Interview of a worker at Doctors without borders
- Lucie Delpech
- Dec 30, 2020
- 3 min read

In order to discuss the subject “colonization of global health” I have interviewed a friend who has worked for several years for Doctors without borders (Médecins sans frontières - MSF).
Lucie: Can you introduce yourself?
Federico: My name is Federico Sirna, I am 34 years old, I am from Rome, Italy. I have a Bachelor’s degree in environmental science and another one in technical logistics. For the last seven years I have worked for MSF as logistic manager, water and sanitation manager and logistics coordinator. I have done 13 missions in several countries. I am now studying at the school of Public Health of Bordeaux, France.
Lucie: Can you explain what the missions of MSF are and can you present missions that have marked you?
Federico: MSF mainly works in contexts where there are health needs that are not met. It can be in France or Italy with migrants, but also in Africa, in the Middle East or South America. Traditionally, they work in zones hit by conflicts, natural disasters or outbreaks.
In context of chronic diseases, they have long term projects that can last 10 to 15 years. I have worked in such projects in Mozambique and Iran. But MSF is very well known for their work in emergency. These are normally short missions that last a few months or a couple of years. I have worked in the Ebola missions in West Africa. I also participated in the emergency response mission to the battle of Mosul.
Lucie: Do you think that the interventions of foreign organizations in these countries are a good solution to solve the problems?
Federico: It is a very complex subject, because these countries are really different from western countries. In some areas, before MSF arrives, local health systems can have really important gaps. So for example, if I am a person that is sick from cholera, and I don’t have a treatment, I am happy about the arrival of a foreign organization that will treat me. In these cases, the international organizations support a national health system that is not working properly for many different reasons (some have been at war for decades, like Iraq or Congo). Everybody has the right to a decent healthcare, and it makes sense to give healthcare to the people who need it. In the long term there should be mechanisms with organizations such as the World Health Organization to develop long term strategies with the local government. In practice, it is complicated to develop consistent strategies in the long term. These can be for many reasons, mostly because of the instability of the security contexts and chronic poverty.
Ideally, MSF arrives following a big crisis and helps. Then they try to make a transition to a working healthcare system. The problem is that sometimes these transitions are very long to achieve, and the contextual instability makes it even harder.
What is important to understand is that every country is different, so every country should be studied separately. One should look into the geopolitical situation and analyze all the economics and political interests that are at stakes in each country, but one cannot do any generalization.
MSF works with the national health system and together with the local doctors, nurses and staff. MSF offers support. It’s a partnership so they can learn from European health professionals as much as European health professionals can learn from African or Middle Eastern health professionals. One of the biggest problems is that when MSF starts a project, MSF comes in with financial, material and human resources. Once MSF goes away, if the transition was not achieved, a gap remains.
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