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In the rare free moments she has had this year between visiting Ebola centres in west Africa and pleading for support in front of the UN, Dr Joanne Liu, international president of Médecins Sans Frontières, reread The Plague by Albert Camus. Unsurprisingly, it had extra resonance this time. She was particularly struck by the narrator Dr Rieux’s statement that he keeps going because he has never managed to get used to seeing people die. Telling me this, she pauses. “I think today it’s one of our problems. Somehow we got used to death and then we dehumanised it. We account for conflicts in figures. Ebola is 13,500 infected, 5,000 people have died… People are losing their sense of empathy, their sense of wanting to do something.”
No one can accuse MSF or the woman who leads it of that. Since the current outbreak of Ebola was confirmed in Guinea in March, the organisation has worked with more than 6,000 patients, manning the front lines in west Africa for months before the world started to take notice. MSF realised this epidemic was different from previous ones almost immediately. “Our experience [with Ebola] is that it’s in a remote village and the chain of transmission dies very quickly . . . That’s it. It’s over in less than three months,” says Liu. “This was different because it was geographically spread.” But the international community didn’t want to know: “We were told that we were getting too excited and ringing the alarm when everything was under control.” Matters were complicated by the sheer number of global crises demanding attention this year. “There was South Sudan and the Central African Republic [CAR] . . . DRC . . . Ukraine . . . and then Gaza was a full-blown crisis in July.”
MSF works in all of those places, with more than 32,000 staff in 67 countries last year. Founded in 1971 and largely privately funded, it provides independent humanitarian aid while bearing witness to what it sees on the ground.
Liu only became international president in October 2013. It seems an understatement to say it’s been a tough first year on the job. “It has hijacked all my life,” she laughs. When thinking about how best to describe it, three words keep coming back to her. Challenging — there have been so many places needing attention. Overstretched — the whole sector has reached its limits. And gap — a hole has been exposed in people’s ability to respond. “We’ve been running behind a train that is moving faster than the response has been in west Africa since the beginning,” she says.
Liu was born in Quebec, Canada to Chinese immigrant parents. For her, MSF is a calling. As a teenager she read a book by a French doctor about his time with the organisation and that was that. “I remember reading that when I was young and saying, ‘Oh my god, this is a real life,’” she says. After her medical training she volunteered with the organisation repeatedly, spending time in the field from Darfur to Haiti and heading the Canadian branch. The opposite of self-promoting, she shows little interest in her own achievements: “I find myself a bit boring because I somehow always wanted to be MSF.”
Boring is not the word most would use to describe someone whose work, this year alone, has seen her travel to Syria, the CAR, Myanmar, the DRC and Sierra Leone among other countries, not to mention multiple trips to the UN and Montreal, where much of her life remains. Liu is a force to be reckoned with: the words flow out of her, punctuated only by the occasional “how you say” as she pauses to allow her French-English translation skills time to catch up with her brain.
This is a woman who, while based in Switzerland, planned to spend her August holidays doing shifts in the Canadian hospital with which she remains associated as a paediatric emergency physician — “to keep a clinical hand in”. Ebola put a stop to that but she is determined to find somewhere to practise in Geneva. She laughs when asked how she fits it all in. “I feel that [in] any position of this kind of exposure and commitment, you have to accept that you won’t be as balanced as you would like. I always think of it as a privilege, an honour.”
Her relentless travel schedule has also served up some difficult insights. “Our humanitarian aid system is sick and needs to be fixed. It needs to get a reality check and get back humanity,” she says. She recounts with disdain a supposed DRC success story about a displaced woman with the resilience to support herself. It turned out she had become a prostitute. “I can’t believe that you’re giving me that . . . That’s resilience for you?” she says, then mentions another visit to a displaced persons camp in the CAR. “People were talking to me with their two feet in mud. And I said, ‘This is not possible, that in the 21st century we still have to see that.’ And that for me is really a call for how can we do better? . . . Can I stand on a spot where I don’t have my two feet in water?”
MSF is not necessarily the popular kid in the humanitarian aid playground. For one thing, it is unusual in having financial autonomy: 89 per cent of its funding comes from individual and private donors. The flexibility that such independence brings also ushers in critics. “Some people say that sometimes we’re a loner, and I accept that. And some people say we’re arrogant and it happens and I’m quite aware of that,” says Liu. “But it’s important to be self-sustaining because that’s what gives you the capacity to respond quickly.” In the case of Ebola, this meant arriving on the spot while others were still having meetings.
Once in the thick of something, MSF stresses the importance of staff sharing what they see. So Liu stood up repeatedly in front of the UN and begged for boots on the ground, rather than mere promises. “I think that when people heard MSF say we were losing the battle, it was a bit of a shock for everybody.” Still, she feels it was the return home for treatment of two infected American missionaries in August that really woke people up. “All of a sudden it was knocking at our door . . . these were our neighbours, these were our colleagues, these were our people . . . And when it changed from them to us, then it got traction,” she recalls.
For Liu, the effect of such proximity was not surprising. Indeed, she thinks the closeness that most MSF workers have to situations propels them to act. For these doctors, it’s not just nameless people in a far-off country who are dying but the cousins of the nurse who has been with them since the beginning of the epidemic. MSF employs a ratio of about 10 national staff to every international member and Liu believes they are the true heroes. “To do it for four weeks [the average international staff placement] is straining but to be living with Ebola for the last eight to nine months, it’s really, really hard,” she says. “Most of our staff have either lost family members or friends, as well as living in the constant potential fear of being exposed.” Thirteen have died so far.
Liu is fiercely protective of the people that she works with: “What makes MSF, the strength of us, it’s our people.” In April, the organisation lost four staff in an attack on hospital grounds in CAR, and the question of how best to work in increasingly dangerous contexts — Syria, Libya, South Sudan, Somalia among others — remains unresolved. “Hospitals being targeted, patients being targeted, ambulances being targeted . . . the last spot that was supposed to have a minimum of respect has been violated in 2014,” she says. She believes it critical that MSF maintains a hands-on presence. How precisely that can happen will be one of her focuses in 2015.
And what about that Ebola train? Are we still running behind? “I think that what is happening now in some places is we’re jumping in the train and trying to get hold of the brake,” she says. “What has been the hampering, the hindering factor is fear . . . People are scared to deploy, scared of being infected.” Her hope is that the episode will teach the international community that someone needs to take responsibility before such a crisis escalates again in the future. “We all know that if the world had woken up in the spring, we wouldn’t be where we are today.”
When we talked, Liu was about to get back on a plane to west Africa to reassess the situation. MSF is hosting trials there and she is determined to make sure that any new treatment will be accessible to those on the ground. (On her return she will speak out about the potential for a double failure, both initially and now in adapting the response.) For her, the most crucial thing is keeping the world’s attention. “It’s like when you’re sick and you have pneumonia and you’ve been given antibiotics for 10 days and then you start to feel better after three days and would like to stop taking your antibiotics,” she says. “We’re just getting ahead of the game. We need to finish.”
Alice Fishburn is the deputy editor of FT Weekend Magazine
Photograph: Namsa Leuba