Issue 63 - Article 10

‘Recently noticed’ aid actors: MSF’s interaction with a changing humanitarian landscape

January 19, 2015
Michiel Hofman and Sandrine Tiller
Pastor Fernand, of the Marabut Christian Community Church, unloads supplies in Leyte.

In an attempt to better understand the new aid landscape, Me´decins Sans Frontie`res (MSF) conducted three studies to see how MSF field teams interact with ‘new’ aid actors, and how decisions on these relations were made. Three countries where MSF was involved in emergency response in 2013 were selected: Mali, Syria and the Philippines. Actors encountered during these studies included international NGOs from the Middle East and Asia, non-European Red Cross and Red Crescent societies working internationally, diaspora groups, regional organisations, governmental agencies, local NGOs and private sector organisations.


Following the resumption of a rebellion in 2012 and a military coup in Bamako, Mali has been beset by one of the worst crises in its history. In January 2013 the former colonial power, France, launched a military intervention aided by African troops to tackle armed opposition groups in northern Mali. In a country where aid actors had been engaged in development work for most of the past 40 years, events in 2012 completely transformed the nature and landscape of assistance.

The security context forced traditional aid actors to limit the presence of mainly Western (white) expatriates. This gap was partially filled by regional Red Crescent societies engaging in Mali for the first time, whilst ‘non-traditional’ donors such as the Organisation of Islamic Cooperation (OIC) and the African Union offered funding to Islamic NGOs willing to work in the country. Some Red Crescent Societies were quick to respond in Gao, but were mistrusted by local people and also by the traditional aid system, which suspected that their presence was linked to the agendas of their governments.

With international organisations absent on the ground, local actors took a prominent role in providing health care. Many chose to operate outside the aid system because of a deep mistrust of the United Nations. This was in part a reflection of the longstanding tensions between Bamako and the north, with the United Nations seen as representing the interests of the central government. Another factor was the UN cluster system, which was regarded as inefficient and unnecessarily substituting for the existing state-run and local coordination mechanisms that have linked local organisations with each other for decades. Some local organisations were created in response to the crisis; others predated it.

Relations between MSF and these ‘new’ aid actors were mixed. MSF teams in Gao, where the biggest Red Crescent Society was based, decided to adopt a ‘no contact’ policy because of rumours about its political allegiance; meanwhile 100 miles down the road in Niger another MSF team had developed a close working relationship with the same Red Crescent Society in a refugee camp. Relations with local Malian organisations were erratic: with some groups a close collaboration was established, whilst with others relations were strained as MSF was perceived to be dominated by patronising staff who did not understand local sensibilities. According to a representative of a Malian civil society platform, interviewed in Bamako: ‘MSF is not very open to locals … This is a very French culture. The Americans, British and Dutch do not operate the same way, they work in partnership. The French are very paternalistic. This attitude must be abandoned’. As a result, delivery of medical assistance was uneven. MSF had little impact on secondary care in Gao, whereas in Timbuktu, where good relations were established with local actors long before the crisis, MSF was able to provide good support to the hospital.

The Philippines

Typhoon Haiyan tore through the central islands of the Philippines on 8 November 2013, causing widespread destruction and leaving 6,201 people dead and 28,000 injured. The main needs following the disaster were shelter and livelihoods. The Philippines government has extensive experience in responding to disasters and created an enabling environment for international assistance, with proactive government departments and a very easy entry system – the One-Stop-Shop – at Cebu and Manila airports which covered registration formalities in one step.

The UN categorised the typhoon as a ‘Level 3’ emergency, and injected huge numbers of staff and goods into the response. However, the aid effort was top-heavy, with too few staff in operational roles and too many in Manila. The UN Cluster system worked in some ways in parallel with – and possibly overwhelmed – national coordination mechanisms and was not very effective. Logistics was key to the success of the operation; only the most experienced humanitarian operators were active in the first weeks of the response, and military assets from 29 countries played a crucial role.

Although many actors responded, the majority were too small or arrived too late. Many ‘new actors’ arrived unprepared or with inexperienced teams. Many large agencies from the traditional system were very slow to mount operations despite already being present in the country, and despite having raised large sums of money earmarked for the disaster. Some took time to shift from development to emergency response, and others had to renegotiate partnerships with local actors.

The private sector in the Philippines was heavily involved, raising money and sending teams to carry out relief activities and repair infrastructure. Others combined relief with business continuity, for example by restocking small shopkeepers with key items such as fridges and shelving, and local mobile phone companies re-established con- nectivity. Many religious organisations also responded to the crisis, predominantly Christian, but also some Muslim and Buddhist groups. These organisations carried out a wide range of activities, from medical care to agricultural support. They played an important role in the distribution of relief items to the most vulnerable, and provided pastoral care to distressed or bereaved families. By and large these organisations worked through their own coordination mechanisms organised by the churches, in part because of distrust of local and national government. Only the larger international religious NGOs participated in the cluster system.

MSF ran a massive operation, spending €17.6 million within about seven weeks, and deploying 171 expatriates providing medical care, shelter and water and sanitation services. Although a wide range of actors were involved in the response, MSF’s interaction with them was entirely pragmatic and based on operational need. MSF invested in relations with national government departments through a dedicated position in Manila. This paid significant dividends, both practically in terms of facilitating the response, but also in terms of MSF’s longer-term relations with the Philippines government. With local actors, MSF’s interaction was entirely practical – loan of a digger by a local company, assessments with the local municipality, joint health messaging – and effective. There was virtually no structured interaction with the private sector or with church-led groups, which meant that MSF may have missed important opportunities to improve community relations and deepen understanding of the wider context. A more strategic approach that looks beyond the traditional sector may pay off in the long term as national capacity grows stronger in countries like the Philippines.


The way in which the war in Syria has been fought – and the regional geopolitical dynamics that frame it – has resulted in a polarised aid environment: either aid is provided officially through Damascus, and subject to a series of administrative and bureaucratic procedures, or it is provided directly into opposition-controlled areas without the consent of the Syrian government. The two modes of delivery are entirely dependent on one or the other party to the conflict and are incorporated into their military tactics and strategies. Although some ‘official’ aid crossed frontlines from Damascus (half of the World Food Programme (WFP)’s food convoys in 2013, for example), in areas controlled by the opposition or under siege aid is provided through armed opposition groups, informal networks of activists, regional organisations, solidarity networks and newly formed foundations.

Many of the estimated 1,000 armed opposition groups include service delivery as part of their activities. In some cases this comes with the responsibility for controlling an area, and in others there is a clear programme to build administrative structures and engage in state-building. The aid environment in opposition-held areas is plagued by the same tensions at work in Syria as a whole: factionalism, sectarianism and a deep divide between internal and external actors. The traditional aid community has relied on old models of accountability and contractual arrangements that are not suitable and are potentially compromising. The result has been a growing gap between the provision of funds and the delivery of services, with multiple layers of bureaucracy either slowing down or obstructing any adequate response.

MSF began negotiating for an official presence in Damascus soon after the uprising began, but when this failed the agency established support programmes from across the Lebanese and Turkish borders. Operational alliances were created with independent relief activists who supported MSF in smuggling medical supplies into areas under the control of the opposition, under siege or in government hands. Initially, teams took a cautious approach, focusing on one network, but then realised that this group had exploited MSF’s support for political purposes. This was later addressed through a more extensive networking process and more diversified contacts. Medical support was provided to local medical staff with whom a relationship of trust had been established through consistent delivery and discretion around their identities.

Many of the organisations interviewed saw MSF as arrogant and reliant on expatriates, and regarded its medical standards and protocols as below the quality expected by both patients and local health professionals. However, they also acknowledged MSF’s flexibility in other areas and its capacity to innovate and work outside the usual aid modalities.


These case studies show that MSF is interacting with a variety of ‘new’ aid actors, and in some cases, such as Syria, is dependent on them. This choice is pragmatic and practical. Some of these groups may have political links, but this has not prevented MSF from engaging with them as long as operational alliances are based on clear criteria and are responding to needs. However, MSF is inconsistent in its dealings with ‘new’ actors and can be perceived as arrogant. The agency has a natural bias towards familiar, traditional aid actors and little understanding of who these ‘new’ actors are or how to work with them. This has led to very contradictory levels of collaboration regionally or even locally, leaving the ‘new’ aid actors very confused about MSF’s identity. MSF would benefit from investing in a better understanding of, and a more open attitude towards, these ‘new’ actors, many of which have been around for years, but have only recently been noticed by MSF and others as access has become more difficult for the traditional aid system.

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Michiel Hofman is senior humanitarian specialist for MSF in Brussels. Sandrine Tiller is humanitarian advisor for MSF in London.


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