Dr Christos Christou, International President of Médecins sans Frontières (MSF), spoke with Robin Davies when he visited Canberra to meet senior government figures and speak at both the National Press Club and the Development Policy Centre.
Dr Christos Christou, International President of Médecins sans Frontières (MSF), spoke with Robin Davies when he visited Canberra to meet senior government figures and speak at both the National Press Club and the Development Policy Centre.
Christos was appointed to his current role in mid-2019. He has been with MSF in many capacities since 2002, including as director of the organisation’s Greek chapter, and has had field assignments in Zambia, South Sudan, Iraq, and Cameroon. Born and educated in Greece, he trained as a general and emergency surgeon and also holds a Masters degree in International Health from the University of Athens, where he is a faculty member.
Christos talks about the shrinking of the humanitarian space in which MSF and other humanitarian organisations operate, through restrictions on access to emergency situations, direct attacks on humanitarian workers, and the criminalisation of humanitarian efforts. He also discusses the role of MSF in protracted crises, the organisation’s ambitions for the pandemic treaty or agreement, policy responses to the plight of the Rohingyas in Cox’s Bazar, and his legacy objectives as he enters the final year of his term.
This is episode four in our 2024 season, which is a new beginning for the podcast after a hiatus of two years. We're bringing you a mix of interviews, event recordings, and in-depth documentary features relating to the topics we research at the centre – Australia's overseas aid, development in Papua New Guinea and the Pacific, and Indo-Pacific regional and global development.
Acknowledgement 00:06
We wish to acknowledge the Indigenous people of Australia, the wider Asia Pacific region, and other parts of the world and express our respect for the traditional knowledge and practices which stemmed from a deep connection to the lands and waters they have inhabited for millennia.
Christos Christou 00:26
And I believe that the Gaza's context as we experience this today, is a big turning point of what we used to know as humanitarian space and IHL and laws of war. And what I'm saying always is, how am I supposed to go and negotiate access in other contexts, in other places, after what has happened and the impunity that we see these days in Gaza?
Robin Davies 01:01
Welcome to Devpolicy Talks, the podcast of the Development Policy Centre. We're part of the Crawford School of Public Policy at the Australian National University on Ngunnawal and Ngambri country in Canberra. I'm Robin Davies. This is episode four of the new season of our podcast, which we relaunched in April of this year after a more than two-year hiatus. In this new season, we're bringing you a mix of interviews, event recordings, and in-depth documentary features relating to the topics we research at the Centre, namely Australia's overseas aid, development in Papua New Guinea and the Pacific, and Indo Pacific regional and global development. This episode is an interview I recently recorded with Dr Christos Christou, International Director of Médecins Sans Frontières, or MSF, when he visited Canberra to meet senior government figures and speak at both the National Press Club and the Development Policy Centre. Christos was appointed to his current role in mid 2019. He has been with MSF in many capacities since 2002, including as director of the organisation's Greek chapter. He's had field assignments in Zambia, South Sudan, Iraq, and Cameroon. Born and educated in Greece, he trained as a general and emergency surgeon, and also holds a master's degree in international health from the University of Athens, where he's a faculty member.
Robin Davies 02:21
So welcome to Devpolicy Talks, Christos, can I first ask you just to introduce yourself your role and maybe say a little bit about how you came to this role?
Christos Christou 02:21
Yes, thanks for having me. My name is Christos Christou. I'm a doctor I'm currently the international president of Médecins Sans Frontières, or Doctors Without Borders. A brief story of my life and my life with MSF. I was born in a small town in Greece, I graduated the medical school in Thessaloniki University Hospital. And since the very early years of my medicine, I felt like medicine is something more than just fixing lungs, hands, or kidneys. I was amazed by the global health agenda. And I felt like I have to be there where no one else is to offer my help to people. So I remember always, in the ante theatres of my university, there was a poster, which saw the bullet and underneath the bullet, there was a tablet of medicine, and it was reading "their weapons kill, ours save lives". And that was a poster by MSF. That's how I joined MSF. Initially, I started with projects in Sub Saharan Africa treating patients living with HIV. That was in the early 2000s. And I was amazed by how MSF working hand in hand with our patients and their communities they didn't just treat HIV patients, but they demonstrated on the streets together in order to gain more access to affordable medicine, safer, cheaper drugs for these people. And indeed, it was a game changer for us, that kept me in MSF. So later on, I had to go back to my studies to get specialised in surgery. And I rejoined MSF with missions that they had to do with conflicts as a surgeon or a highly insecure contexts until 2019, when having already had enough experience in what we call governance in MSF being the president of one of the small sections that we have MSF Greece. I put my candidacy forward to be elected as the international president. So this is my fifth year, and there is one more year to go in my tenure.
Robin Davies 02:41
Just for our listeners, could you say a little bit about how MSF is organised globally? And what is the workforce and what is the support base look like?
Christos Christou 04:34
So it is a medical humanitarian organisation that now is currently based in more than 27 different countries around the world, we have what we call headquarters or sections. And we do have five plus a new one six operational centres, those directors that they run the operations. Now they are mainly in Europe, but now the new ones are outside Europe, like the first one that we have is in Africa. We operate in more than 70 countries this moment, we have 68,000 people working for MSF in all these different contexts. And thanks to the generosity of more than seven million of individuals around the world, we have gained this financial independence that enable us to not only impartially assess the needs of the patients, but also make the choices where to go.
Robin Davies 06:16
In case people are not clear, it's essentially MSF's policy not to accept funding from governments. Is that correct?
Christos Christou 06:23
That's correct. We don't accept funds from governments. We do engage with foundations, and with some institutions, but the 98- 99% of the support that we get is from individuals.
Robin Davies 06:39
I wanted to ask you how MSF defines its core role in the current global environment. Clearly, it could no longer be said that MSF responds to acute emergencies, goes in and then a few weeks or a few months later exits again. MSF is there supporting people during protracted crises. But where do you draw the line? Do you have exit criteria?
Christos Christou 06:39
There are always exit strategies, and they are there in our action plans before we even intervene in what we call emergency. But as you rightly said, many emergencies become protracted crisis. And in many of the places that we are, we find ourselves being present there for many, many years. From the top of my head, I can bring examples like Democratic Republic of Congo or South Sudan, where our presence is more than 40 years. Why? Have we shifted to something that is more developmental? No, it's because there are crises on top of other crises going on in all these places. And we keep looking at them as an emergency situation that we have to stay and respond to.
Robin Davies 07:58
Something I know you've spoken about in other contexts is the uneven allocation of humanitarian resources between emergency situations, which to some extent reflects the priorities of the donors. So humanitarian organisations that depend on donor funding, have to go where the funding is. Now, does that create a sort of moral hazard for MSF that your organisation ends up filling the gaps or picking up the pieces and working in the neglected scenarios? And how do you deal with that?
Christos Christou 08:33
That's an excellent question, because this depicts very well the reality of the day and the humanitarian environment of the day. All these agencies and organisations that are based in what we call earmarked funding, and our donor countries indicating to them where they want to donate, and for what reason. They are obliged to respond in this crisis. And at the same time, they don't have the flexibility to be present also in other places that they should be. Just to give you an example, if we look at the budgets that different agencies have for Ukraine, and the ones that they have for Haiti, there's a huge, huge difference. And same applies these days in Sudan and Chad, where seems to be another reported and neglected crisis for many of the organisations and they don't have the funds to be there and respond. At the same time, MSF, thanks to the financial independence that we discussed before, they have this privilege of being always based on the assessment of the needs and more proportionally distribute their resources, and focus in all those neglected places where there are no others. So in many of these places, and in few contexts that I can think of at this right moment, we have been, we have been the only ones. Especially in Dafur these days I call to this describe the context in Darfur as a humanitarian desert. Because there are no other actors present.
Robin Davies 10:16
Clearly that's not a position MSF wants to be in. You don't want to abandon the people that you're helping in Darfur and elsewhere. But how do you actually deal with that moral hazard? Do you feed that back into your advocacy with global leaders? I mean, what action do you think you can take?
Christos Christou 10:36
We do bear the witness, we carry the evidence we collect, sometimes, even retrospectively, through surveys. The evidence that I hope that will attract more attention by others. Just to give you an example, back in January, we had to run a nutrition survey in one of our camps, the Zamzam camp in north Dafur. It was in the middle of this horrific situation is a conflict that started last April, in 2023. Or for some people, it never ended since 2003. When we all remember the genocidal acts in Darfur. And there was no attention. That nutritional surveys showed to us and to the rest of the world, that there are kids there and that they are dying every couple of hours. So it kick started a series of reactions, first of all, media came in the ground, UN agencies started getting more alert. I'm not saying that the whole situation dramatically changed, we still face serious challenges there. But at least, this is an example of how the eyes and the boots on the ground can really help the international community and the whole world understand better what is happening in places that they don't have any information about and why they don't have any information? Because there's no media attention, primarily.
Robin Davies 11:58
I guess, another pathway out of those protracted situations for the organisation is perhaps a move toward a development assistance role for local service providers. In other words, a move away from humanitarian service delivery for affected individuals toward building the capacity of local health providers often in camps that are - they're still called camps, but they're essentially cities - and they're going to be there forever. Do you is that part of your approach in these really protracted situations?
Christos Christou 12:54
We hear this and we see, for example, the table next to us, which is the humanitarian response, and development and peace, and where the standard logic, and we would like also to say more of a developmental action, there, we fully agree that the solution should not be a humanitarian one. However, when we dive into the crises and analyse them, we will see that the emergency response needs to come first. And that's where we focus, hoping that by addressing the humanitarian needs, the urgent humanitarian needs, then the others can come and take over. But unfortunately, this doesn't work well, so far. It doesn't. And maybe sometimes, we skip the steps. And we jump straight to development without having addressed the very emergency situations. And that backfires. That's what we see in other places, even in Nigeria. And that's not the approach that we should have.
Robin Davies 14:06
You've spoken a lot during this visit to Australia, about the shrinking of the humanitarian space, particularly in the context of Gaza. So we're seeing the norms, the laws of war, being ignored, or eroded by various parties. And you've talked about the need to protect or strengthen international humanitarian law and hold agents accountable for breaches of international humanitarian law. What do you think in practice would achieve that and what sort of change to the international architecture would achieve that?
Christos Christou 14:44
I will start by unpacking a little bit what we mean by humanitarian space being shrink. We mean three main areas, the first one has to do with access. And access is getting less and less in most of the places where there are huge humanitarian crises. The second has to do with the attack to the medical care itself, and attack to the hospitals attached to the medical humanitarians, to the health workers. And the third has to do also with the criminalisation of the humanitarian aid in several places, given this basic act of solidarity of offering a helping hand to people that are in need can be penalised. And examples that they've been in my mind is mainly the ones that we see in the Mediterranean Sea with search and rescue activities. And there's a pattern also repeated in other places like the United States and Mexican borders. So humanitarians, offering help to people on the move, may find themselves at the end of the day, in a cold case. So behind all this is one thing, as you rightly said, it's the very basic law of the war or the international humanitarian law. And this is what we need to defend and protect. And this is the only framework that we have that enables us to work. And it's something that worries me today. I have seen and have several examples where the humanitarian law is not respected by any of the warring parties. We've seen that in Syria, we've seen that in Ukraine see that in places like Yemen or in the whole Sahel region. But that place is involved, also known state armed groups where it's even more challenging, and how can you hold them accountable? But when it comes in context, like Gaza, by states, by armies, and when you see the indiscriminate bombardment of civilians, the massive attacks in hospitals in Gaza these days, out of 36 hospitals, maybe nine are still functioning and partially functioning, is that getting really, really worried about what's gonna be happening in the future, how the future is gonna look like. For many of my colleagues, just to give you an example, Al Shifa Hospital, and the attacks on the Al Shifa Hospital, as they say, has become the graveyard of IHL. And I believe that Gaza as a context, as we experience this, today, is a big turning point of what we used to know as humanitarian space and an IHL and laws of war. And what I'm saying always is, how am I supposed to go and negotiate access in other contexts, in other places, after what has happened in the impunity that we see these days in Gaza?
Robin Davies 18:17
So what kind of mechanism do you think could be either strengthened or established to increase the accountability of actors in these situations?
Christos Christou 18:27
Well, that's the question. That's the question of the day. In my messages these last days and being horrified by the attack in Rafa, which for most of us was the red line, and this line has been crossed now, is that it's not for the humanitarians anymore. We throw this ball, but to those that they have to take action, and these are the states. These are the governments and, of course we have the International Court of Justice, we have the International Criminal Court, they are ruling, is this enough? No. This is the moment now to hold everyone accountable. Every warring party, and especially when it comes to the context of Gaza. What we think that should be done at the moment is every single government, especially those that they have leverage, and Australia is one of them. They have to practice and exercise any kind of action that they can. And we are not the ones to indicate exactly what we don't understand politics in all the details, and we cannot really contextualise that in every single country. But I guess that it's not the first time that you're confronted with violations of the international humanitarian law, and this is not the first time that you have to comply with the ruling of ICJ. What I advise is that all these governments do the same as they may have done before. And there are very recent examples like the example of Ukraine. The sanctions were applied in states that they didn't respect IHL in that context.
Robin Davies 20:22
Now on a different topic this week in Geneva at the World Health Assembly, the member states of WHO are negotiating on the text of a pandemic treaty or agreement. And some of the contentious issues in those negotiations have been important for MSF. In the past, I remember back in 2018-19, MSF was very critical of the public private partnership approach to vaccine development for pandemic vaccines that was being followed by the Coalition for Epidemic Preparedness Innovations. And these issues are coming to the fore very much so now. What are the most important things that you would want to see come from these negotiations?
Christos Christou 21:06
What was the biggest lesson that we learned from that pandemic? It is, again, the lesson of standing in solidarity within each other in all levels, and of course, in state levels. What we witnessed at the beginning was this absolute situation, this insane situation where states were bidding against each other for the PPE, for the vaccines, for the treatments. And we knew that no one could be safe unless everyone is safe. So what we expect from any future treaty is exactly this. To be able to work as an interconnected world, and to be able to share knowledge resources. More specifically, when it comes to research and development. There, we would like to see what we call communities of knowledge in all different places of this world. We would like to see Africa taking a leading role also in that and it's not just about that continent, we would like to see the unknown usual suspects or those that we always expect the development to come from, or the research of new treatments, to play an important part of that as well. And that model, where we were based in partnerships, let's say with the private sector. To my opinion, and what we witnessed in most of the places where we intervened, didn't work. The private sector is here to make profits. So they cannot really address and treat the treatments the vaccines as a common good, as we would like to see that. So we expect from this pandemic treaty, and maybe we have very big expectations, not only to agree, as a whole world, in the basics, how we change information, how we do the surveillance, how we monitor, how we work together in the research and development. But we would like to see also how part of this happens in the places that we know that will be also affected and mostly affected. And at the end, we want a paradigm shift where the products to treat any future pandemic are really becoming common goods and not opportunities for profit.
Robin Davies 22:48
So ideally, there would be much more public investment in things like the mRNA vaccine manufacturing hub in South Africa. But I guess the hard piece is that the intellectual property came from and still resides in the private sector with companies like Moderna and Pfizer. Does MSF have a particular view about how that intellectual property should become a public good? Is it through IP reform? Or is it through rediscovery of the same technologies through public investment?
Christos Christou 24:25
It's I think the latter. Is a lot about public investment. And yes, we have experience on IPs on intellectual property. Also from the past, we several times had to advocate and give our own battles in challenging intellectual property, and how this affected our population like people, they had to get the antiretroviral treatments. And there is a lot of experience these days and there's a whole movement of lawyers, activists, doctors that they keep challenging the big companies. Like for example, one of our very recent petitions is on products of diagnostic products that we use for tuberculosis, for HIV, for sexually transmitted diseases. We have companies that they make huge profit from that, they sell cartridges in a price that is four times the price that they could still have and have a profit. And we have the evidence, we have done the analysis of the costs, and we push them to drop the prices. So yes, this is the experience that we can share with everyone when it comes also to expectations as we said before, that we should have in future products. But it takes a lot of public investment.
Robin Davies 25:55
I wanted to touch briefly on the situation of the Rohingyas in Bangladesh, that's a situation, seems eternally hopeless, and it's currently becoming less and less visible as attention is focused on Ukraine and Gaza and other crises. Does MSF see any way forward from this situation? And what do you think governments like Australia's could be doing to alleviate the suffering of the Rohingyas?
Christos Christou 26:22
So Rohingyas is one of the examples that came to my mind when we touched upon the very first question about emergencies, that they tend to become so protracted crises. Cox's Bazar in Bangladesh is a place, is an open prison of more than 1 million people, that they live in real dire human conditions. Just very indicatively to share with you that we see more than half of the population suffering from scabies, which shows that not the very basic hygiene conditions can be maintained in such places. And on top of these, then, of course, Rohingyas in Cox's Bazar, never managed to integrate because they were not allowed to even leave the camps, accessing the people is also very difficult. We do have some medical services. But this is again, a drop in the ocean of the needs that we see inside the camps. And after all these years, we see that the solution should not be by funding more of the humanitarian response or bringing more actors in, it has to be a durable solution where Australia has a very important role to play. They are already one of the biggest funders in this humanitarian response. But this is not enough. Now we need the political solution. We need the India, we need the China, we need the ASEAN leaders to really look at how to relocate the people and put an end in Cox's Bazar. That's the solution. And they need to create those conditions for the people to go back. They want to go back. And this cannot happen. There's no chance that this can happen only with humanitarian responses, no matter if they are in Bangladesh or in Myanmar. That's how we look at the situation in Rohingyas in Bangladesh. And that's why we insist that Australia can play a key role on that. And is a leverage for this political solution.
Robin Davies 28:42
This assumes that the situation, the political situation in Myanmar would change dramatically, though.
Christos Christou 28:47
And again, these days, we see that there is several different areas on fire, if I would say so. Maybe, I don't know how to politically analyse what's happening these days and who can really influence and change something, but maybe the very first step is to ensure that there is the basic safety and security for people to start thinking of going back. That's where we need to focus and that's well, I think not us, the medical humanitarian organisations but the United Nations agencies, UNHCR, together with the leaders of the regional countries, and try to create some more safe circumstances, some safe conditions for the people to start rethinking their repatriation.
Robin Davies 29:46
Has MSF been advocating for advanced countries to accept more Rohingya refugees as permanent migrants under their humanitarian programmes, or is the focus more on the long-term return to Myanmar?
Robin Davies 30:00
No we, you're right, we cannot focus only on one thing. But we don't advocate for these populations to be accepted massively by other countries. What we do advocate for is whoever flees wherever they go to be treated with dignity and with respect to their dignity and to be treated as human beings. We are in Malaysia, for example. And we see that they still have this stateless status, which does not allow them to even have the basic access to health services. This is what we advocate for, since the moment that they have come here. They have to be treated as human.
Robin Davies 30:00
The last question I wanted to ask you is about your legacy. So as you said, you're one year from completing your six-year term, and you've overseen a period of organisational reform. What would you like to leave behind? What changes would you be most proud of when you finish your term?
Christos Christou 31:05
So there are two things. Internally, I would like to finalise some transformational ideas that we have in order to make MSF a truly global humanitarian organisation and not just an organisation that as we look back in its history started from Europe, and was mainly based in funds from wealthy countries, mobilising resources, and addressing needs in those very poor countries. This has changed a lot, especially with a pandemic of the COVID pandemic, we realise that there are pockets of poverty and there are marginalised population everywhere. So having also in mind all the challenges that we have on access, the one thing that can at least improve a little bit our negotiations is to have a truly global humanitarian organisation. And we're having a lot of progress. If we look back, especially the last 10 years, we see that almost 50% of our coordinators, wherever they are around the world, they come from what we call Global South. They're not those white male saviours that we may used to know from the past history of MSF. So transforming the organisation, creating more operational hubs in other places that are closer to where our populations are, is my priority. Also at the same time rewarding and developing the people, our people that we have in all these places. Externally, I think there are not many reasons to feel very optimistic about the world. I feel that, as we said before, there is going to be further shrinkage of the humanitarian space, we will have more and more challenges, there will be more and more, the humanitarian environment will be more and more hostile. So what we have to do is to remain solid in our principles, to always remind to ourselves that what should guide us is the people's needs, and our Northstar should always be the humanity. And we have to remain the ones who defend humanity, we have to stay the ones that are what we call an island of humanity and hope in this world. And these are my two legacies that I would like to leave behind.
Robin Davies 34:06
Well, thank you very much for speaking with us today. I wish you well with those two objectives for your final year. Thanks again.
Christos Christou 34:15
It was such a pleasure. Thank you.
Outro 34:22
Devpolicy Talks is the podcast of the Australian National University's Development Policy Centre. Show notes are posted to Simplecast. Our producers are Robin Davies, Amita Monterola, and Jackie Hanafie. You can read and subscribe to our daily blogs on aid, international development, and the Pacific at devpolicy.org. And you can follow us on Facebook, LinkedIn, Instagram and Twitter. You can send us feedback and ideas for episodes to devpolicy@anu.edu.au. Join us again in another fortnight for the next episode of Devpolicy Talks.