Book Review by Bradley Williams
How do the experiences of leaders and members of a medical humanitarian aid organization structure the organization’s principles and practices and enlighten us to the meaning and purpose of their work? Médecins Sans Frontières (MSF), (Doctors Without Borders in English), is “an international medical humanitarian organization created by a small group of French doctors and journalists in 1971 (p. 1). Throughout the book, Doctors Without Borders: Humanitarian Quests, Impossible Dreams of Médecins Sans Frontières, sociologist Renée C. Fox succinctly makes perceptible MSF’s complex existence, including maintaining transnational autonomy while operating within the borders of various democratic and authoritarian polities. Drawing from her extensive field research, the author reviews the history of MSF, the goals that they have set as an “international movement”, their organization and mobilization efforts and how they affect the prioritization and execution of these goals (p. 2).
The first three parts of the book, a little under half in length, offer analyses of MSF’s origin, history, and some of the earlier crises that tested MSF’s core principles. The first chapter in particular presents weblogs of members’ personal accounts of their service “in the field” (13-40). Web entries reflect such thoughts as members’ appreciation and pride for serving distressed populations, “culture shock” or “existential transformation” from their experiences, and disappointment with organizational, political, and resource limitations (p. 39). The fourth and fifth parts detail thoroughly the author’s studies using her ethnographic data drawn from the experiences of MSF workers in South Africa combating HIV/AIDS and in Post socialist Russia fighting Tuberculosis in Siberian prisons. The book contains a handful of photographs featuring significant events during the MSF missions in South Africa and Siberia, which were the subject of Fox’s analysis. There are also several sociopolitical cartoons from creator Samuel “Brax” Hanryon that offer a critique of the various core concerns of MSF, including organizational growth, gendered violence, and “the limits of humanitarian action” (p. 98). These illustrations added a playful form of conscience which acted as a barometer of the most impactful concerns of the movement’s present. Added to all of this, the book contains the insight-filled notes, placed before the index and after the text, one might expect from a leading sociologist.
A central theme examined throughout the book is the relationship between MSF’s principle of témoignage, or “bearing witness” in English, to threats to human rights and its political neutrality. This is primarily illustrated through cases of events in which humanitarian needs, political influence, social environmental factors, and internal dynamics shaped transformations in MSF’s organizational structure. For example, the project aiding the resistance to HIV/AIDS in Khayelitsha, Cape Town, South Africa ultimately culminated in the creation of a South African section of MSF (p. 193). The author’s greatest accomplishment is bringing the history of MSF’s organizational evolution to life.
Doctors Without Borders feels semi-biographical, even a little autobiographical upon reading. This will most likely set it apart from other contributions to literature on MSF and international medical NGOs. The author acknowledges that she feels personally invested in the mission of MSF, noting that her experiences conducting sociological research in the Democratic Republic of the Congo was the inspiration for her work on MSF. She underscores early in the book that her ethnography required that she navigate the “culture of debate” that pervades the organization (p. 5). Reading this book makes apparent the personal care she took to understand this culture and translate her experiences. Books about MSF have tended to focus primarily on pragmatic analyses of the movement’s contributions to the populations it aids; one notable exception being Life in Crisis: The Ethical Journey of Doctors Without Borders by Peter Redfield, an example of recent ethnographic research.
The author provides a well written ethnographic account of the often conflictual internal dynamics of inclusion and exclusion among various factions within MSF. This book is original in its scope, taking seriously the opinions and personal history of past and current MSF members, from the more prominent and infamous leaders to veterans of humanitarian aid and newcomers alike. The photographs are highly welcome and the caricaturist illustrations are particularly elucidative; the “Brax” illustrations include short descriptions of their depictions as they relate to specific events and concerns relevant to MSF. The author makes an excellent contribution to sociological ethnography while demystifying the important role played by NGOs in international relations. I would recommend this book particularly to researchers interested in the meanings that members of NGOs place on their work. Readers will have no problem jumping into this book without prior knowledge of NGOs. I think this book would make a good additional reader for a course in medical sociology or a similar course concerning the work of medical NGOs.