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This chapter discusses how within the arena of humanitarianism itself, hierarchies of humanity are passively established where the expatriate aid workers are provided with due protection whereas the aid workers from the recipient society are paradoxically excluded from this protection. It discusses the decision of the French chapter of Médecins Sans Frontières' to remain in Baghdad during the onset of Iraq War which finally exposed the politics of life in humanitarian actions. By exposing themselves to danger during the bombings, the French team raised the question of the equality of lives in a concrete and immediate way to show that life is equally vulnerable for the Iraqis and for the humanitarian agents assisting them. Similarly the military forces that intervene in international conflicts in the name either of country or of higher concerns also do not reject the idea and sentiment of humanity in principle, however, their practice of according value to lives calls it into question.

In 2014, the world began to witness an unprecedented Ebola epidemic in West Africa that is now smoldering. Ebola had a fatality rate of 40% to 60% in this epidemic due to a lack of adequate health infrastructure and overwhelmed aid organizations at the height of the outbreak. These grim prospects quickly prompted proposals to use experimental treatments and vaccines for Ebola that were in the earliest phases of development at the time. Doctors Without Borders/Médecins sans Frontières (MSF) played a key role in the rapid launch of clinical trials of the available experimental interventions. This chapter traces how MSF negotiated the trials under challenging circumstances, focusing on trials of experimental treatments. It provides a detailed account of the difficult tradeoffs MSF faced and shows how the organization’s values and beliefs shaped key decisions about research priority setting and clinical trial design.

This chapter presents a study on Médecins Sans Frontières and Médecins du Monde assistance programs in the Israeli-Palestinian conflict to analyze the transformation of the status of witnesses in humanitarianism. Humanitarian workers, on the basis of a moral imperative, are increasingly taking on the role of witness for those they assist and thus end up as spokespeople for the oppressed in order to make their suffering public. The process of humanitarian subjectivation has found psychiatry a key tool for giving form to the experience of victims of war, disaster, and famine. The presence of mental health specialists in Médecins Sans Frontières and Médecins du Monde in their Palestinain missions where the health services are fairly equipped indicates their aim to expose the consequences of a humanitarian crisis. The massive overrepresentation of young men among the Palestinians who fought and died during the Second Intifada and the prevalence of enuresis in them is also discussed.

This chapter traces the genealogy of one critical transnational regime of care—what has been called the “new humanitarianism,” referring to the movement of sans-frontière-isme that started with Médecins sans Frontières in 1971. The chapter suggests that, in practice, this shift to the moral imperative occurs through a conflation of the social, the political, and the medical: for instance, illness becomes one of the primary ways not only to render visible but to experience forms of alienation, isolation, malaise, inequality, hardship, violence, or disability. It also explores the increasing emphasis on doing politics through regimes of care by discussing two movements born about twenty years apart, but brought into the world by many of the same actors: Médecins sans Frontières and SAMU Social, the social emergency service.

This chapter considers the degree to which secular organization finds a “sacred purpose” through seeking to preserve human existence. The key example for this study is the humanitarian association Médecins Sans Frontières (MSF). The MSF is a secular organization—a group operating without mandate, and maintains complete independence from all political, economic, or religious powers—that conducts emergency response operations and provides AIDS medication. Beyond regularly deploying calls to “save lives,” the group offers the nominal advantage of combining an assertive faith in medical care. The organization also reflects a biopolitical expectation that states should attend to the health of their populations. However, their vision exceeds questions of governance—whereas a state might display the capacity to “make live” or “let die,” MSF members can never legitimately reject a suffering person.

The contemporary security environment presents a challenge for Doctors Without Borders/Médecins sans Frontières (MSF). It exacerbates a tension that has shaped this organization since its inception, between its role as a humanitarian action and emergency response organization and its advocacy for global health justice. The 2014-15 Ebola outbreak in West Africa underscored this tension. This security landscape also offers an opportunity to move forward. The chapter argues that MSF should embrace its security actorness without reservations, embedding its emergency response role within a conception of health security that looks toward the alleviation of harm and vulnerability. MSF can also move forward by acknowledging the broad transformative potentialities of health interventions. MSF should revisit its approach to borderlessness in a global health arena that is still strongly determined by multiple borders, not just territorial divisions but also inequalities based on gender, race, class, and sexual orientation.

To what extent does the contemporary transnational humanitarian field continue to bear the mark of the religious faith of its founders? This chapter shows that although the field has seen significant upheavals, its core identity and logics have persevered since the late-nineteenth-century. However, humanitarians have continuously disagreed about the ways in which they believed core field values should be realized. The chapter traces the increasing contestation among humanitarian actors over the proper ways to organize their field. It focuses in particular on the 1970s rise of Doctors without Borders, a movement highly critical of Red Cross organizational and ethical logics. The chapter shows that despite the multiple aspirations for revolution, Doctors without Borders had to rely on the existing moral infrastructure laid in place by the Red Cross to gain a prominent standing in the civil sphere.

In chapter 2, Heather Pagano and Marc Poncin detail, from the perspective of Doctors Without Borders (Médecins Sans Frontières), the unique features of the outbreak that made past approaches to filovirus-infection emergencies inadequate, as well as the core reasons the global response preliminarily failed. The chapter describes how the dispersal of small numbers of cases over a wide geographical area multiplied the human resources, logistics, and laboratory capacity required in each individual location to bring the epidemic under control while also presenting communication and coordination difficulties between MSF, healthcare workers, UNICEF, WHO, and the US CDC. It analyzes WHO leadership, including poor logistical presence and politicized decision-making. The chapter highlights the critical gaps in the formal national and international system for responding to serious infectious disease threats and the process by which those gaps may be filled by nongovernmental organizations.

Doctors Without Borders/Médecins sans Frontières (MSF)’s prior engagements with the Ebola epidemic elsewhere in West Africa prevented it from mounting a robust response to the outbreak in Monrovia, Liberia, in July and August 2014. Unfortunately, this would be the time and place where the West African outbreak would undergo its most dramatic explosive growth. Faced with great suffering and mounting need for care, the MSF team in Monrovia decided to open an Ebola treatment unit, ELWA 3, despite their being woefully understaffed. This forced the team to make difficult compromises in the care it provided. These tradeoffs became the source of much controversy and debates over medical ethics and healthcare rationing, both within MSF and in the public sphere.

The two World Wars and the Cold War resulted in mass destruction across the globe and subsequent episodes of humanitarian crisis. This chapter explores the growth of the infrastructure to respond to humanitarian crisis following the the Wars and the Cold War. It examines the role of Médecins Sans Frontières (MSF) or “Doctors without Borders,” formed in 1971 in Paris, to provide rapid emergency response in human tragedy by way of mobile medical supplies and hospital care and the technopolitics of emergency. MSF has helped thousands of wounded victims in Bangladesh and Cambodia. They provide excellent healthcare and emergency care all over the world, which constitutes an effort to clean up the grim aftermath of the Cold War.

In making large-scale decisions about resource use, how much weight should INGOs put on considerations of cost-effectiveness? Chapter 6 examines three answers to this question: the principle of “aid based on need alone,” the “harm minimization” principle, and the “ethics of refusal.” It argues that all three of these approaches fall short. Among other things, they all fail to acknowledge the cost-effectiveness conundrum. They therefore do not direct INGOs to develop the kind of political judgment that is necessary to navigate this conundrum effectively. Drawing on the example of Médecins sans Frontière’s response to an Ebola epidemic in Northern Uganda, the chapter introduces an appropriate type of political judgment for this purpose, the “ethics of resistance.”

This chapter examines how the Syrian crisis has exposed the limitations of mixing political and humanitarian activities and its damaging impact on the delivery of much-needed assistance to Syrian civilians. Some actors, such as United Nations and some of its agencies, have faced challenges in their ability to provide aid to people on the ground because their political mandate has largely overruled the humanitarian imperative. Other actors, such as Médecins Sans Frontières (or Doctors without Borders; MSF), are compelled to challenge this political frame, even if they face huge difficulties in delivering humanitarian aid in an impartial and independent manner. The chapter considers how the Middle East challenges conventional actors—in particular MSF and the UN—over the limits of their mandates and/or actions. It presents case studies to demonstrate how these limits have influenced the delivery of humanitarian assistance in Syria.

This introductory chapter presents three prominent nongoverment organizations—Médecins Sans Frontières (MSF), Oxford Committee for Famine Relief (Oxfam International), and Cooperative for Assistance and Relief Everywhere (CARE)—that convened a donor conference to discuss Haiti's reconstruction and development after the nation was hit by a magnitude 7.0 earthquake. These three charitable groups had decades of experience in Haiti and all faced the same situations, but throughout the year following the earthquake, each organization focused on distinct aspects of the crisis and used different tactics to make their point. In relation to this case, the book details the organizational life at many of the world's leading international nongovernmental organizations (INGOs) in order to understand the causes and consequences of this variation in organizational practices.

In early September 2014, Doctors Without Borders/Medecins Sans Frontieres (MSF) urged governments to send military personnel and assets to respond to the Ebola crisis in West Africa. MSF emphasized that the military’s medical assets could be effectively separated from the military’s association with force and coercion to improve the quality and extent of care. However, foreign troops’ zero-casualty approach, in which little clinical care was provided, and domestic military–civilian conflicts, which arose during military-led containment efforts, suggested otherwise. Drawing on a review of images, key program documents, and news accounts, this chapter addresses the stakes and pitfalls of trying to separate military logics from military logistics. It focuses on what happened as foreign militaries largely organized their work around logics that prioritized the “rescue” of foreigners and risk avoidance, and as domestic militaries, at least nominally, secured state interests by threatening violence against vulnerable citizens.

When several small disasters occurred in rapid succession during the larger unfolding disaster of the Ebola epidemic in Liberia, the fight against Ebola seemed increasingly hopeless. This vignette recounts just such a moment. In late July 2014, Doctors Without Borders/Médecins sans Frontières (MSF) staff had to decide whether to remain on the ground after Samaritan’s Purse, the only other international nongovernmental organization working with them in providing care for Ebola patients, withdrew from the country after a healthcare worker became infected. At the same moment, violence against healthcare workers in the Ebola response was rising, as was the number of dying and dead. Ultimately, the choice to stay in the face of an impending human catastrophe did not derive from organizational logic or medical planning, but was based on a spur-of-the-moment choice driven by a sense of solidarity and commitment.

On July 29, 2014, Dr. Sheik Humarr Khan, Sierra Leone’s leading expert on viral hemorrhagic fevers, died of Ebola virus disease in the Ebola treatment center in Kailahun run by Doctors Without Borders/Médecins sans Frontières (MSF). From the day he learned he had tested positive for Ebola until the day he died, Dr. Khan became the focal point of urgent discussion and debate on medical ethics. These discussions included the proper use of experimental therapeutic agents during an unprecedented epidemic and policies and preparedness for international medical evacuation. Healthcare workers debated ethical points such as whether they should prioritize the greater common good over the interests of an individual. They agonized over whether they could justify placing the value of the life of one person above that of another.