médecins sans frontières médecins sans frontières médecins sans frontières (msf; pronounced (listen)), also known as doctors without borders, is a charity that provides humanitarian medical care. it is a non-governmental organisation (ngo) of french origin known for its projects in conflict zones and in countries affected by endemic diseases. the organisation provides care for: diabetes, drug-resistant infections, hiv/aids, hepatitis c, tropical and neglected diseases, tuberculosis, vaccines and covid-19. in 2019, the charity was active in 70 countries with over 35,000 personnel; mostly local doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers, and administrators. private donors provide about 90% of the organisation's funding, while corporate donations provide the rest, giving msf an annual budget of approximately us$1.63 billion. not to be confused with médecins du monde, which was formed in part by members of msf, but is an entirely independent non-governmental organisation with no links to msf today. médecins sans frontièresfounded22 december 1971 (1971-12-22)founded atparistypeinternational ngofocushumanitarian aidheadquartersglobal: genevaoperational centres: amsterdam (oca)barcelona-athens (ocba)brussels (ocb)paris (ocp)geneva (ocg)area served worldwideinternational presidentchristos christoumain organinternational general assemblyrevenue (2020) €1.9 billionemployees 45,375websitewww.msf.org msf was founded in 1971, in the aftermath of the biafran famine of the nigerian civil war, by a small group of french doctors and journalists who sought to expand accessibility to medical care across national boundaries and irrespective of race, religion, creed or political affiliation. msf's principles and operational guidelines are highlighted in its charter, the chantilly principles, and the later la mancha agreement. governance is addressed in section 2 of the rules portion of this final document. msf has an associative, rather chaotic structure, where operational decisions are made, independently, by the five operational centres (amsterdam, barcelona-athens, brussels, geneva and paris). common policies on core issues are coordinated by the international council, in which each of the 24 sections (national offices) is represented. the international council meets in geneva, switzerland, where the international office, which coordinates international activities common to the operational centres, is based. msf has general consultative status with the united nations economic and social council. it received the 1999 nobel peace prize in recognition of its members' continued efforts to provide medical care in acute crises, as well as raising international awareness of potential humanitarian disasters. james orbinski, who was the president of the organisation at the time, accepted the prize on behalf of msf. prior to this, msf also received the 1996 seoul peace prize. christos christou succeeded joanne liu as international president in june 2019. history 1967 to 1970 biafra a child with kwashiorkor during the nigerian civil war during the nigerian civil war of 1967 to 1970, the nigerian military formed a blockade around the nation's newly independent south-eastern region, biafra. at this time, france was one of the few major countries supportive of the biafrans (the united kingdom, the soviet union and the united states sided with the nigerian government), and the conditions within the blockade were unknown to the world. a number of french doctors volunteered with the french red cross to work in hospitals and feeding centers in besieged biafra. one of the co-founders of the organisation was bernard kouchner, who later had a career in french politics, rising to the position of minister for europe and foreign affairs, which he held 2007–2010. after entering the country, the volunteers, in addition to biafran health workers and hospitals, were subjected to attacks by the nigerian armed forces, and witnessed civilians being murdered and starved by the blockading forces. the doctors publicly criticised the nigerian government and the red cross for their seemingly complicit behaviour. these doctors concluded that a new aid organisation was needed that would ignore political/religious boundaries and prioritise the welfare of survivors. apart from nigeria, msf exists in several african countries including benin, zambia, uganda, kenya, south africa, rwanda, sudan, sierra leone, and others. 1971 establishment the groupe d'intervention médicale et chirurgicale en urgence ("emergency medical and surgical intervention group") was formed in 1971 by french doctors who had worked in biafra, to provide aid and to emphasize the importance of survivors' rights. at the same time, raymond borel, the editor of the french medical journal tonus, had started a group called secours médical français ("french medical relief") in response to the 1970 bhola cyclone, which killed at least 625,000 in east pakistan (now bangladesh). borel had intended to recruit doctors to provide aid to survivors of natural disasters. on 22 december 1971, the two groups of colleagues merged to form médecins sans frontières. msf's first mission was to the nicaraguan capital, managua, where a 1972 earthquake had destroyed most of the city and killed between 10,000 and 30,000 people. the organisation, today known for its quick response in an emergency, arrived three days after the red cross had set up a relief mission. on 18 and 19 september 1974, hurricane fifi caused major flooding in honduras and killed thousands of people (estimates vary), and msf set up its first long-term medical relief mission. between 1975 and 1979, after south vietnam had fallen to north vietnam, millions of cambodians immigrated to thailand to avoid the khmer rouge. in response, msf set up its first refugee camp missions in thailand. when vietnam withdrew from cambodia in 1989, msf started long-term relief missions to help survivors of the mass killings and reconstruct the country's health care system. although its missions to thailand to help victims of war in southeast asia could arguably be seen as its first wartime mission, msf saw its first mission to a true war zone, including exposure to hostile fire, in 1976. msf spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in lebanon, during the lebanese civil war, and established a reputation for its neutrality and willingness to work under fire. throughout the war, msf helped both christian and muslim soldiers alike, helping whichever group required the most medical aid at the time. in 1984, as the situation in lebanon deteriorated further and security for aid groups was minimised, msf withdrew its volunteers. original founders jacques bérès philippe bernier raymond borel jean cabrol marcel delcourt xavier emmanuelli pascal grellety bosviel gérard illiouz bernard kouchner gérard pigeon vladan radoman max récamier 1970s claude malhuret was elected as the new president of médecins sans frontières in 1977, and soon after debates began over the future of the organisation. in particular, the concept of témoignage ("witnessing"), which refers to speaking out about the suffering that one sees as opposed to remaining silent, was being opposed or played down by malhuret and his supporters. malhuret thought msf should avoid criticism of the governments of countries in which they were working, while kouchner believed that documenting and broadcasting the suffering in a country was the most effective way to solve a problem. in 1979, after four years of refugee movement from south vietnam and the surrounding countries by foot and by boat, french intellectuals made an appeal in le monde for "a boat for vietnam", a project intended to provide medical aid to the refugees. although the project did not receive support from the majority of msf, some, including later minister bernard kouchner, chartered a ship called l'île de lumière ("the island of light"), and, along with doctors, journalists and photographers, sailed to the south china sea and provided some medical aid to the boat people. the splinter organisation that undertook this, médecins du monde, later developed the idea of humanitarian intervention as a duty, in particular on the part of western nations such as france. in 2007 msf clarified that for nearly 30 years msf and kouchner have had public disagreements on such issues as the right to intervene and the use of armed force for humanitarian reasons. kouchner is in favour of the latter, whereas msf stands up for an impartial humanitarian action, independent from all political, economic and religious powers. 1980s in 1982, malhuret and rony brauman (who became the organisation's president in 1982) brought increased financial independence to msf by introducing fundraising-by-mail to better collect donations. the 1980s also saw the establishment of the other operational sections from msf-france (1971): msf-belgium (1980), msf-switzerland (1981), msf-holland (1984), and msf-spain (1986). msf-luxembourg was the first support section, created in 1986. the early 1990s saw the establishment of the majority of the support sections: msf-greece (1990), msf-usa (1990), msf-canada (1991), msf-japan (1992), msf-uk (1993), msf-italy (1993), msf-australia (1994), as well as germany, austria, denmark, sweden, norway, and hong kong (msf-uae was formed later). malhuret and brauman were instrumental in professionalising msf. in december 1979, after the soviet army had invaded afghanistan, field missions were immediately set up to provide medical aid to the mujahideen, and in february 1980, msf publicly denounced the khmer rouge. during the 1983–1985 famine in ethiopia, msf set up nutrition programmes in the country in 1984, but was expelled in 1985 after denouncing the abuse of international aid and the forced resettlements. msf's explicit attacks on the ethiopian government led to other ngos criticizing their abandonment of their supposed neutrality and contributed to a series of debates in france around humanitarian ethics. the group also set up equipment to produce clean drinking water for the population of san salvador, capital of el salvador, after the 10 october 1986 earthquake that struck the city. 1990s the early 1990s saw msf open a number of new national sections, and at the same time, set up field missions in some of the most dangerous and distressing situations it had ever encountered. in 1990, msf first entered liberia to help civilians and refugees affected by the liberian civil war. constant fighting throughout the 1990s and the second liberian civil war have kept msf volunteers actively providing nutrition, basic health care, and mass vaccinations, and speaking out against attacks on hospitals and feeding stations, especially in monrovia. field missions were set up to provide relief to kurdish refugees who had survived the al-anfal campaign, for which evidence of atrocities was being collected in 1991. 1991 also saw the beginning of the civil war in somalia, during which msf set up field missions in 1992 alongside a un peacekeeping mission. although the un-aborted operations by 1993, msf representatives continued with their relief work, running clinics and hospitals for civilians. msf first began work in srebrenica (in bosnia and herzegovina) as part of a un convoy in 1993, one year after the bosnian war had begun. the city had become surrounded by the bosnian serb army and, containing about 60,000 bosniaks, had become an enclave guarded by a united nations protection force. msf was the only organisation providing medical care to the surrounded civilians, and as such, did not denounce the genocide for fear of being expelled from the country (it did, however, denounce the lack of access for other organisations). msf was forced to leave the area in 1995 when the bosnian serb army captured the town. 40,000 bosniak civilian inhabitants were deported, and approximately 7,000 were killed in mass executions. 1994 rwandan genocide when the genocide in rwanda began in april 1994, some delegates of msf working in the country were incorporated into the international committee of the red cross (icrc) medical team for protection. both groups succeeded in keeping all main hospitals in rwanda's capital kigali operational throughout the main period of the genocide. msf, together with several other aid organisations, had to leave the country in 1995, although many msf and icrc volunteers worked together under the icrc's rules of engagement, which held that neutrality was of the utmost importance. these events led to a debate within the organisation about the concept of balancing neutrality of humanitarian aid workers against their witnessing role. as a result of its rwanda mission, the position of msf with respect to neutrality moved closer to that of the icrc, a remarkable development in the light of the origin of the organisation. aerial photograph of a mihanda, zaire refugee camp in 1996. pictured are 500+ tents set up in the mitumba mountains. the icrc lost 56 and msf lost almost one hundred of their respective local staff in rwanda, and msf-france, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a french military intervention stop the genocide. msf-france introduced the slogan "one cannot stop