The MSF Pocket Sanou. Médecins Sans Frontières at a glance

The MSF Pocket Sanou Médecins Sans Frontières at a glance Sanou means welcome, hello in Hausa, one of the languages of Niger where the Sanou training course was launched in 2010

January 2012 OPERATIONAL CENTRE BRUSSELS TRAINING UNIT Foreword This document is for people working with Médecins Sans Frontières. It is a general introduction to help you better understand Médecins Sans Frontières, its origins, how it has progressed, its values and how it works. We hope you enjoy it! By : Xavier Tislair Layout : Annick Filot Illustrations : Gérard Lemaire 2

CONTENT 3 CONTENT 4 OUR VALUES 6 OUR PRINCIPLES 10 WHERE WE WORK 14 HOW WE WORK 22 OUR HISTORY 27 OUR ASSOCIATION 3

OUR VALUES Our humanitarian work is founded on the principles and values set out in the charter. These values neutrality, impartiality, non-discrimination, personal commitment, and medical ethics are lived and put into practice every day through the choices made by both MSF as a whole and every one of its members. We expect MSF members to understand these values and to make them their own. That is why, when you join MSF, you must read, understand, accept and sign the Employee s Charter, which is a fundamental part of your employment contract. THE MSF CHARTER Médecins Sans Frontières is a private, international association whose members agree to honour the following principles: 1. 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. 2. 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. 3. Members undertake to respect their professional code of ethics and maintain complete independence from all political, economic or religious powers. 4. As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their beneficiaries for any form of compensation other than that which the association might be able to afford them. We have received a mandate from no-one: our action stems from our own vision of humanitarian work and our own aim to help save life and relieve suffering while respecting people s dignity and the determination to restore to all people the ability to make their own choices. Every MSF member undertakes to respect the Charter as part of his or her contract with MSF. 4

VALUES THE EMPLOYEE S CHARTER 1. MSF employees undertake to refuse all physical or psychological abuse of any person and any behaviour that offends human dignity. 2. MSF employees undertake never to tolerate sexual relations with minors under any circumstances. 3. MSF employees undertake to refuse all forms of exploitation of an individual s vulnerability in the broadest sense (for example, economic or social vulnerability) and any involvement of personnel in such exploitation. 4.MSF employees undertake not to derive any personal benefit from the posts they hold. 5. MSF employees undertake to respect the opinions, knowledge, lifestyle, religion and beliefs of other member of personnel and the local population in general, provided that they do not infringe the humanitarian values and principles upheld by the association. 5

OUR PRINCIPLES and how we put them into practice OUR WORK IS OF A HUMANITARIAN NATURE AND SEEKS TO SAVE LIVES WHILE RESPECTING PEOPLE S DIGNITY AND TO RESTORE TO ALL PEOPLE THE ABILITY TO MAKE THEIR OWN CHOICES WHEN CIRCUMSTANCES HAVE DEPRIVED THEM OF THIS. THIS WORK IS CARRIED OUT IN COMPLETE INDEPENDENCE, NEU- TRALITY AND IMPARTIALITY. 6 THESE THREE KEY PRINCIPLES GUIDING OUR WORK REPRESENT THE FOUNDATION OF EVERYTHING WE DO

PRINCIPLES I NDEPENDENCE Our independence is reflected above all in our independent thinking: this is essential if we are to analyse and act independently. It enables us to freely choose our operations, how long they should last and the resources needed to carry them out according to the requirements identified in the field. And it enables us to ensure that we are not responding to needs fixed by governments who may have a specific political agenda. I MPARTIALITY Impartiality cannot be separated from our independence of action. Impartiality is defined by the principles of non-discrimination and proportionality : - non-discrimination on the grounds of political conviction, religion, gender or any comparable criterion; - proportionality of assistance to the intensity of needs. MSF gives priority to helping the most seriously and most immediately endangered people. N EUTRALITY We do not take sides in armed conflicts, observing the principle of neutrality. Humanitarian neutrality means insisting that rescue operations are not in themselves hostile acts or contributions to the war effort of any of the belligerents. But remember: neutrality is not synonymous with silence or preserving absolute confidentiality. When volunteers witness extreme violations of international humanitarian law, bearing witness may be the last means left to them to help the people we are assisting. In these cases, we must speak out and mobilise opinion to bring a halt to abuses and improve the situation of the population in question. 7

Putting our principles into practice V OLUNTEERING MSF is an association made up of volunteers. Volunteering means making an individual commitment and taking on a personal responsibility. It carries with it the idea of an actively committed, politically-aware approach to humanitarian action rather than that of charity work. Volunteers accept the risks of the missions they join as well as a certain degree of occupational insecurity. This is a decisive factor in continuing to resist compromise, routine and institutionalisation. MEDICAL ACTION COMES FIRST Our action is first of all medical. The main task is to offer curative and preventive care to people in danger, regardless of the country they are in. This work forms part of an operational policy that determines the general direction of our actions. It guides our choice of priorities, within the limits of our resources, faced with endless needs. This policy evolves over time depending on the environment and the key challenges facing populations. 8

PRINCIPLES RESPECT FOR ETHICS Medical ethics require us to provide care without causing harm and to assist all persons in danger with humanity and impartiality, while respecting medical secrecy. In this area, international humanitarian law lays down that no-one may be punished for carrying out medical work in keeping with medical ethics, whatever the circumstances and whoever the recipients of such work. Those performing medical tasks may not be made to carry out acts or work that are unethical SPEAKING OUT ( TÉMOIGNAGE ) This is one of the pillars of our action and is what makes our organisation unique. Our closeness to populations enables us simultaneously to carry out medical work and to speak out where necessary. Our familiarity with the field and the real situation of victims gives strength and credibility to our witness-bearing. In revealing suffering by speaking out, MSF confronts decision-makers with their responsibilities and helps to create an ethical awareness in civil society. 9

WHERE WE INTERVENE The contexts where we intervene include: Violence During conflicts and other violent situations, MSF teams can provide care to refugees and internally displaced persons. MSF can also provide health services for entire populations in conflict zones. Our teams are involved equally in treating the direct effects of violence, such as gunshot wounds or sexual violence, and the indirect impact, such as epidemics. Assisting the victims of natural disasters Natural disaster response includes rapid intervention in the wake of earthquakes, hurricanes, cyclones and tsunamis. Epidemics and endemic diseases We run programmes targeting specific diseases such as tuberculosis, malaria, HIV/AIDS, cholera, meningitis, measles and haemorrhagic fevers. We keep a constant eye on neglected diseases such as kala-azar and sleeping sickness. Acute health system shortcomings Regions emerging from conflict are often in acute need of medical assistance, as populations remain vulnerable and medical systems have not yet had time to fully rebuild themselves. 10

Some of our activities ACTIVITIES SURGERY We send surgeons to many different contexts. These range from war surgery in highly unstable contexts, to caesarean sections in maternity clinics. Where support for health structures is concerned, we often refurbish operating theatres and provide personnel to treat hospital cases in deprived areas. MOTHERS & CHILDREN Women and children are among the most vulnerable groups in the emergency situations where we are involved. Gynaecological and obstetric health checks, neonatal consultations, special nutritional programmes, vaccination campaigns, contraception, treatment of sexuallytransmitted diseases and health education are a major part of our work. WATER & SANITATION Supplying drinking water may be particularly difficult in some contexts. It is crucial for us to be able to provide emergency access to drinking water for population groups such as refugees and internally displaced persons (IDPs) or to health structures. We can also ensure the evacuation of raw sewage and waste management in situations of this kind. 11

Some of our activities NUTRITION VACCINATION MENTAL HEALTH We regularly monitor the nutritional situation in our intervention zones. When critical situations are detected, we set up intensive therapeutic feeding centres (ITFC) so we can feed children suffering from severe malnutrition with medical complications. Children suffering from severe malnutrition without medical complications, and who have an appetite, are treated in Ambulatory Therapeutic Feeding Centres (ATFC) while children suffering from moderate malnutrition, pregnant women and breast-feeding mothers visit Supplementary Feeding Centres (SFC). Epidemics often develop in emergency situations where large numbers of vulnerable people are affected by crowding and poor sanitary conditions. In order to prevent diseases such as yellow fever, measles and meningitis from spreading, we launch mass vaccination campaigns whenever necessary. The death of loved ones, violence or the threat of violence, and witnessing massacres are among the traumatic events that can give rise to serious mental and physical problems in the course of conflicts and crisis situations. If no assistance is available, traumatised victims may suffer from long-term insomnia, anxiety, headaches, apathy and other symptoms of physiological and psychological disorder. When necessary, we include psychosocial care within both emergency and long-term projects. 12

ACTIVITIES PRIMARY HEALTH CARE Treating people who need medical care is at the core of what we do. When necessary, we carry out and coordinate this work. We also arrange for adequate supplies of medical equipment and medicines. Primary health care mainly comprises basic health care, distribution of medicines and directing patients towards secondary health care. ACCESS TO ESSENTIAL MEDICINES Since 1997, we have been spearheading a campaign for the most disadvantaged populations to have access to essential medicines. The aims are simple in practice: making high-quality medicines accessible for forgotten or neglected diseases. 13

HOW WE WORK? MSF STRUCTURE MSF is made up of two structures: the executive sphere and the associative sphere. They work together to provide effective governance and create a coherent movement. The executive manages day-to-day operations. It shapes the various aspects of each project activities, human resources, finance etc. The associative deals with MSF s identity, its ethics and principles. The executive might be seen as MSF s brain and the association as its heart. While the executive sphere is organised as a hierarchy, the association is made up of members who may be from the field, the various headquarters or even people who no longer work for MSF but still maintain an interest. All these people have the same right to see what is going on. When the association takes decisions, the vote of a new member is just as important as that of the general director. 14

THE EXECUTIVE Operational centres and partners HOW DO WE WORK The OCB is a partnership comprising the MSF sections of Belgium, Denmark, Hong Kong, Luxembourg, Norway and Sweden, together with the delegate office in Brazil and the branch office in South Africa. An OC (operational centre) is made up of a group of sections whose purpose is to guide and support field interventions. There are currently five OCs, based in Brussels (OCB), Amsterdam (OCA), Barcelona (OCBA), Paris (OCP) and Geneva (OCG). Each section has an office, headed by a general director who is appointed by the Board, and several departments Delegate & branch offices These offices do more than raise funds and recruit volunteers like the partner sections. They have a broader role within the movement. Amongst other things, they can provide operational support. Although they are independent of each other, they all belong to the same organisation and share the same Charter. Partner sections Apart from operational and operational support functions, each section has a wide range of tasks, geared to : - Recruiting international personnel - Fund raising - Communication. 15

THE OCB EXECUTIVE Operational Centre of Brussels OCB The Operations Department is at the heart of the OCB and directly runs field activities. The Operations Department and the field are supported by the expertise provided by the support departments (Medical, Logistics, Human Resources, Finance and Communication). The Analysis & Advocacy Unit is not a department, but performs a crucial role within the OCB. It is directly attached to the General Direction. The AAU provides analyses of our intervention contexts and helps to shape MSF s external positions. AAU The Finance Department manages accounts and checks expenditure and income. It is also responsible for contacting institutional donors and seeking new sources of funding. FIN 16

The Medical Department comprises experts on matters including mental health, nutrition, hygiene, water & sanitation and specialists in specific diseases such as AIDS and tuberculosis and in vaccination and laboratory work. They contribute their expertise to our missions. HOW DO WE WORK MED HR The Human Resources Dpt ensures the harmonious and coherent management of both headquarters and field personnel. It deals with personnel recruitment, career development and training so as best to meet field needs. O PS COM The Communication Department defines our strategy for communicating with the general public. It is responsible firstly for communication and fundraising with the Belgian public, and secondly for advising the field and the cells on operational communication. LOG The Logistics Department deals with transport, technology, communications, telecommunications, construction, technical assistance and refurbishment. 17

THE OCB EXECUTIVE Operations BRUSSELS HEADQUARTERS DEPARTMENTS OCB General Director Operations Director HEADQUARTERS CELLS Operations Coordinator FIELD COORDINATION Head of Mission (HOM) FIELD PROJECTS COTL Field Coordinator (Field co) 18

Each department is headed by a director who reports to the general director. Together they form the management team. The way the executive sphere is organised at headquarters level reflects the way a mission executive is organised. HOW DO WE WORK Medical Director HR Director Finance Director Logistics Director Com Director Medical Referent HR Officer Finance Referent Logistics Referent Com Ops Medical Coordinator (MEDCO) HR Coordinator (HRCO) Finance Coordinator (FINCO) Logistics Coordinator (COTL) Medical Team HR Team Finance Team Logistics Team 19

Satellite organisations In its constant search for efficiency, MSF has decided to set up specialist organisations known as satellites to implement specific actions, including supplies to humanitarian work, medical and epidemiological research, and research into humanitarian and social action. Epicentre contributes its know-how to organisations who need short-term field epidemiological studies in developing countries. Epicentre develops and provides training courses for MSF and other partners in the field of public health and epidemiology The Foundation MSF was set up in 1989 with the aim of promoting humanitarian and social action in France and abroad. Its purpose is to provide support for MSF actions and the MSF association. MSF Supply is a humanitarian supply centre. MSF Supply also handles packing and customs formalities for goods and prepares the emergency kits. In addition, it is responsible for the quality control of equipment and medicines. MSF Supply acts under OCB leadership and supplies both OCB and OCBA. MSF Supply was set up in 1989. MSF-Logistique is the OCP counterpart of MSF Supply, performing the same functions. It is based in Mérignac, near Bordeaux. It mainly supplies OCP, OCG and OCBA. In 1999, after being awarded the Nobel Peace Prize, MSF launched the Campaign for Access to Essential Medicines (CAEM). The campaign s objective is to improve access to medicines and boost the development not only of life-saving and life-prolonging medicines, but also of diagnostic tests and vaccines. 20

MSF fundings HOW DO WE WORK MSF SAFEGUARDS ITS INDEPENDENCE BY STRIVING TO REMAIN FINANCIALLY AUTONOMOUS The bulk of MSF s financial resources comes from donations (private funds) from individual people in more than twenty countries, with only a small portion (approximately one tenth) coming from governments. Where sensitive intervention contexts are concerned, we do not accept any institutional funding. The high level of private independent funding fully guarantees MSF s freedom. This is what enables us to mobilise funds rapidly in response to those needs identified as most urgent by our volunteers. It also means that when an emergency occurs, MSF does not need to wait for funds to be released by governments, or for them to decide to intervene. 21

KEY MOMENTS IN OUR HISTORY 1971 MSF gets off to a tentative start On 20 December 1971, MSF is set up by a group of doctors and journalists at the offices of TONUS (a journal for doctors) in Paris. A founding document, the Charter is drawn up. MSF is born that evening, but the delivery is not easy. The dream of the new organisation is to get quickly to the scene of every disaster, to cross borders and go where the Red Cross cannot. It opts to be on the side of the victims, whoever their oppressors may be and whatever borders may stand in the way of intervening. 1985 Ethiopia: the humanitarian trap An unprecedented famine wipes out thousands of people struggling with drought. MSF sends tonnes of medical equipment, medicines, food, tents and blankets. The operation is enormous for the time. But our volunteers cannot remain silent when they see humanitarian aid being misappropriated and thousands of deaths caused by the government s policy of transferring populations. The Ethiopian case sparks a debate on how humanitarian assistance can be turned against the populations it is supposed to help. Constant vigilance is needed not to fall into this humanitarian trap. 1984 MSF-Netherlands born 1971-1979 Between 1971 and 1979, MSF intervenes in the floods in Nicaragua, the Vietnam and Lebanon wars, in East Pakistan (future Bangladesh) and in the Cambodian refugee camps in Thailand. 1981 Chad, the Belgian section s first flagship mission In a country bled dry, devastated by war and drought, MSF implements a fullyfledged medical replacement programme. 1979-1989 Multiplication of intervention zones, professionalisation and spread of the MSF ideal 1980 Creation of MSF-Belgium by ex-msf workers and young doctors who have worked in the refugee camps in Thailand. MSF- Switzerland is also born the same year. 22

HISTORY 1987 1988 Western Europe Aid projects for excluded populations within western countries open in Brussels, Paris, Rome and Barcelona (AIDS, the homeless, drug addicts, etc.) Massive earthquake in Armenia, 50 000 dead 1991 Somalia: civil war, Mogadishu devastated Seen through western eyes, the suicide of a nation seems to be unfolding. More than 300 000 Somalis die. On 9 December 1992, US Marines acting under a UN mandate land on the beaches of Mogadishu to restore order and bring in food. The operation descends into chaos. 1989-1994 The first large-scale, concerted intervention by the six operational sections (Belgium, France, Spain, Luxembourg, Netherlands and Switzerland). This intervention, pointing to future developments, marked the opening up of Eastern Europe. World disorder and the right of humanitarian intervention 1989 The Americans fear getting bogged down, withdraw and hand over to UN blue helmet peacekeepers. A first in world history: a humanitarian war to impose peace! The UN becomes a party to the conflict just like the others. MSF consistently condemns the inconsistency of this humanitarian war, together with the many military excesses. Liberia: war breaks out off-screen A particularly vicious conflict erupts in Monrovia, the capital of Liberia, to the general indifference of the international community. The dream, however, appears to become reality in 1991, the UN recognises the right of humanitarian intervention, on the understanding that the right to life and human dignity of people takes priority. Our volunteers remain completely incommunicado for a lengthy period, cut off from the world. Liberia displays the first symptoms of an explosion of violence in a toxic mix of war lords of no particular ideology, child soldiers, state collapse, intervention by outside military forces to impose peace and the breakdown of immunity for humanitarian workers From the outset, however, military-humanitarian interventions carried out under the banner of the right to intervention, prove disastrous. Each time, the mandate given to armed forces focuses on protecting humanitarian aid although the primary need is to protect the affected population. MSF strives to keep afloat the idea of a neutral, independent humanitarian space to help populations. 23

OUR HISTORY CONTINUES 1991 Yugoslavia falls apart, war in Europe The war in former Yugoslavia combines every kind of abuse: humanitarian work is used as an alibi for western political players, incapable of shouldering their responsibilities in this European conflict. It serves to justify the arrival of UN troops to protect humanitarian action, while it is the populations in place who are primarily in need of protection against ethnic cleansing. MSF provides assistance everywhere in the country. Our presence throughout the war is marked by powerful instances of bearing witness. 1995-1998 1995-1998 Internationalisation Towards the end of the 1980s, the need for coordination between the various sections becomes clear and the sections set up an International Office. The years between 1995 and 1998 are marked by doubt and self-criticism, and a crisis of identity for the entire organisation. Against this backdrop, all the sections meet in Chantilly and adopt a common text stating that they want to preserve an international organisation sharing a single vision. 1994 Rwanda - MSF confronted with the 20th century s third April to June 1994: genocide of Tutsis and moderate Hutus in Rwanda. MSF witnesses the Rwandan genocide, condemning it swiftly and completely. In the field, violence and threats towards Belgian nationals are such that our volunteers have no choice but to withdraw. The genocide unfolds practically behind closed doors for 3 months. 1994 December 1994: Chechnya Russian tanks enter the capital, Grozny A million people are trapped in Grozny, digging in as best they can under a hail of bombs, rockets and machine gun fire. Hospitals, public buildings, homes nothing is spared. The city is in ruins, razed to the ground. A small team of volunteers provides medical support in a delicate mission, under highly unstable security conditions. In May, MSF comes back to Rwanda, just behind the front lines. And when the new regime massacres thousands of displaced people in Kibeho camp (1995), our witness is crucial to breaking the silence. 24

1998 Famine in Sudan aid systems called into question This intervention goes hand in hand with criticism of the United Nations aid system, which has become completely distorted. MSF successfully demonstrates that the most vulnerable people receive nothing, and that the Unicef and WFP logistical effort principally benefits the most powerful. 2004 Withdrawal from Afghanistan and Iraq Expatriate personnel have to be evacuated following the events of 11 September, but programmes continue and teams soon return. International military actors often make use of humanitarian aid in these regions to win hearts and minds among the population. The line between military and humanitarian activity is blurred, putting humanitarian workers in danger. HISTORY 1999 NOBEL PEACE PRICE NATO bombs Kosovo under the humanitarian war banner Kosovo is completely emptied of its inhabitants, who flee to Albania. The humanitarian-military overlap is intolerable. MSF objects, refusing funding from NATO member countries in order to maintain its absolute neutrality. This principled stance is a turningpoint, but does nothing to help MSF s perceived neutrality : MSF never gets the green light from the Serbian authorities to intervene at the heart of the conflict. 15 October 1999 : Médecins Sans Frontières receives the Nobel Peace Prize for its overall work as an organisation 2000 9/11 and after 1999 2000 MSF accepts this honour but reminds the great and good of this world that awarding a prize does not diminish their political responsibility towards populations in danger in the slightest. The United States declaration of war on terror changes the conditions under which humanitarian organisations operate. MSF faces increasing difficulties in explaining to local actors that it is completely independent of the governments that support or sometimes even carry out military interventions in their countries. AIDS and the access to medicines campaign MSF broadens its scope to combating the AIDS epidemic, tuberculosis, malaria, the progressive break-down of health systems and lack of access to medicines and health care. Humanitarian action is essential when politicians fail or are caught up in crisis. 25

OUR HISTORY CONTINUES 2004 Afghanistan five MSF employees murdered in June 2005 For MSF, this incident illustrates the authorities passivity and lack of commitment to the security of humanitarian workers on their territory. As a result, MSF withdraws completely from the country in July. In November, MSF also quits Iraq, judging that the risks to its expatriate and local personnel are too high. Emergency in Darfur MSF sets up supply centres, health care centres and carries out vaccination campaigns in the Darfur region of western Sudan, as well as in neighbouring Chad, where hundreds of thousands of people have fled from the extreme violence perpetrated in Darfur. La Mancha In order to cope with the constant growth of its activities, budget, sections and satellite offices, MSF decides to devote an entire year to a series of consultations and debates involving all the sections. The main result is a series of plans to improve MSF s decision-making processes and governance structures as a movement and as an association. 2009 2010 Haïti MSF launches its biggest-ever emergency intervention straight after the earthquake in January 2010. This operation is directly followed by an unprecedented intervention against the cholera epidemic. MSF employs 2000 people (90% of them Haitians) working in 5 hospitals and medical centres across the country. The upsurge of international solidarity is impressive. In 2010, MSF gathers EUR 111 million for its Haiti emergency fund, EUR 106 million of which were used in 2010. MSF not any particular section returns to Afghanistan (under OCB coordination) 26

OUR ASSOCIATIVE ASSOCIATIVE MSF was set up by a group of people with shared objectives and ideas, as indicated in the Charter. This feature of MSF as an association remains true today, although several decades later, MSF has grown into a much bigger organisation bringing together 19 sections and four delegate/ branch offices and so more than 20 associations. Through the association, MSF members can raise questions and influence the direction taken by the organisation. THE ROLE OF MEMBERS Members or associates represent the supreme authority when meeting in General Assembly. The association is responsible for the overall direction of the movement where MSF wants to go while the organisation s employees are responsible for putting ideals and specifications into practice in the field. The added value brought by the associative dynamic lies in challenging the executive, but also in bringing everyone together into the various debates and questions facing MSF. On a day-to-day basis, members entrust this task to each section s Board. It is made up of members of the MSF association elected at the annual General Assemblies. Therefore it represents the members, and its task is to ensure that MSF respects the principles enshrined in the MSF Charter in its work and development. The Board appoints the General Director and gives him or her the responsibility for the decisions taken and actions implemented by the executive sphere. The General Director has an observer role, and opens debates that question the executive sphere. 27

THE OCB GATHERING ORGANISATION The OCB Gathering is the major event of the year for the association. It is for the OCB what the General Assembly is for the sections. It is held once a year in Brussels, in conjunction with the week for heads of mission and medical coordinators, and brings together between 200 and 300 members from headquarters, the partner sections, other sections and missions where projects are under way. It is filmed and broadcast live to the missions whenever possible, so debates can be held regardless of distance. The aim is to create a real link between the field, members, and the OCB decisionmaking process. It is the main associative platform for debates and motions on OCB operations, and the main platform for field representatives (chosen during the Field Associative Debates or mini-gas). MOTIONS Motions are formal procedures for submitting questions to the assembly for debate. They reflect the thoughts and questions of members or the Field Associative Debates regarding the movement s origins, its image, aspirations, responsibilities, principles and mandate. A Motions Committee, made up of OCB Board members, selects the motions to be submitted to the OCB Gathering each year, preferably by their original authors. The OCB Board members are also elected at the OCB Gathering. The Board is made up of one representative from each of the OCB partner sections and 6 members elected directly at the Gathering. 28

THE OCB GATHERING ASSOCIATIVE RECOMMENDATIONS LES MOTIONS Recommendations, in contrast, are always addressed to the executive, i.e. mainly the directors of the various services. They bring together suggestions (whether new or intended to refocus the existing debate on particular points) regarding the structural, operational or administrative policies implemented by the executive. AFTER GATHERING The motions adopted at the OCB Gathering are acted upon by the OCB Board and the executive, and the results are presented at the following year s OCB Gathering. Motions can have important effects on the way MSF s operations are conducted. In 2001, a motion prompted MSF to undertake antiretroviral therapy. MSF must take responsibility for the AIDS treatment of national staff and their immediate families. This must be done without allowing problems related to continuity, sustainability or access to treatment for the whole population, which it is imperative to resolve, to become a barrier to implementation. Following this resolution, MSF introduced a specific policy on how to handle HIV/ AIDS for its employees. The policy includes free treatment, access to ARVs, management of opportunistic infections in all contexts, everywhere MSF is present, and regardless of whether or not an HIV/AIDS project is under way or not at the location of the infection. 29

THE ASSOCIATION IN THE FIELD FADS- FIELD ASSOCIATIVE DEBATES Associative activity may be central to some missions, less visible in others. It is up to each individual member to stimulate its existence The minimum is usually a yearly field associative debate (FAD), also known as mini-gas. The FADs give everyone working for MSF in the field the opportunity to discuss issues that are important to the association. Board or headquarters members often visit the missions so they can also take part in the FADs. In the course of a FAD, recommendations and proposals ( motions ) can be formulated with the aim of reorienting and improving MSF s work. The conclusions of the field debates are sent to the International Office, which puts all the information together and forwards it to all the sections. At the OCB, some of the motions are presented, debated and voted on at the OCB Gathering. 30

THE ASSOCIATIVE PROJECT IN THE FIELD ASSOCIATIVE Since 2009, the missions have been asked every year to set up an associative project using the planning and budget tools like any other mission project. The basic idea is to build up the life of the association within each mission, allowing each member of staff on an MSF project to be associated in the context of the mission. In other words, the aim is create an informal forum for debate and discussion where everyone can share their questions and thoughts on how MSF works within their mission or project. People often start by getting involved in this way at local level and then go on to become interested in the broader associative activity of MSF. The field associative project can be implemented in a number of different ways. It can take the form of association information sessions and/or debates with personnel. It can also involve holding discussions on the ARO (annual review of operations), or setting up an association committee in charge of organising debates or social events. Events within the host civil society might also be envisaged, for example focusing on MSF s image or communication on how it operates. Such events could be run not only by the executive, but also by association representatives. 31

THE INFORMAL ASPECT OF THE ASSOCIATION The informal aspect of the associative dimension means there is no distinction between members and non-members, covering anyone who is active within MSF, at all levels. Informal associative life is intended to promote means of associating personnel with projects on a daily basis. This applies both to headquarters and to the field. Examples of this aspect of the associative dimension include: Regular debates between colleagues on MSF and what it does. People ought to know who and what they are working for! Some mission coordination teams invite their personnel to take part in debates when drawing up the annual review of operations (ARO). The project committees (CoPro) held at headquarters when a project is to be set up, modified or closed, are public events, where all members of personnel are welcome to join in the debate. Following the discussions, the Director of Operations takes a decision. Part of every Board meeting is opened up to participation by members and employees. «The quality of our projects depends directly on the quality of our debates». The informal aspect of the associative dimensions represents what in many other organisations would be known as the corporate culture. The purpose is to encourage debate and questioning, to ensure that decision-makers are available to all and listen to everyone, and to bring out the best from each person (know-how, experience, etc.) for the benefit of operations. 32

ASSOCIATIVE GOVERNANCE AT INTERNATIONAL LEVEL ASSOCIATIVE In 2010 and 2011 MSF undertook a process of reform of its international associative governance. The International Council (IC) was replaced by the International General Assembly (IGA), which now constitutes the highest authority of the MSF International Association, responsible for safeguarding MSF s socio-medical and humanitarian mission. As well as the 19 sections, it is also open to the delegate/branch offices and other regional MSF associations. It will take the final decision on key questions concerning associative governance and will provide strategic guidelines for the MSF movement. The International Board (IB), responsible for associative governance, reports to the IGA. Its main role is to resolve problems or conflicts within the MSF movement, to open or close executive bodies, ensure the IGA s decisions are implemented, and to follow up on the work of the executive. 33

ASSOCIATION TOOLS & RESOURCES THE MAGAZINE : CONTACT One of the aims of the magazine is to create a forum for freedom of expression, where members can say what they think. All members can send in articles for publication. http://www.insideocb.com There are also association websites that serve as a source of information on the association and a forum for debate between members worldwide. For the association, visit : http://www.insideocb.com You can also contact an association support team, based in Brussels, at : asso.brussels@brussels.msf.org 34

What does «being a member» mean? ASSOCIATIVE The decision to become a member of the MSF association is a matter of commitment to MSF. It means that you want to play a full part in the MSF project and get actively involved in thinking and questioning, in discussing and taking the decisions that shape our identity, our strategies and the directions we take. It means saying what you think is best for our beneficiaries and to improve our action, or to sound the alarm when you think we are drifting away from our mission or principles. Joining provides no individual advantages, but does give you the right to vote at General Assemblies and OCB Gatherings. Many people stay members of the associations years after they have finished working for MSF, because for them MSF represents a lifelong ideal and commitment. Whether or not you become an associate member is a matter for you and you alone. It is in no way compulsory to become a member because you work for MSF. 35

How can I become a member? ASSOCIATIVE You can become a member of any MSF association. You must meet certain conditions to become a member. These vary from country to country and from one association to another. As far as the MSF Belgium association is concerned, candidates for membership must, by the end of the year before their application, have at least: 6 months experience for expatriates 12 months experience for national and headquarters personnel, and must pay the EUR 10 annual subscription. In practice, this means that national personnel with 12 months experience in the field can become members the following year if they have paid the EUR 10 subscription. National personnel who want to become a member for the first time must ask the HRCo of their mission to fill in an application for national personnel membership, and send it to headquarters. For further information, please contact the association team : 36 asso.brussels@brussels.msf.org