This publication presents the results of an evaluation of how the work of Doctors Without Borders/Médecins Sans Frontières (MSF) is perceived in volatile environments. The study attempted to understand how MSF’s image is constructed and how it is conveyed to audiences outside the organisation by using a multifaceted methodology: literature reviews, questionnaires, discussion groups and semi-structured interviews, among others.
MSF has developed a reputation as an emergency medical humanitarian organisation willing to go almost anywhere to deliver care to people in need. Yet when questioned about MSF, people in countries where it works had different perceptions.
Key findings are as follows:
- Lack of communication concerning MSF’s objectives and identity was raised frequently by respondents. In most cases, people know about the organization because of a previous intervention in the country or interventions that have received high-profile media coverage in other regions of the world. However, people who are not employed by MSF seem to have little understanding of ongoing projects and what differentiates MSF and its objectives from other organisations working in the region.
- Many would like to see greater collaboration with other stakeholders, including national health systems, to make MSF’s missions more sustainable. People often express their concern about the dependency that the organization creates and the medical and economic consequences of its departure. More training is requested, not only for national staff but also for civil servants and certain government employees, in order to guarantee the sustainability of medical action.
- Although one of the main working hypotheses was knowledge of MSF’s financial independence, the study showed that the general public are generally unaware of its funding sources.
- Another initial hypothesis was that being an external (rather than Western) actor was more important than all the other considerations for acceptance. All the responses disprove this. The premise that the proximity of the teams to the population contributed to a positive perception was generally disproved. Indeed, to the contrary, security management measures usually created a distance between MSF’s teams and the local populations.
- The image the organization transmits is that of a western NGO. MSF is sending field workers with increasingly technical profiles into the field, overlooking generalists who might be better able to understand the complex contexts. Respondents suggest that MSF move away from this technical model, instead placing more emphasis on general profiles in each mission, making it possible to develop links with authorities and the community.
Consequently, these are the key implications for MSF operations:
- MSF must establish cooperation with actors in the political sphere: politicians, ministries of health, and local people, while taking care to avoid being exploited. In the practice of humanitarian action, there has been a tendency to neglect these negotiation processes.
- MSF should be more consistent in its public positioning, communication, actions, and advocacy work. It still presents itself as an emergency relief organization, while a large part of its programs are not perceived as such, either internally or externally. Due to the increased bureaucracy within MSF, messages tend to lose their substance and become less political. Another issue is that the target audience for MSF’s communication is mostly Western, when it should be focusing on the countries where it has operations.