MSF in North Kivu

In North Kivu, international aid organisations installed themselves en masse after the influx of Rwandan refugees in 1994. The urban landscape of its capital, Goma, has been dramatically reshaped in consequence, while a range of NGOs have established projects in rural areas. The medical humanitarian organisation, MSF, has a long history in the region, having opened its first project in DRC in 1977. Today, three MSF sections work in the Petit Nord: France, Belgium and Holland, with their coordination offices based in Goma and Kinshasa. MSF is far from a homogenous movement: these different sections are autonomous and often have conflicting interpretations of MSF’s principles and of appropriate action in practice. This article focuses on projects based in Masisi, Rutshuru and Walikale, from their inception in the early 2000s: the MSF sections support health facilities, respond to cyclical epidemics of measles, malaria, cholera and Ebola, treat wounded combatants and operate ‘mobile clinics’ to provide healthcare to rural areas.

North Kivu has been at the centre of violence in the DRC since the L’Alliance des forces démocratiques pour la libération du Congo (AFDL) invasion in 1996, during the second war between 1998 and 2003 when the province was controlled by the Le Rassemblement congolais pour la démocratie (RCD), the Congrès national pour la défense du people (CNDP) conflict from 2004 to 2009 when the zone was divided between different warring groups, and the Mouvement du 23 mars (M23) conflict which played out from 2012 to 2013. The province epitomises Richards’ (2005) ‘no-peace-no-war’, characterised by ‘stable instability’: cyclical violence with a ‘militarized’ everyday social environment (Verweijen, 2016). A shifting patchwork of over one hundred armed groups operates in eastern DRC – embedded in social and political networks which straddle both ‘state’ and ‘non-state’ spheres (Verweijen, 2016: 11).

MSF project sites are governed by an array of evolving networks: power is exercised through alliances between actors who ‘partially stand in opposition and partially collaborate with the state’ (Vlassenroot and Raeymaekers, 2008: 50). Governance is not a static ‘thing’, but a negotiated process between politicians, customary authorities, ethnic associations, social movements, armed groups, churches, multinational corporations, the national army and international and national NGOs. These negotiation arenas are informal: ‘embedded in social relations’ (Hagmann and Péclard, 2010: 551). In order to operate, MSF needs to build up and maintain an extensive network to communicate with, and receive security reassurances from, relevant powerholders – a process of renegotiation on the terms of the organisation’s presence.

‘Proximity’ is one of MSF’s operational principles: ‘proximity has been and remains a fundamental part of our security management’, one security guideline for DRC summarises (MSF-OCB, 2018). ‘Being there’ to provide emergency healthcare is central to MSF’s raison d’être. However, proximity is also important to ensure that MSF teams can analyse the context in order better to understand where MSF fits into the interests of different actors. In order to ‘do security’, MSF employees must analyse the political and social context by collecting information from a wide range of sources. As MSF France’s former president summarised: ‘The first line of protection is our own position, our understanding of the context, our ability to forge links’ (MSF-OCP, 2002). MSF does not work in a ‘space’ purified from political interference; rather, MSF’s presence is the product of ‘negotiation, power-games and interest-seeking’ (Hilhorst and Jansen, 2010: 116). Security management is an inherently social and political process (Neuman and Weissman, 2016), which involves people and their interactions – perceptions, relationships and interpretations of the context and abstract symbolic principles, as well as shared interests with governing authorities (Magone et al., 2011: 2). In sum, being well-connected is an essential part of MSF’s everyday practice. As one head of mission told me: ‘Networking is key to my job description. My job is to enable the doctors to do theirs.’

The Other 92%

This article shifts the focus onto everyday practice because aid interventions are ‘socially constructed and negotiated processes’, transformed by actors and their interactions (Long and Long, 1992: 35). Too often, ‘Aidland’ is seen as an exclusionary ‘bubble of northern-based’ expatriates (Harrison, 2013), overlooking the significance of locally based aid workers who are intricately interwoven with local politics. Local staff must balance their embeddedness ‘in the field’ with their professional position (Redfield, 2012; Crombé and Kruper, 2019), while institutional structures often reproduce inequalities between ‘national’ and ‘international’ staff, thereby reflecting broader structures of (post)colonial global inequity (Fassin, 2007; Geissler, 2013). In MSF, ‘national staff’ – employees who are recruited within their country of origin rather than flown in for short-term ‘missions’ – account for 92% of employees ‘in the field’ (Fox, 2014: 106). If MSF is a dispersed collection of individuals, Congolese employees are MSF’s permanent human infrastructure in North Kivu: drivers, guards, logisticians, doctors, nurses, pharmacists, technicians. Senior decision-making positions (such as heads of mission and project coordinators) are held by foreign staff, who since 2013 have been ‘partnered’ with a Congolese ‘assistant’, a guide relied upon for ‘local’ knowledge.

The ‘relational and interpretive’ labour of local aid workers often remains overlooked, or ‘invisible’, in aid implementation (Peters, 2020). But the everyday processes of brokerage and translation (Lewis and Mosse, 2006; Bierschenk et al., 2000) conducted by local staff are central to understanding humanitarian operations in conflict. To make sense of these dynamics, I draw upon the literature on intermediaries and brokers: missionaries, colonial regimes, explorers, as well as researchers, journalists and NGOs, have all depended on local employees to network and adapt predesigned policies to specific contexts (Kennedy, 2013; Lawrence et al., 2006). The defining feature of brokers is that they straddle and connect social worlds, often in zones where multiple forms of political authority coexist. They construct strategic identity positions (James, 2011), and their position is ambiguous: they negotiate their legitimacy over time, with competing pressures and expectations. They broker relationships between different actors, drawing on personal networks, and conduct translation – complex processes of negotiating shared meanings. While some authors highlight the advantageous position of such individuals, others emphasise the risks of being ‘in-between’. This article illustrates how Congolese humanitarians are simultaneously empowered and exposed.

Security Brokers

First, Congolese MSF staff used their own personal contacts to access information and network for MSF: having a network is central to their humanitarian practice. As one MSF security plan for Congo summarises, ‘networking and context analysis is the basis of our capacity to negotiate acceptance’ and ‘national staff have a key role in this’ (MSF-OCB, 2018). ‘Assistants’, for example, maintain a network and introduce rotating foreigners to local actors. Jean was a former project coordinator assistant in North Kivu. ‘To be connected is my job,’ he explained, because internationals ‘lack informants, they live in an expatriate ghetto.’ Jean would ‘find out who the project coordinator needs to know, find a way to contact and introduce them.’ One head of mission assistant described his daily work as ‘treading water’, analysing the evolving context and sorting through a ‘casserole’ of information and rumours. In his words: ‘I am the institutional memory – the branch, where birds [expatriates] land for support, before flying off again.’ It is not only assistants who network: security is ‘the job of everyone’ (MSF-OCP, 2007). All staff are encouraged to share any information that may be pertinent for MSF’s operations and are expected to network as part of their role. In short, they ‘do security’ on the side.

To accomplish this, local staff draw from their diverse experience and backgrounds. Some have friends and family in political networks or have political histories themselves – experience in the political wings of armed groups or local government. Others have military pasts: thousands of Congolese youth have been going in and out of armed groups for several decades. NGOs and armed groups are key employers in the region: some humanitarians have histories in rebel groups, some rebels have histories as humanitarians. In addition, it is striking how many MSF employees are linked to customary structures. This was commented upon by one experienced Congolese employee, who contrasted his own modest origins: ‘No royal blood here!’ Other employees brought extensive contacts from their past experience of brokering uncertainty in the Kivus – as négociants in the mining sector (Vogel and Musamba, 2017), employees in the government health structure, or long-distance drivers and traders. To take one example, Bahati joined MSF as a guard in Rutshuru. During his introductory briefing, he learnt that ‘security also meant information’. Bahati had an advantage: he had family and friends in local armed groups and the national army who shared information with him. Not only this, but Bahati had been part of the AFDL rebel movement and had contacts from his military past among the armed group in control of MSF’s project site.

Translation

Congolese staff also translate linguistically between foreign staff who do not speak Swahili or local dialects, and armed actors who do not speak French. Yet, this process is more complex than linguistic translation. Congolese employees described a second, simultaneous conversation which internationals could not understand, and acted as a form of ‘aside’. Richard, a former project coordinator assistant, described his role as ‘reassuring’: he guided his international colleagues, while trying to ‘build trust’ with armed commanders by responding to questions such as ‘what does this muzungu really want?’. These interactions relied on a balance between performed ‘local-ness’ through language (Peters, 2016), and the perceived remoteness of unknown foreigners. In one meeting, for instance, a rebel commander told Richard that he had confidence Richard was telling the truth about MSF’s intentions, as Richard was unable to escape the repercussions of lying. Yet, this commander would only share sensitive information with the ‘expat’, who did not have links locally. Translation was also strategic: staff described adjusting meaning in these ‘asides’. As Jean explained, it was impossible to ‘translate tone, exact meaning’, and at times, it was not necessarily desirable: ‘I didn’t want to translate exactly how they [expats] said it: it would cause tensions or didn’t make much sense.’

Congolese staff, therefore, also helped negotiate the meanings that MSF’s policies and principles acquired in practice (Mosse, 2005). They reproduced an institutional binary of ‘local’ and ‘non-local’, which justified their own position as mediating between the two, making ‘local culture’ intelligible to ‘internationals’, and MSF’s interventions intelligible locally in order to facilitate ‘acceptance’. Congolese staff described themselves as ‘cultural guides’ for foreigners, helping to ensure that ‘expatriates’ ‘behave accordingly in order to have a good acceptance and image of MSF’ (MSF-OCA, 2014b). In cultural briefings given to newly arrived foreign staff, one head of mission assistant covered a range of topics: ‘don’t wear flip-flops to meetings with political authorities, they are for the toilet’, and ‘don’t ask too many questions of armed groups, it creates suspicion’. He saw himself as a cultural ‘référent’: MSF ‘needs to be adapted, we are here to help.’ A former project coordinator described local staff as ‘cultural bridges that help us avoid dangerous faux pas.’

In addition, local staff described ‘translating principles’ – abstract concepts of neutrality, impartiality and independence – so that they gained meaning in practice. One experienced employee, for instance, argued that the biggest mistake any foreign colleague can make is assuming that MSF’s message will work in Congo as it might in other places: ‘some expatriates just start talking MSF as if they were in France.’ MSF’s ‘perception study’ concluded that the translation of principles in line with cultural specificity was important for the organisation’s security (Abu-Sada, 2012). Local staff are seen to play an essential role. In one MSF project in Masisi, for instance, the promo santé team travelled to rural areas to raise awareness (sensibiliser) about MSF’s medical services, and to communicate MSF’s values, using ‘strategies’, such as theatre or workshops. One Congolese health promoter, Prudence, described the team as ‘intermediaries’ who ‘help pass MSF’s message’ and prevent ‘misperceptions’ to help ‘security’. In Prudence’s words, she learnt to ‘speak humanitarianism’ and translate it to others.

Congolese staff also help interpret or ‘read’ (Pottier, 2006) the security context: ‘after all, they live it,’ one head of mission summarised. Jean, the former project coordinator assistant, explained: ‘We are guides. We analyse and help them [expatriates] understand, we see things they don’t.’ Security is an everyday experience with detectable locally determined signifiers – different staff members drew on diverse past experiences in order to read them. Many possessed a form of situated savoir faire about how to navigate a particular context, gained through experience. For instance, drivers play a central role. As MSF France’s former President, Jean-Hervé Bradol, explained: the driver is an ‘ambassador … who mediates with local powerholders and with the population’ (MSF-OCP, 2003). In North Kivu, they were described as MSF’s porte-parole: well-connected, skilled in navigating roadblocks, and the ‘first line of contact’ in case of an aggression on the road (MSF-OCA, 2014b). In Masisi, one driver described his job as ‘reading the road’. During mobile clinics and health promotion trips, while ‘nurses and doctors do their work’, he described the driver’s role as talking to people, collecting information and ‘taking the temperature’.

Performing Principles

Finally, the proximity of some staff became a means of illustrating MSF’s impartiality in practice. As well as interpersonal networks, local staff possessed perceived collective and personal identities which held a collection of meanings and associations. Some staff were known quantities locally, with family ties or political histories. Others had fluid and overlapping, ‘ethnic’ and regional identity markers which mapped onto highly politicised and historically formed discourses of belonging (Mathys, 2017). As Pottier (2006: 151) describes, humanitarians could not ‘shed their ethnic identities: instead they accept that a perceived ethnic identity brings strategic advantages, as well as disadvantages’. In short, local staff had meaningful perceived identities, and in times of tension, advised their colleagues on how to take these identities into account for the organisation’s advantage – another micro-practice of translation.

Luc, one experienced humanitarian, employed the following analogy: MSF already has the ‘lyrics’ – the humanitarian principles and the discourse. But Luc helps choose ‘who is going to sing the song’, the most appropriate person to ‘communicate MSF’s message’. In other words, who can best perform a humanitarian role in that context? The most common example was ‘balancing’ convoys: Congolese staff highlighted the importance of mixed and representative MSF teams as a way of rendering impartiality visible, especially when crossing frontlines, roadblocks or travelling through areas controlled by different armed actors (Pottier, 2006). As one driver explained, the humanitarian status of local staff was often questioned at roadblocks: but, ‘when they see one of their brothers with us’ – someone known or trusted – ‘they think ok, it’s un des nôtres’ [one of ours]. In sum, the political and social embeddedness of ‘locals’ was understood as an advantage, and central to enabling MSF to navigate project sites in the province.

At Risk

Congolese staff from diverse backgrounds were unanimous: they felt more exposed than their foreign colleagues – subjected to pressure and coercion from local armed actors during negotiations. One experienced employee argued that armed actors do not ‘buy into’ the humanitarian principles coming from ‘a local’, but make demands that they would not make of foreigners: for phone credit, contributions at checkpoints, to hire certain personnel or purchase from certain suppliers, to pay additional fees, or to give equipment and set up systems of fraud. While networking, local staff found themselves in a precarious position with a set of complex, competing expectations and demands. For example, Moise worked in his hometown in Masisi territory, and described the difficulty of presenting himself as a representative of MSF. He had multiple family and friend links to local armed networks, and faced mounting pressure: ‘Armed groups ask you for things, find out about you, your origin, family. They exploit any personal links between you and them. You are exposed.’

Theoretically, the MSF emblem is supposed to become employees’ new ‘identity marker’ (Hilhorst and Schmiemann, 2002): the organisation is performed through an ‘assemblage’ of the white cars, flags, and people in MSF T-shirts (Latour, 2005). Yet, not everyone can perform this humanitarian identity with the same ease. For some local staff, their situation in society and their military, political and personal histories often made it difficult for them to be viewed as mere representatives of MSF. Employees with military histories described the difficulty of presenting themselves as impartial to the conflict: for instance, individuals with experience in Rwandan-backed rebellions endeavoured to keep their background a secret from ‘self-defence’ Mai-Mai who mobilised against these rebellions. Others described an increasing ‘ethnicisation’ of armed networks in the region. Jean, the former project coordinator assistant, summarised: ‘MSF itself is accepted, but it’s more difficult to get them [armed actors] to accept MSF staff from other groups.’ The problem, Jean explained, was that these staff were viewed as ‘implicated’ in historical violence.

A Risk

As well as facing additional risks, local staff were seen by foreign MSF employees to constitute a potential risk: there was a concern that their behaviour might jeopardise MSF’s organisational image, and thus security. Ultimately, many foreign MSF staff seemed to doubt whether their local colleagues could be neutral and impartial, or perceived as such by armed actors. Because Congolese staff were subject to increased pressures, there were concerns that they might be forced to make unacceptable compromises. In other words, among foreign staff in MSF, there remained some doubt about locals’ commitment to so-called ‘MSF spirit’ which transcended ‘particularist ties and affiliations’ (Shevchenko and Fox, 2008: 116). There were concerns among senior management about systems of fraud which occurred without ‘expat supervision’: fuel or mechanic parts being sold on the side, or irregularities in pharmacy stocks. In other cases, foreign staff were concerned that ‘ethnic alliances’ would be prioritised over the ‘MSF behaviour’. After tensions within the team and the discovery of a system of fraud in one project, the ‘expat’ team concluded that the national team ‘know the principles very well, but prioritise their own benefit (power, position, money) and their ethnicity over MSF’: they are ‘embedded in society’ (MSF-OCA, 2014a).

The interpersonal networks of local staff were useful, but viewed with some distrust by MSF ‘expats’. In response to accusations of Congolese staff being sympathetic or allied with certain armed groups, one employee concluded: ‘We don’t know what our staff do in their free time.’ Several foreign MSF staff described their unease at never knowing the extent of the links between their local colleagues and armed actors. One former head of mission remembered how during one meeting, ‘the first thing the leader of the CNDP did was to ask our local colleague about his father – there were family connections, I had no idea.’ Some Congolese staff admitted that they had not disclosed their military background to their colleagues: although many foreigners have military histories, Congolese staff argued that their own military experience was viewed with suspicion.

This distrust was aggravated by instances when foreign MSF staff felt that the organisation’s neutrality had been ‘compromised’ by local staff. I was told about cases of local staff socialising publicly with armed actors, or using MSF equipment for the administrative tasks of armed groups – ‘some willingly, but most out of survival,’ one project coordinator remembered. In a few extreme cases, staff were discovered to have concurrent military affiliations: joining active combat, or spotted in military uniform (MSF-OCP, 2012). Humanitarians had military pasts, and some returned to their politico-military careers. At one project, the new Administrator of the Territory appointed by the M23 rebel administration was a former MSF employee: ‘I knew him well, we had to reset boundaries,’ the project coordinator remembered. In other cases, the personal lives of local staff became seen as a security risk. After the relationship between an employee and a woman from a well-connected family had soured, one MSF team received threats and were forced to withdraw. During sensibilisation sessions, it was emphasised to local staff that ‘their behaviour will also detriment the image/security of MSF … being seen as too close/in favour/connected to specific groups can be a potential risk’ (MSF-OCA, 2011): they were ‘MSF 24/7 – not only during work hours’ (MSF-OCA, 2014a).

In this way, Congolese staff were also approached in MSF as a potential source of insecurity: a group with different interests, links, alliances that needed to be analysed and ‘managed’ in order to avoid ‘security incidents’. Their perceptions, too, were considered important for security (Abu-Sada, 2012). As one former head of mission put it, ‘most of the security problems came from within: issues of staff management and accusations of partiality.’ Balanced recruitment, for instance, was considered essential in MSF teams. The security guidelines stated that ‘proximity among our national staff’ is ‘fundamental’ but ‘needs to be balanced’, to avoid tensions becoming a potential threat (MSF-OCB, 2018). One Congolese MSF nurse told me that local staff ‘may betray la maison’ by sharing information with bandits if they perceived MSF to be partial, they felt personally wronged, or for their own personal interest. In the face of robberies targeting MSF’s vehicles, there was suspicion of internal collaboration within MSF teams – ‘an internal leak’ about the convoy’s exact itinerary.

Imperial Duress: The Functions of Detachment

Such concerns acted to emphasise the importance of foreign staff: MSF considers ‘complementarity’ between foreign and local employees as central to maintaining its presence. Jean, the former project coordinator assistant, argued that expatriates and Congolese ‘keep one another mutually safe: we do things together, like a couple who complement each other’s weaknesses.’ Just as ‘local-ness’ is understood to hold functions in MSF, so does ‘foreign-ness’ (Redfield, 2012). As one head of mission explained, ‘being out of the context is a resource, we are less exposed, we can go home if things go wrong.’ Foreign staff in North Kivu saw their role as ‘diffusing tensions’ because they do not face the same pressures or risks as their local colleagues. Some Congolese staff similarly described their foreign colleagues as a form of protection. In the words of one driver, foreigners ‘bolster our humanitarian identity, locals are mixed up in their own disagreements, personal things.’ Luc, an experienced employee, described a ‘parapluie (umbrella) strategy’, whereby Congolese staff use expatriates, in particular ‘white expatriates who are visibly foreign’, to ‘cover’ themselves from demands of armed interlocutors. One head of mission assistant concluded that, even if MSF asked him to become Head of Mission in North Kivu, he would refuse: ‘Head of Mission abroad, as an expatriate? Of course! But here? No thank you, that would be impossible.’

Second, in MSF’s security frameworks foreign staff are seen as central ‘to safeguard impartiality in conflict settings’ (Hofman and Heller Pérache, 2014: 1178). Being foreign is described within MSF as central to decision-making: international staff ‘have the benefit of an external point of reference that hasn’t already been appropriated by the local political landscape’ (ibid.). In other words, in MSF, foreign-ness is described as central to any construction of impartiality and neutrality: foreign staff are tasked with preventing any behaviour that might jeopardise MSF’s image or working relationships. Although Congolese staff are crucial, their interpretations are seen as partial. Expatriate-only meetings discuss sensitive information, and the potential power of local staff’s role is minimised: ‘expats’ lead negotiations with armed groups in an official capacity. ‘National staff guide you, but in a certain direction, so you need to diversify your sources and do your own analysis,’ one former head of mission summarised. Instead, local staff’s role is to ‘help collect information, but not take the decision,’ another project coordinator explained, because they could not ‘give an analysis that isn’t influenced by who they are.’ MSF endeavoured to prevent local employees becoming powerful interfaces between the organisation and external actors, and Congolese staff were not often in senior positions in their own country. Instead, the way to progress in MSF was to be expatriated abroad: ‘there, they can be neutral,’ one former head of mission claimed.

Structural elements of international humanitarianism which are usually identified as weaknesses, such as thematic rather than contextual knowledge among ‘expats’, or hypermobility, are in fact seen to hold functions within MSF: helping to preserve a degree of (perceived) detachment of foreign staff from the complexities of everyday politics in the site of intervention. Senior managers of North Kivu projects explained that there are time-limits on ‘missions’ to prevent expatriates becoming ‘too implicated’ at a local level. In effect, it is imperative that foreigners do not ‘go native’. Personal relationships are understood through a security logic in MSF: although networking is crucial to their job, foreign staff must not become too socially entangled – this includes with local staff, with whom sexual relations are often forbidden in rural projects, apparently in part to avoid tensions or perceptions of partiality within the team, as well as ‘perception problems’ locally. In other words, foreign MSF staff must balance proximity and distance, engagement and containment. They must work with everyone, but be seen as close to no one in particular. Their ‘proximity’ to ‘the local’ must be ‘balanced’ – not tilting the perceived position of the organisation as a whole, or their own perceived alliances as individuals.

Ann Stoler (2016: 28) emphasises the need to explore the ‘messy, troubled spaces of ambiguous colonial lineages’, whereby the ‘configurations are different, as are the actors’, with a ‘displacement of certain elements and conversation of others’. In this case, the aims and actors have changed, but they still involve the maintenance of distance between foreign interveners and local populations. While colonial regimes ‘cordoned itself off from the native world’ (Stoler, 1995: 112) based on notions of racial purity, MSF tries to preserve the supposed detachment of foreign fieldworkers, who must not become ‘polluted’ by personal proximity to local political networks. Imperial duress lingers in the perceived dangers that ‘proximity’ presents to ‘neutrality’, and the description of ‘locals’ as open to corruption or tied up in particularistic loyalties. This reactivates colonial discourses of Otherness that portray ‘the rest’ as bound up in particular attachments, while universal values are ‘encompassed by the Westerner’ (Mudimbe, 1988: 46). Local staff are essential to the everyday work of MSF, but remain seen as part of the ‘native world’.