage, and the importance of all sections being associations[5]. The delegate’s offices[6] were instrumental in solving the conflicts within the organization.
With the formation of the International Council in 1997 MSF changed from 6,5 operational sections and 13,5 delegates offices[7] to a movement with 19 members. The earlier operational sections were all formed as Associations while the delegate offices were discouraged from creating associations to complement and lead the executive. MSF Sweden, founded in 1993 with the support of MSF Belgium, was an exception in that it was created as an Association first with the executive structure following. In allowing more associations to form there were fears that the operational sections would lose control, and that the lack of vision and structure for how MSF was governed would create too many independent voices hampering our reactivity and ability to speak out[8].  The executive also challenged the notion of having an Association overseeing the activities, seeing a loss of authority and decision making[9].
At the IC meeting in November 1998 a final set of associative criteria were adopted:
  1. Each MSF Section subscribes to the MSF Charger and each Section subscribes to the Chantilly Text on MSF’s identity and guiding principles.
  2. Each Section delegates authority to the MSF International Council in its fields of responsibility.
  3. Persons who accept the MSF Charter and have demonstrated their commitment become, if they so wish, members of the MSF Section(s) of their choice.
  4. Through an Annual General Assembly the members participate in decision making.
  5. Board Members are elected by the members during the General Assembly.  Subsequently the President is elected. So as to ensure the cohesion of the international movement the Board cannot be homogenously national.
  6. The Section ensures its anchoring in society[10].
By 1999, after a grace period of two years, all 19 sections were Associations with representation (the section President) on the International Council.  In 1997 the IC agreed to a moratorium of new sections, making it impossible for new sections to join the IC.[11]
Despite the moratorium on adding new sections, MSF continued to grow at an alarming speed, and was, to quote Morten Rostrup[12] “growing older, fatter, and more bureaucratic[13]”. MSF had been going through rapid change, and unprecedented growth, and plans were made according to national interests rather than a common international vision for MSF. In the same paper from 2002 Morten brings up the possibility of merging MSF Denmark, Norway and Sweden into a “Scandinavian section[14]”, as a way to increase participation from new sections located outside of Europe/ North America / Japan / Australia / Hong Kong without increasing the number of representatives in the decisional bodies. While sections in the 80s emerged primarily as operational centers, and in the 90s as non-operational centers in rich countries ripe for fundraising, he saw a future where the movement would gain new sections from existing MSF field programs in countries like South Africa and Brazil.  He argues that it would bring a new dimension and a field perspective into the movement.
In 2006 the tensions were running high and the movement undertook another identity/governance process. Again there were underlying mistrust and tensions, and sections complained that little progress had been achieved internationally due to internal fighting and disagreement. The level of tension between operational centers had paralyzed the movement to some extent and a lot of time was spent perpetrating old conflicts which prevented the movement to make decisions and to progress[1].  To remedy this the La Mancha process was launched to be an open dialogue on the main areas of conflict: underlying agendas and conflicts; transparency; independence; commitment to decisions; the role of the International Office; and accountability.
Subsequently during the La Mancha process the MSF charter and founding principles were reconfirmed. As were MSF’s associative nature and the need for operational diversity while making efforts to increase the coherence, efficiency, transparency, and responsibilities of our operations and actions as an international movement. Among other things, the La Mancha Agreement stressed the need for mutual accountability and active transparency in MSF, both at sectional and international levels, something that was delegated to the International Council (IC).
As for the association it was stated in La Mancha that “We must take proactive steps to ensure fair opportunities for access to meaningful membership in associations, while preserving the spirit of volunteerism. In doing so, we accept the need to explore new avenues for associative participation, giving priority to regions where MSF is underrepresented, including for instance, through the creation of new MSF entities.[2]
While La Mancha was triggered by governance issues, growth, and a need to revisit MSF’s principles, the IC minutes from 1997-2008 show that the role of the IC, and the balance between section autonomy and movement wide decisions, had been at the center of crisis. Most notably:
  • The expulsion of MSF Greece in 1999.
  • The alleged non-compliance of MSF Holland to the IC DNDi decision in 2002.
  • The role of MSF International in the aftermath of the Arjan Erkel kidnapping in 2004.
  • Speaking out on Darfur and Sri Lanka in 2005
However, despite best efforts of the International Council (IC) mutual accountability[3] was not being realised and many of the negative pre-La Mancha trends continued. 
In 2009 it was time to take another look at our governance structure. The triggers that lead to the governance reform were complex, and the reform was as a result of cumulative factors rather than a single issue[4], and had been evolving from a series of studies and decisions by the International Council (IC) and Executive Directors (ExDir).
As a movement we had grown from a small office in Paris in the early 70s to incorporating 19 sections[5] and five Operating Centers (OC:s), with at least 11 so called “new entities” waiting in the periphery to be let in despite the fact that the moratorium on new sections had been in effect since 1997.
In 2007 the IC took a bold step forward when they decided that the income from the different sections of MSF had to be shared. It was not acceptable anymore that some OC:s had to close operations for financial reasons while others were building big reserves in the bank[6]. During the same period the IC also decided on a .cap on growth, which means that no section would be allowed to grow more than 8%, annually, over a period of four years[7]. This was followed by an agreement by the ExDir to freeze the number of staff members at headquarters level (the so called FTE freeze).  Both agreements were to be widely contested by individual sections and OCs who felt they were chafing under the rules.  We are still seeing the effects, especially of the FTE freeze in many sections.
At the time it was recognized that, in order to fix the problem of uncontrolled growth, we first needed to know what exactly was going on in the different sections. What activities did we have and how did they support operations?
First up for review were the so called new entities. These were offices launched by OCs in an effort to expand their HR, and fundraising activities.  In some cases the new entities were created to make an OCs position stronger by having more offices in more countries. It had become evident that the new entities were created without any real oversight or coordination from the movement as a whole. A complete mapping was done in 2008, and it turned out that 11 new entities had been created during a period when MSF had agreed that no more new associations would be created (the ‘moratorium’[8]).
A working group of the IC was assembled and conduced a review of all new entities, granting some the status of delegate office, and some the status of branch office. It was also recognized that initiatives such as MSF-East Africa needed to be given a voice in the movement, but not necessarily as a section, branch- or delegate office. The working group came to the ultimate conclusion that to fit the new entities in the organization, the whole movement (all sections) needed to be reviewed to see where we wanted to go as a movement.
Following the ‘New Entities study’, the ExDir and IC requested a review of all the existing 19 sections in order to understand and clarify the contributions, potential and intentions of said sections. The review took place in 2009 and all sections were evaluated using a peer based evaluation system. The recommendations stemming from the review were presented at the IC meeting, and it was found that there was an overall worrying increase in management layers in the movement, growing bureaucracy, and that more or less all sections were looking to expand their activities.
This lead to the question: does everyone have to do everything or would it be more pertinent for sections to specialize in what they do best? Wouldn’t that lead to a more efficient movement with less overlap?
On top of that, there are a number of issues and problems that were tackled during the La Mancha agreement, but still kept popping up across the movement.  For instance the lack of coherence in témoignage led to situations where it became impossible for MSF to speak with one voice in a timely manner about the situation in the Palestinian territories during the Gaza war (2008-09) because there were too many different opinions within the movement. The lack of one voice also made for increasingly dangerous situations in high risk situations such as in Afghanistan or Iraq, where the different messages of the different OCs made negotiations almost impossible.
Also it was felt that there were a lot of unmet needs in the field that MSF wasn’t addressing. Could our resources be used more efficiently if the different OC’s would collaborate more?
There were are also questions around our Associations how we can ensure that everyone who works for MSF has access to meaningful membership and the possibility to influence the decision making within the movement. Especially given that all 19 sections were located in Western Europe, North America, Australia, Hong Kong, and Japan.  How do we include everyone and thus make sure that MSF continues to be a democratic movement?
The ambition of the Governance Reform[9] was for MSF to develop a governance system that reflected the common ownership of our social mission while ensuring “a diverse, inclusive, and meaningful membership, a shared vision for the movement with complementary operational approaches, and a system of governance that provides leadership and accountability[10]”. The aim of the Governance Reform was to move away from bureaucracy, slow decision making and a lack of diversity and inclusiveness.
An International General Assembly[11] and an International Board[12] were put in place.  Whilst the membership on the IC had been tied to the 19 sections, the IGA was created to accommodate alternative forms of Associative entities.  In fact the new regional or trans-national models would create new dynamic and will take pressure off MSF to create new associations in many countries.  Regional associations were not a completely new concept in MSF[13], but this was the first time we consciously chose them as a model for development.  In fact in 2015 there are five regional associations represented (Hong Kong, SARA, East Africa, Southern Africa, and Latin America).
Caution was given as to not develop “geographical empires”[14], further it was expressed that there would be a future need for current Associations to join and develop regional constellations in order to allow for new Associations (from the regions where we have our operations), while at the same time avoiding becoming a UN like structure where each country has a representative.
Further the IB has on several occasions expressed that there is a need to keep MSF a “limited, manageable organization”[15] and that “inclusiveness and openness is viewed by some as key to the future of MSF but should come along with the merging or closing of existent entities”[16].  In May 2013 they stated that “The IB believes that an increase in the overall number of institutional members is not compatible with a reactive and decisive governance structure. Therefore it wants the number of institutional members not to increase, and would even prefer this number to decrease. At the same time, the IB strongly supports associative life and action, and it is open to and welcomes new associations. In order to give space to potential new associations in the governance structure, it encourages the merging of existing ones and/or the development of regional initiatives.” In October 2013 they agreed on the following: “that the new associative applications to the IGA should not be delinked from merging existing associations, as described in the Associative Roadmap. It is acknowledged that the will of the IGA to bring in new associations can and should be used to ensure that some other associations merge.  The IB agrees that a clear [commitment/timeline] for associative mergers should be in place by the IGA 2014 and that, while it is extremely desirable, the mergers themselves need not be fully finalized by that time.  Demonstrating concrete progress on mergers will support the IGA’s will to admit new associations.”
In the Nordic countries we have had a long history of collaboration, both on the Associative and the Executive side.  The PowWow, started in the 1990s, and has been a very successful platform for members from three relatively small sections to meet and debate.
As stated earlier in the paper, Morten Rostrup suggested a merger of the Scandinavian sections as early as 2002.
In 2010, Dan Sermand (GD MSF-Sweden), Patrice Vastel (GD MSF-Norway), and Michael Gylling Nielsen (GD MSF-Denmark) presented “How to develop in a coherent & optimized manner the 3 Scandinavian sections together in order to strengthen our impact on operations?” at the Office Days[17] in Stockholm.  This was followed up by a presentation from Greenpeace on what a joint Nordic MSF might look like.
The same year the MSF Nordic idea was presented at the Governance Reform Meeting in Barcelona.
In 2011 the Boards of MSF Denmark, Norway and Sweden met in Oslo, and for a first official meeting.  At the meeting it was unanimously agreed that MSF Denmark, MSF Norway, and MSF Sweden have a desire to collaborate, to build on their common strengths and knowledge and have an obligation to make better use of their common resources.  The meeting also discussed the reasoning behind a Nordic model. One of the motivating factors was the wish to improve assistance to populations in danger through better collaboration between the Nordic countries. The name MSF Nordic was chosen over MSF Scandinavia as it would then be able to include new initiatives (such as Finland, Iceland, or the Baltic states) and not limit us to just Scandinavia[18]. The statement from the meeting declares:
In 2013 the General Assemblies (GA) of MSF Norway[19] and MSF Sweden[20] passed a motion requesting their respective Boards to explore the option for a potential merging of the Associations.  MSF Sweden went one step further and also asked that the option of merging offices also to be investigated. While the motion proposed this to be a “Nordic process”, there was no motion presented at the Danish GA and thus no mandate from the Danish members to go ahead with the motion.
After the 2013 motions there were several meetings to further discuss the vision of a MSF Nordic, it was discussed by the members at the 2014 PowWow in Oslo in as well.  Each section appointed a Nordic Focal Poin within the Board to act as a link and share information between the Boards as well as facilitate cooperation.  Since March 2013 it was decided that the three Presidents will exchange information on strategic issues in advance of important national and international Board Meetings, share debate evenings via streaming, hold common activities such as a shared newsletter and to consult the other Nordic Presidents prior to opening new positions within any of the Nordic sections[21].
Following the 2013 GA votes in Sweden and Norway, KPMG conducted a pro-bono study of three potential models for MSF Nordic, which were presented to the members of all three sections for a vote at the 2014 GAs. The study looked at various factors when evaluating the models, the feeling of belonging of national members, office employees, and expats; participation and active engagement; the interest of donors; efficiency; effectiveness and cost savings, the national impact and practical organization issues and functionality[22].  The models were:
1. Nordic co-operation:  No major change from how the Boards were functioning at the time, with maintained national governance, influence, and particpation.  The co-operation model maintains the local assocaitoins and preserve the relationship to local donors and expats.
2. Nordic medium: The national associations with strong local offices and engagement would remain, but moving the governance would move to a Nordic level. The reduced national influence on local levels could be viewed as a risk factor, though there would be positive gains in terms of costs and an effective way of collaborating through e.g. a shared service center and benchmarking.
3. Nordic united (also called Nordic Extreme): One joint association and one Board overseeing the activities of all three offices.  There could be negative impacts in terms of engagement, as people do not have a nation association or a strong local office to relate to.  On the other hand it would mean an increase of the Nordic influence and a strong Board.  
Again the outcome varied between the three GAs. While MSF Denmark voted in favor of Nordic Cooperation, the members of MSF Sweden overwhelmingly voted in favor for model three – Nordic United.  In Norway the Board asked the members for a consultative vote, not a binding motion, and the members voted in favor for model three as well but with a smaller margin than in Sweden.
In December 2014 a decision was taken by MSF Norway and MSF Sweden to recruit a Nordic Manager[23], preferable someone with experience in change management, to facilitate the merger.  The recruitment was postponed until the end of 2015.  The plan is for the Nordic Manager to report back to the 2016 General Assembly in Oslo.
Following on the 2014 votes, the Board of MSF Norway and MSF Sweden decided to hold a first joint General Assembly in Göteborg in 2015.  Significant work was also done to begin harmonizing the statutes and General Assembly Guidelines to facilitate for a joint event.  At the GA the member proposed motion where they asked the Boards of MSF Norway and MSF Sweden to “present a shared set of legal statutes, fully harmonized between both associations in order to give clear direction to the MSF Nordic vision process, the associations of MSF Norway and MSF Sweden mandates the Boards of MSF Norway and MSF Sweden to present a shared set of legal statutes, fully harmonized between both associations and also towards the statutes of MSF International and applicable for the general governance of both associations.  The proposed set of common statutes changes should be presented for approval by the associative at the joint General Assembly in 2016”[24].
In September 2015 the Swedish Board unanimously approved a statement for the Nordic where they wrote: “We, the Board of MSF-Sweden, stand unanimously behind the creation of ‘MSF-Nordic’ and the MSF-Sweden General Assembly motions passed in 2013, 2014 and 2015. We do so for the benefit of our patients and the people we speak out for[25]” and “Acting on the motions put forth, and approved by our members, our short to medium term goal (to be completed latest by 2018 given the legal complexities of the process) is to fully merge the MSF-Sweden and MSF-Norway Associations and Boards in order to create the MSF-Nordic Association. The implications of this merger are being thoroughly considered in order to deliver the best results for our Associations and the movement. MSF-Nordic will be a joint voice at the international level while maintaining our diversity and strength.[26]
To be continued…

[1] This is in no way a comprehensive history of MSF, rather an attempt to look at some of the major decisions and reasons leading up to the formation of MSF Nordic. Therefore the focus is on governance, organizational growth and development of the associative.
[2]  Médecins Sans Frontières is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principles:
  • Médecins Sans Frontières provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. They do so irrespective of race, religion, creed or political convictions.
  • Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions.
  • Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic, or religious powers.
  • As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them.
[3] Today Operational Centers
[4] GD 19 Meeting Minutes 14-15 June 2005 - Montreal
[1] GD 19 Meeting Minutes 14-15 June 2005 - Montreal
[2] La Mancha Agreement 25 June 2006, Athens
[3] ‘Mutual accountability’ refers to members being transparent and holding each other to account for adhering to international decisions.
[4] MSF Governance Reform: Looking Back, Looking Forwards (Report by Adrio Bacchetta, Foreword by Unni Karunakara, August 2013)
[5] From Royaumont to La Mancha: 10 years of MSF History (by: Ulrike von Pilar June 2005)
[6] Post 1997 sections. 
[7] The 6 were MSF France, MSF Belgium, MSF Holland, MSF Switzerland, MSF Spain, and MSF Luxembourg, while MSF Greece was counted as 0,5 since it was created to become operational but was stopped by a moratorium on new operational sections in 1994.
[8] A state of play on the associative constitution of MSF (part of the La Mancha background documents) (by Anneli Eriksson, in collaboration with Dan Sermand and Lennart Dahlberg March 2006)
[9] Ibid
[10] Minutes IC meeting – 6-8 November 1998
[11] MSF and its unhealthy growth (A Discussion paper by: Morten Rostrup 2002)
[12] The International Council President 2000 - 2003
[13] MSF and its unhealthy growth (A Discussion paper by: Morten Rostrup 2002)
[14] ibid
[15] GD 19 Meeting Minutes 14-15 June 2005 - Montreal
[16] La Mancha Agreement 25 June 2006, Athens
[17] ‘Mutual accountability’ refers to members being transparent and holding each other to account for adhering to international decisions. 
[18] MSF Governance Reform: Looking Back, Looking Forwards (Report by Adrio Bacchetta, Foreword by Unni Karunakara, August 2013)
[19] Today the movement is made up of 24 Associations.
[20] IC Meeting Minutes December 2007
[21] ibid
[22] ‘Moratorium’ refers to the international council decision not to open any new non-operational MSF entities
[23] Created by governance working group, September 2009
[24] MSF International Statutes (approved June 2011)
[25] The International General Assembly (IGA) is the highest authority in MSF International, charged with safeguarding MSF’s medical humanitarian social mission. The IGA has the final decision on key associative governance issues and provides strategic directions for the MSF movement, while delegating the ongoing oversight of the executive to an International Board (IB) and holding it accountable.
[26] The International Board (IB) has the necessary authority to carry out the duties delegated by the IGA. The Board holds the Executive to account and is accountable to the International General Assembly (IGA).

Temoignage (witnessing, speaking out) is an important part of MSF identity and is seen as a way to give voice to our beneficiaries. However, the price for speaking out could be very high: suspension of MSF activities or even expulsion of the organization from the country/region concerned. In this way, temoignage can lead to the loss of access to the very victims of conflicts, social exclusion and injustices we are giving voice to.  
During this session, we will discuss different issues and dilemmas surrounding our desire to speak out and our interest in maintaining access to the beneficiaries. We will take the recent crisis in Myanmar (suspension of OCA’s activities in Rakhine in 2014) as an example to analyze some of these issues.   
Hélène Lorinquerformer Director of Communications and Fundraising in OCB
Peter Paul de Grooteformer Head of OCA’s Mission in Myanmar (2009-2014)
Nikita Bulanin, HR Department DK
The Ebola epidemic was unprecedented in its impact at every level. Thousands of lives were lost in West Africa. It activated a global insecurity and a high level of medical alertness when it crossed the boarders of the Western Word.
MSF, being one of the very early responders, was faced with an overwhelming task. Both national and international staff got infected and the death toll kept rising until it eventually declined.
A year later and still ongoing incidents of Ebola, we look at the following:
  • How did MSF respond and how are things different today?
  • Were MSF’s advocacy and efforts successful in managing the epidemic?
  • How did other international actors’ effort, or lack of it, impact MSFs work and the epidemic?
  • What weakness and strengths did Ebola epidemic reveal within MSF? Within the international health actors?
  • What have we learnt and how will that make a difference in the future?
Christopher Stokes, General Director MSF OCB
Jay Achar, MD, Ebola Referent MSF OCA
Armand Sprecher,  MSF OCB
Sanne Jespersen, MD, field staff, MSF DK
Morten Rostrup, MD, IB member, MSF NO
Sohur Mire MD, MSF DK Board member and moderator of the debate  
Armand Sprecher - Introduction
Morten Rostrup - 
Jay Archer Ebola Reserach
Christopher Stokes - Overview

Manon Frenken (HR dir OCA)
Sebastien Roy (HR dir OCB)
Sebastien Libert (HR OCB)
Johanne Sekkenes (Former Head of Mission)
Chairperson: Arash Izadkhasti (MSF S)
When we asked what the association members wanted to discuss at PowWow, it was one topic that had a majority of the votes: Human Resources and the challenges in the field.  The headline was big and included many different topics around challenges within human resources in MSF. Trying to keep an open and active debate we still needed to narrow it down. Human resources is a never-ending discussion because expats as well as national staff are at the core of our operations. Therefore many of us have strong opinions about it. 
Some question have been raised to start this debate:  
  • Is the MSF HR vision meeting the challenges we have in the field?  
  • Where have we improved the last years and where is there still need for improvements
  • Are gaps in the field still affecting the quality of our work?
  • Do we need to change or are we on the right track?
The panel will be people with different perspective on the MSF movement when it comes to HR. In the panel there will be people from the field and headquarters and external eye on different management than MSF on HR. This theme many of you felt passionate about so join the debate and make your perspective heard.
Jesper Jørgensen (MSF Dk)
Meinie Nicolai (OCB)
Joan Hu (MSF HK)
Morten Rostrup (IB)
Chairperson: Dina Hovland (MSF N)
In 2011 MSF Norway, MSF Sweden and MSF Denmark established MSF Nordic. Through MSF Nordic we agreed to collaborate and make better use of our common resources.  During the following years, in a variety of settings, there has been a discussion whether MSF Nordic should become something more than a collaboration between the three countries; What about merging the three associations?
In 2013 two different GA motions were passed in MSF Norway and MSF Sweden: The Norwegian GA asked their board to work on merging the three Scandinavian associations, the Swedish GA went further and asked their board to work on merging both the associations and the offices of the three sections. During the Nordic meeting in September 2013 it was decided to let KPMG do a pro bono study on possible shared resources on the executive side. In addition KPMG were requested to do a pro-bono formal analysis on possible models of a Nordic Associative structure.
KPMG has been working with the three Nordic boards since the fall 2013, focusing on questions like "How could a possible merge of the asso look like?" "Could there in the future be one big Nordic GA?" "What would the challenges be for asso life?" "How can we become a stronger and better asso by merging?" There are no clear answers for this yet but the discussion starts at PowWow. This is a first take at really looking at the different options and it will be an interesting and exciting exercise. We need all voices to join in to get a good perspective and discussion on this important topic. Maybe a new idea about Nordic will be born? J
For more background information about MSF Nordic:
Open sessions are sometimes called “unsessions” or “open space.” They’re an alternative to preplanned panels and workshops, and create a space for the attendees to take some control over the conference. Sessions are for the most part proposed by participants the day of the conference, and are participant-led. It’s an opportunity to share work you’re currently engaged in, put forth a question that’s come up for you in your work or at the conference, follow up on conversations you’ve started at the conference, network with others with similar interests or generate new ideas.
If you would like to propose a topic in advance, need help with printing handouts etc please e-mail ellen.schive@oslo.msf.org.
Topics already suggested for Open Session:
  • NCD's
  • Somalia - Withdrawal and now what?
  • Growth: Is MSF losing its impact and focus due to its growth?
  • Are we doing the right things in the right places? The way forward in a global perspective

This year the medical topic at the PowWow will be a presentation and discussion on breakthroughs in MDR-TB drug development. OCA is planning to launch treatment of MDR-TB with bedaquiline, the first new TB drug in 50 years, but a drug that is not out on the market yet. Are there any risks involved in using a new drug? What is the role of MSF in this phase of research/new treatments?
We will have representatives from OCA, the Swedish medical society and also from the ACCESS Campaign giving their views on the issues around MDT-TB and the new drug bedaquiline.
Here is some text from the general press release from MSF on the new drug bedaquiline (see ANNEXES on right side of this page for more):
Médecins Sans Frontières (MSF) welcomed the approval by the US Food and Drug Administration of bedaquiline, the first new drug active against tuberculosis (TB) to be registered since 1963.
“The first new drug to treat TB in 50 years is an immense milestone,” said Dr Manica Balasegaram, Executive Director of the MSF Access Campaign. “The fact that the drug is active against drug-resistant forms of the disease makes it a potential game changer.” 
Today’s treatment for multidrug-resistant TB (MDR-TB) is a two-year course of up to 20 different pills per day and around eight months of daily injections. Patients are subjected to excruciating side effects, ranging from permanent deafness and persistent nausea to psychosis. Globally, only 48% of people who start treatment for DR-TB are cured.   In MSF programmes, the cure rate is slightly better – 53% - but still unacceptably low.
“Ministries of health and drug regulators need to work together to make sure people with MDR-TB benefit from this important medical advance as soon as possible. The onus is on all of us to use bedaquiline to devise new treatment regimens for drug-resistant TB that are shorter, more tolerable for patients, and are more effective,” said Dr. Balasegaram. “With better treatment on the way, there should be all the more incentive to scale up our efforts to treat MDR-TB today.”
MSF's Jennifer Hughes is interviewed on live television about MDR-TB and bedaquiline (26 Jan 2012):
Also, here is a video about Dalene Von Delft, South African doctor who was cured of MDRTB after being granted compassionate use of the new treatment:
Background Materials: 
The United Nations High Commissioner Report of December 2012 states that this conflict has become ‘overly sectarian’. The same report also indicates that communities are arming themselves and confirms that hospitals are routinely targeted as part of the conflict:
Although none of our hospitals have been hit, in January a missile landed 800 metres from an MSF field hospital in the Aleppo area.  The severity of the polarization in Syria is such that conducting medical activities is seen as actively engaging in the conflict; "Being caught with patients is like being caught with a weapon," said an orthopedic surgeon whom MSF met in a village in Idlib Governorate. It is also an obvious, even extreme example of what CRASH describes as “the integration of the aid system in the United Nations’ political strategies” (CRASH:2012). As a result of the UN’s positioning, there is a distinct lack of purely humanitarian aid. Whilst security is an issue, the main reasonthe humanitarian community is not willing or able to engage in the context in a meaningful way is because of a lack of available funding. Dounia Dekhili of MSF says that "We are in a very particular situation in Syria: no impartial humanitarian aid can be brought in, and the harassment of the wounded and doctors is part of the regime's police strategy".
Since the outbreak of the conflict in March 2011 MSF has worked tirelessly to gain access via official channels but however decided to enter Syria via Turkey in June 2012 to begin operations in the northern parts of Syria in areas of opposition control and in doing so have endured severe operational and security constraints: “MSF doctors, after failing to get permission to work in the country, entered clandestinely and managed to reach the rebel strongholds of Homs and Idlib, where "patients and medical personnel are hunted down and run the risk of being arrested and tortured," according to MSF’s Dounia Dekhili.
In such contexts the humanitarian principles become much more than just words in a charter, they become essential operational tools used to mitigate the security of our operations.  The theory goes that as the security environment deteriorates; the security of our staff is determined by our ability to present ourselves as a neutral, impartial and independent humanitarian actor. The fact is that we have chosen to operate in Syria, where there seems to be a real void of the international humanitarian community due to the political complexities, and we are assuming risks, including targeted attacks. At La Mancha there were landmark discussions around how much risk we should incur in order to provide medical care where ‘political and military forces reject our very presence’. The level of risk on MSF right now in Syria is high, however the needs are clear and the argument for humanitarian imperative and solidarity in the case of Syria is compelling. Either way, from an internal point of view there still remains a necessity to discuss the nature of our engagement in Syria - how do we assess the risks involved, both for our teams on the ground and for our identity as a neutral, impartial and independent organisation?
In addition, since the beginning of the conflict we have been engaging with non-neutral actors such as networks of Syrian doctors and various Diasporas. Perhaps it is in order to question the management of our identity; how we have presented our impartiality in Syria, and what implications this could have on the security profile of our operations.
Efforts to gain access to the State controlled areas in Damascus has been an example of contention between operational centres, largely based on the level of compromise we should be willing to accept in order to be allowed to work there. As a result it is not clear to what length we are willing to go in order to become active on both sides in this conflict (in the name of impartiality) and also what these compromises would mean for our humanitarian principles?
In an era of humanitarianism marked by GWOT (Global War on Terror), one which has brought a new and increased complexity to managing security in contexts of political conflict (a.k.a. complex humanitarian emergencies or CHEs), MSF has been forced to adapt its preferred operational model in order to maintain access to populations critically in need of medical humanitarian assistance. From places like Somalia, where targeted attacks on MSF staff have led to forced removal of expatriate staff and a reliance on remote management models and national staff competencies, to a context such as Afghanistan where political and humanitarian agendas have been so blurred that MSF have for the first time operated as just one MSF with the understanding that an uncomplicated humanitarian message will improve the security profile there. In Somalia last year, and where two of our colleagues still remain in captivity, MSF field staff called for an intersectional strategy on Somalia, a motion coming from the FAD that was passed at the IGA in June.
In Syria, how do we show that we are learning from our previous experiences?
  • The conflict began with nationwide demonstrations in the middle of March 2011, in Deraa, before spreading across the country.
  • Latest figures from UNOCHA estimate the conflict has displaced over 2 million people internally and there number of refugees as a result of the crisis is estimated at 700,000.
  • MSF teams are providing emergency, obstetric and general healthcare in Syria. From June 2012 to January 2013, they conducted more than 10,000 consultations and performed over 900 surgical interventions.
  • On 24 January a missile landed 800 metres from an MSF field hospital in the Aleppo area, although no casualties were reported. On 13 January, after an airstrike on a market in the nearby town of Azaz, 20 wounded were treated at MSF’s hospital.
  • Since the protests began in Syria almost two years ago, MSF has tried to gain access to the areas where humanitarian needs are most urgent. However, the scope of MSF activities inside Syria remains limited due to insecurity and official restrictions. For months MSF has been seeking official authorisation to assist Syrians in government-controlled areas, so far without success.
Background Materials:
During the 8th and 9th of March, 127 members from MSF Nordic gathered in the island of Skeppsholmen, in downtown Stockholm for the PowWow 2013. From listening to panellists on the new treatment against Multi-Drug Resistant Tuberculosis, debating enthusiastically on MSF principles in Syria and participating in Open Space sessions, MSFers raised their voices and their concerns. The event ended with the so-traditional Nordic game and a vibrant party!
Moderated by Hernan Del Valle, Session 1 about MDR-TB counted with presentations by Pim De Graf from OCA, Oliver Moldenhauer from ACCESS and Judith Brunchfeld from Karolinska Hospital. They emphasized on the need for liaisons to commence the experimental phase of a shorter, less painful medical treatment for TB patients.
On a bright Saturday morning, MSFers gave way to Session 2 about operations in Syria and humanitarian principles. It was moderated by Jean-Marie Kindermans, and it counted with the participation of Fabrice Weissman (OCP), Morten Rostrup (IB), Teresa Sancristóval (OCBA) and Marie-Christine Ferir (OCB). Questions like: is MSF jeopardizing its impartiality by bringing relief solely in areas under control of one side of the conflict?
 Is the communication campaign balanced enough? These and others were debated by MSF members ahead of new humanitarian challenges of the two-year armed conflict.
Saturday afternoon was time for the Open Space “Speakers Corner”, where MSFers chose to participate in discussions on a variety of topics, from the role of gender in humanitarian operations to the future of institutional funding.
Saturday night closed the PowWow with MSF Sweden celebrating its 20th Anniversary. Balloons and a flamenco crown for its founder, Johan Von Screeb started the party mood. The Nordic Game also took place during the night with MSF Norway, Sweden and Denmark having to take an MSF Emergency Team off an island infected with a strange, horse-meet induced diseases. The night ended with an authentic, Nordic-style party.



By: Rebecca Cederholm