The case of Médecins Sans Frontières

​​Content warning: This article contains mentions of mental illness, racism, and discriminatory language.

Trauma projects and expeditions to ‘aid’ victims in resource-poor settings have become increasingly attractive and are fashionable for Western donors and non-governmental organisations (NGOs). However, the permeation of Western schools of thought surrounding trauma limits the degree to which the actions of these non-governmental organisations are effective or helpful. For example, Médecins Sans Frontières (MSF) deploys hundreds of their staff to conflict situations or areas affected by natural disasters. They have saved the lives of people worldwide, providing medical aid to all regardless of differences in their race, religion, creed, or political affiliation. Whilst MSF and their staff (from Western and non-Western countries) have shown courage and selflessness in their attempts to care for those most vulnerable around the world, their acts of goodwill do not come without criticism. This second part of this essay series will explore the extent to which NGOs are manipulating situations in areas of conflict and natural disaster by constructing trauma narratives as ‘epidemics’ in urgent need of attention to gain further donations, publicity, and resources. Lastly, we will explore the damaging consequences of being depicted as receptive patients or helpless victims by aid missions.

Founded in France in the second half of the twentieth century, MSF is a private international association of doctors and healthcare professionals working to “provide assistance to populations in distress”. Despite their pledge to observe “neutrality and impartiality”, their humanitarian aim is deeply rooted in Western ideals of human rights. The rigidity of these ideals mean issues are framed and solutions are generated through the lens of colonial thinking. In the simplest sense: a humanitarian mission originating from a European country to help people deemed to be in need in Africa or Asia resembles colonial civilising missions. More specifically, in the case of post-traumatic stress disorder (PTSD), repetitive quotes in the media referring to trauma as the “hidden epidemic” likens the psychological condition to concrete communicable diseases capable of causing mass pathology. Framing localised trauma as Westernised conceptions of PTSD provides an incentive and authority for companies such as MSF to “resolve the issue”. 

For example, the MSF handbook on refugee health makes claims that “20% of survivors of traumatic experiences will not recover without professional help.” Such language works to posit MSF as saviours and superior bearers of knowledge and healing, linguistically reflecting a “modern echo of the age of Empire when Christian missionaries set sail to cool the savagery of primitive peoples and gather their souls, which would otherwise be lost”. The colonial use of language was exemplified in the wake of the Rwandan genocide, when European NGOs sought out to make an early psychological intervention for the Tutsi refugees as a “preventative measure to thwart the later development of more serious mental problems,” inciting a sense of fear towards trauma and a need to “control the mentally ill of the global south”. However, the NGOs failed to provide adequate treatments, as concepts integral to the English understanding of trauma such as ‘stress’ and ‘family member’ were not translatable in Kinyarwanda and didn’t apply to Rwandan social contexts. As such, Western knowledge and its tools are incapable of identifying the expressions of trauma and the appropriate treatments cross-culturally. Further, such absolute depictions of trauma not only simplify it as a biological entity to be ‘fixed’, but pathologise human emotions and victims of traumatic events.

The white saviour complex at the centre of MSF's ideology is a symptom of a historical mindset that is accepting of discriminatory language and generalisations. Members and employees past and present of MSF made attempts to challenge their work environment through publishing an independent report exposing the racism, discrimination, and abhorrent behaviours observed within the organisation. As an employee of MSF relays, “I hear harmful generalisations and racist comments all the time when working internationally for MSF, from fellow international colleagues.” Employees went on to take note of their experiences in varied settings, stating they have overheard senior colleagues using hateful and ignorant language such as “These people aren't careful”, “They smell bad”, “People here can't figure it out”, “People here don't know how to do s***.” Yet the organisation's work sustains its faultless appearance, continuing to appeal to the Western eye and be championed for its exemplary humanitarian action.

MSF's exacerbation of white supremacy and neo-colonialism—the use of power by developed countries “to produce a colonial-like exploitation” and maintain control—are further evidenced within its division of labour: workers are split  into both ‘international’ and ‘national’ categories, providing individuals in the same role with varied rates of pay and privileges dependent on their nationality and passport. Such divisions were described by MSF staff as "coded racialised language", with over 50% of its workers reporting experiences of racism. Since many ‘international’ workers depend on MSF for employment, it is hard for them to confront the administration and demand tough reforms for fear of losing their jobs. 

Members of the organisation have made considerable attempts to stand against their work’s ethos, calling for MSF to look deeper into its history and what it represents, and demanding accountability for their harmful actions. Their stance is summarised by present MSF staff in the MSF dignity report published in 2021: it is impossible to view current activities and policies in MSF “outside the legacies of colonialism itself, from which MSF and the wider humanitarian sector grew, or contemporary power dynamics that maintain oppressions”. However, the impact of the report has done little to tarnish the reputation of MSF, or to change the lived experiences of both its staff and those on the receiving end of its ‘aid’. MSF joins many other Western non-government organisations in an inability to concede and amend their colonial history, address their white saviorism discourse, and dismantle their archaic protocols and procedures.

The future of trauma narratives

To conclude, modern Western psychiatry and the clinical protocols and manuals that form it are based on biased Western research and experiences that are not inclusive of other cultural understandings nor the contexts in which mental ill-health arises. It is argued that the West medicalises and objectifies despair—responses to mass social upheaval, poor human rights, and diminishing social security—by categorising them into identifiable somatic symptoms. The 5th and most recent edition of the DSM has been criticised for its cultural bias and tendency to categorise all mental illnesses that do not align with Western understandings of psychology as “culture-bound syndromes”—that is, diseases or illnesses that are deemed to be specific to a particular culture or society. Subsequently, non-Western expressions of trauma are either falsely medicalised, untreated, misdiagnosed, or underrepresented, leading to inequalities in access to treatment for poor mental health globally. Implications of these discriminations bleed into the social lives of those afflicted and can have adverse effects on survivors. As Western diagnoses and understandings are prioritised, traditional coping strategies and idioms of distress are no longer meaningful to discuss patients' suffering, nor utilised as a common language for survivors, therefore exacerbating mental illness itself. 

To address colonial cycles in healthcare, critics are calling for a decolonised approach to psychology. A decolonised approach places human diversity as a priority in its thinking through actions like rewriting the curriculum used in medical schools to expand upon the limited Western frameworks currently used. The decolonisation movement emphasises the diversity of human experience, arguing that no single lens or methodology can encapsulate various understandings, ways of life, or experiences without falling into generalisations and omitting elements of people’s existences. In the case of NGOs such as MSF, training should be provided to inform their staff of the cultures that they work in. Learning about the ideas and practices intrinsic to other cultures would be a step towards acknowledging the gap between their expertise and those of local healthcare workers, community leaders, and healers. Culturally-cognisant work empowers locals to lead humanitarian agencies towards the concerns of their survivor groups, and guide them in understanding their way of life through respecting their rights, integrity, and traditional ways of coping.

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