In Chapter 2, I follow patients and staff through their daily routines in the hospital. I describe the spectrum of emotions experienced by members of hospital staff, ranging from their personal motivation to the emotional impact on them of the daily support they provide to the victims of war. The hospital routine is marked by mutual informal interactions between patients and staff, lending a general sense of informality and friendliness to the institutional relationships. Nevertheless, providing a “healing environment” and remaining steady under the visual impact of deformed limbs carries a certain price. Interviews with staff suggest feelings of sadness, guilt, and generalized emotional distress. These overwhelming emotions are linked to the staff’s perceptions of patients. Patients are predominantly viewed as victims, lacking their own agency, and patronizing attitudes are sometimes imposed to justify the social order in the hospital. An enduring hospital culture of stereotyping is widespread. This became obvious through positive descriptions of Iraqi patients in contrast to derogatory portrayals of Yemeni patients, who are viewed as lacking proper hygiene practices, for example, or not understanding the Jordanian dialect of Arabic. Despite all of this, the hospital appears to be a successful melting pot, where cultures blend and transformation takes place. It becomes a place where a patient’s sense of self is gradually altered.
among a plethora of scientific, public health, UN and
humanitarian organisations, as well as the Congolese government and state
institutions. Building on its long-standing presence in the region as well its
prominent role in the response to the West African epidemic, MédecinsSansFrontières (MSF) positioned itself as a key response actor from the first day
of the outbreak. Yet despite incorporating all the elements considered requisite for
success, the Kivu response was
Chapter 1 explains the initiation of the anthropological research in 2017, when the MSF programme in Amman entered its tenth year. Multiple questions about the patients’ wellbeing both in the hospital and after they returned home required answers. Simultaneously, the concept of a “patient-centred approach” was flourishing at MSF, and the RSP had declared it one of its main preoccupations. The chapter details the qualitative-research methodology used in my research. In-depth interviews with ninety-nine MSF staff members and seventy-four patients from Syria and Iraq were transcribed, coded, and analysed using a thematic-analysis approach. Furthermore, extended observations of participants both inside the MSF hospital and in patients’ homes, and internal MSF documents provided information used in the process of triangulation. I describe how my observations over the six months I spent in the RSP hospital grew out of my integrated position, embedded in the hospital microcosm. My constant presence there facilitated my formal and informal interaction with staff. The chapter concludes with reports from my fieldwork in Jordan and Iraq. My vantage point – inside the home countries and literally inside patients’ homes – gave me the unique opportunity to observe the intimate physical and social environments of my participants.
This is the story of a meeting between a humanitarian operation and a conspiracy
theory, and what happened next. The operation was a search and rescue mission run on
the Mediterranean by many different non-governmental organisations (NGOs), including
MédecinsSansFrontières, 1 aiming to save the lives of migrants, refugees and asylum
seekers lost at sea. The conspiracy theory 2 was that this operation was the opposite of what it
Interpreting Violence on Healthcare in the Early Stage of the South
Sudanese Civil War
Xavier Crombé and Joanna Kuper
On 15 December 2013, only two and a half years after the Republic of South Sudan had
become an independent state, the long-simmering tensions between President Salva
Kiir and his former vice-president, Riek Machar, erupted into armed clashes in the
capital, Juba. War soon broke out. This article seeks to document and analyse
violence affecting the provision of healthcare by MédecinsSansFrontières (MSF) and its intended
The Introduction opens with a description of the book’s intent and my position as an anthropologist examining the humanitarian field. I introduce the story of one war victim – Ismael – who presents in microcosm the unique aspects of the patients in the MSF Reconstructive Surgery Programme (RSP). I go on to explore the invisibility of the war-wounded, especially those who have never participated in combat. The Introduction continues with a discussion on the delivery of humanitarian surgery, a specific field in the larger world of humanitarian aid. I touch briefly on the history of MSF surgical programmes and capture some of the history of MSF’s surgical practices, which go back to the very origins of the organization itself. RSP is a programme that reflects the cumulative MSF experience. The Introduction concludes with an in-depth description of MSF’s RSP in Amman, Jordan. Currently, patients in the RSP, who often sustain critical injuries years before they are admitted to the hospital, have various levels of disability or have lived with significant post-surgical complications. The Introduction explores several of the aspects that make the RSP unique. Among them are surgical procedures focused on functional improvements, the months and sometimes years-long rehabilitation undergone by patients away from their home countries, the scale of the programme, and the multi-disciplinary treatment provided.
, and how? Remotely or on site? At the very
least, we had to decipher the diverging political and military agendas, and then
adapt, persist or sometimes just give up. In this article, I will present the full
range of methods used to acquire knowledge and obtain information as well as the
various networks used to carry out this venture. I will also show how
MédecinsSansFrontières’ operations became a balancing act,
punctuated by episodes of adapting to the various
and efficiency of aid delivery
implicitly override the principle of humanity. And the search for solutions to
today’s increasingly protracted crises overshadows the need for social
In some ways, this supposed tension between a strictly technical and neutral
humanitarian action and a more political and morally driven one has existed for some
time. MédecinsSansFrontières (MSF) starkly illustrates this tension.
It may be built into the DNA of the
The Politics of ‘Proximity’ and Performing Humanitarianism in Eastern DRC
and Change , 1 – 22 .
Fassin , D. ( 2007 ), ‘Humanitarianism as a Politics of Life’ , Public Culture , 19 : 3 , 499 – 520 .
Fox , R. C. ( 2014 ), Doctors Without Borders: Humanitarian Quests, Impossible Dreams of MédecinsSansFrontières ( Baltimore : Johns Hopkins University Press ).
Geissler , P. ( 2013 ), ‘Public Secrets in Public Health: Knowing Not to Know While Making Scientific Knowledge’ , American Ethnologist , 40 : 1 , 13 – 34 .
Givoni , M. ( 2016 ), ‘Reluctant Cosmopolitanism: Perceptions Management and the Performance of
publish the entire report to prevent inaccurate and incomplete interpretations. 49 The ICRC will also “go public” if, after repeated requests, it is denied access to prisoners and has exhausted all other diplomatic avenues. 50
MédecinsSansFrontières. MSF is a humanitarian NGO that delivers emergency aid to people affected by armed conflicts, natural disasters, and complex emergencies and operates under the principles of neutrality, impartiality, and medical ethics. 51 It is comprised of thousands of medical and logistical professionals working in over