International Activity Report 2020 > Foreword

The spread of COVID-19 around the world presented MSF with extraordinary challenges in 2020. It also exposed the weaknesses of many health systems and exacerbated the suffering of people in countries where we were already working before the pandemic. As the epicentre of the global public health crisis shifted, we lent our expertise in emergency response and infectious disease control to health authorities and medical staff in certain countries for the first time in our history. 

Although we had to suspend our services in some locations, the relentless commitment and efforts of our teams allowed us – for the most part – to ensure that the communities we serve could still have access to surgery, mother and child care, vaccinations and treatment for other infectious and non-communicable diseases.  

We learned valuable lessons too. In any given year, our staff originate from and move between more than 140 countries, with locally hired professionals making up over 80 per cent of our workforce. In mid-March, the closing of international borders and strict quarantine measures prevented MSF doctors, nurses, technical specialists and support staff from joining or replacing colleagues in the field.  Our projects had to manage and mitigate substantial staff shortages, notably in humanitarian crisis settings and conflict zones such as Bangladesh, Nigeria and Yemen. Despite the difficulties, this situation provided an opportunity to accelerate the ongoing process of decentralisation and localisation efforts in the management of key elements of our interventions. It also forced our teams on the ground to find alternative operating solutions, including shifting away from our traditional, and mainly European-based, supply hubs, to sourcing more equipment and materials locally.  

At a time when everyone, everywhere was affected by the socio-economic impacts of the global health crisis, the generous public response to our appeal for donations to our COVID-19 Crisis Fund was astounding. It is thanks to the €121 million raised in 2020 that we were able to commit resources to dedicated COVID-19 projects and support health systems. 

COVID-19 will remain a threat until it is under control everywhere. Only international solidarity and action will ensure fair and equitable access to protective equipment, diagnostic tools, therapies and vaccines. Yet as 2020 drew to a close, nationalistic and “me first” tendencies were trumping solidarity calls, especially as new vaccines had begun to roll out. As the richer countries negotiated to secure a surplus of vaccines for their own people, pharmaceutical companies offered to the highest bidder, leaving low- and middle-income countries out in the cold and unable to benefit from vaccines in the near future.   

Against the backdrop of the race to develop vaccines, MSF continues to call for scaling up of resources through optimisation and diversification of manufacturing capacities, including knowledge transfer. To this end, we join other civil society organisations in supporting India and South Africa’s call to waive certain intellectual property rights. 

We advocate access to these tools for marginalised people and communities in conflict and crisis settings who have no – or very limited ─ access to healthcare. Witnessing the situations the most vulnerable people face has been at the core of our work since the beginning and we will continue to push for no one to be left behind.  

The year 2020 also shone a glaring spotlight on racial injustice and discrimination.  The international outrage, protests and debate sparked by the killing of George Floyd in the USA in May 2020 led some organisations – including MSF – to assess their progress in fighting these issues.  

Many of our staff across the globe raised their voices to highlight longstanding issues of structural racism and inequity within MSF. They rightly demanded change. Despite years of raising awareness and implementing improvements, our progress has been far too slow.  

To dismantle barriers and ensure that all our colleagues are included, respected and valued as they should be, our Core Executive Committee launched an actionable plan on racism and discrimination towards the end of 2020. It aims to translate commitments into concrete and meaningful outcomes.  

Priorities include guaranteeing fairness when it comes to staff recruitment and development and reviewing how our global workforce is rewarded. Alongside these fundamental equity issues, we need changes in culture and mindsets at both institutional and personal levels. We are also painfully aware the current distribution of power within our movement does not adequately reflect the diversity of our organisation.  We now need to explore governance and operational models that will enable us to better help those in need. 

In 2020, the MSF movement formally recognised and responded to the medical and humanitarian consequences of climate change, environmental degradation and our own contribution towards it. We decided to hold ourselves accountable through a new Environmental Pact, which entails measuring and minimising our environmental footprint while continuing to deliver high-quality medical and humanitarian assistance. It is also a commitment to work with others to develop and share knowledge about the humanitarian consequences of climate and environmental changes.  

As we embark on changing the way we understand and respond to crises, we know that we must do more, without compromising the quality and relevance of our medical humanitarian action.