Our partners take the floor

forum’s minutes [Panel discussions of Saturday June 5, 2010]

Š Steven Wassenaar

Humanitarian organisations and their partners: have things changed?

«Our partners take the floor»

Panel discussions Doctor of the world France June 5, 2010

panel discussion n°1....................... p.3 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

Panel discussion n°2....................... p.9 When beneficiaries become actors: what is the best way to proceed?

Testimonies from Serbian, Guinean, Bengali and French partner associations

Panel discussion n°3....................... P.15 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

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Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

Panel discussion n°1 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

Presentation of the panel discussion

Panel discussion

In its 30 years of existence, Médecins du Monde has profoundly modified its view of its own activities. At this panel discussion several of its partner organisations will present the projects that they have conducted under this new philosophy.

The panel discussion was moderated by François MABILLE, an international relations professor-researcher at the Catholic University of Lille.

DUGA is an association established in 1995 in Bosnia on the initiative of Médecins du Monde. At first, it provided support for young people traumatised by the war in the former Yugoslavia. It now assists young people from minority backgrounds in integrating the educational and association systems. DUGA also works with the government through advocacy, which helps strengthen Bosnian civil society.

MCWAK (Maternity and Child Welfare) was established in 2000 to continue a project initiated by Médecins du Monde. Once it became independent, MCWAK signed a technical support contract with MDM, through which Médecins du Monde helped it organise itself and to devise its strategy. While MCWAK retains responsibility for managing its own projects, Médecins du Monde sometimes assists it in making its requests for international funding.

For 37 years, Amel has operated in the very complex environment of southern Lebanon. It continued operating even after the political movement from which it originally sprang disappeared from the scene. It is now uniquely positioned and highly respected internationally for its independence from all parties and religions. Since being established, Amel has created more than 150 field hospitals.

Ibuka assists Rwandan society in overcoming the trauma of the 1994 genocide. It supports victims in their appeals for justice, promotes peaceful coexistence and provides guidance to young people from violent backgrounds. Médecins du Monde has helped it organise itself and plan activities that best deal with the deep scars left from the genocide. Ibuka France makes a contribution by “giving voice to the diaspora”.

It is a valuable intermediary that tempers the decisions of Ibuka Rwanda and helps French partners understand the local situation.

Bernard GRANJON,

Former President of Médecins du Monde It would be hard to sum up in so little time everything that Médecins du Monde has done over the last 30 years. However, it is possible to draw up a basic outline. Médecins du Monde was born of two episodes of conflict: its opposition to the Red Cross during the Biafra war, and Bernard Kouchner’s expulsion from the Médecins sans Frontières association.

A conflict always pits two adversaries, each of which tries to gain the upper hand. As it always acts in conflict situations, Médecins du Monde has from the very start sought to carve out a position of superiority for itself within the framework of its humanitarian activity, and to apply the principle of “justifiable intervention”. In fact, this principle is a modern-day manifestation of the myth of Antigone, the message of which is that morality must always take precedence over legality.

From the start, Médecins du Monde has stood apart from other charitable organisations. Its initial objective was to impose compliance with human rights. But, as Hannah Arendt used to say, “All ideologies are dominating by nature”. In some ways justifiable intervention is also a form of domination.

A former Central African Republic prime minister made a very enlightening comment to me recently regarding the Arche de Zoé episode. He felt that the watershed event of the 20th century was the end of colonialism.

This occurred in the 1960s, at the very moment when the concept of justifiable intervention was emerging and supplanting a now-obsolete political model. I fully share his view. In my opinion, justifiable intervention is the manifestation of a superiority complex, and one that I think Médecins du Monde suffered from for a long time. For too long, we thought we had a monopoly on truth, and we tended to impose this truth on others as part of a top-down activism model.

Médecins du Monde has gradually become more humble. It has taken on a heartfelt civic engagement and a bottom-up model, which is most keenly

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Panel discussion n°1 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

expressed in the idea of partnerships. In Turkey we have worked for more than 10 years with local associations. We assist them but leave the initiative to them. And that is now Médecins du Monde’s philosophy. A successful mission is one whose results outlast our involvement. A successful mission is recognisable as much by what one has contributed as by what one has received from it.

François MABILLE

The political philosophy underlying the activities of any association is a fundamental issue. Perhaps more attention should be devoted to the relationship between the notions of intervention and partnerships.

The differences between top-down and bottom-up models is also an important issue.

Anka IZETBOGEVIC,

a representative of DUGA, Bosnian association Bosnia-Herzegovina is only 15 years old. It has experienced war but also, fortunately, Médecins du Monde.

I am pleased to celebrate, along with the 30th anniversary of Médecins du Monde, our 15 years of working together. Médecins du Monde has supported a group of Bosnian professionals in speaking out and in best contributing to the development and involvement of civil society.

This year DUGA is leading a campaign in partnership with UNICEF and the Soros Foundation. In the run-up to the coming elections, we will urge candidates to better address the issues of childhood welfare, access to healthcare and compliance with international standards in these areas, with a view to a future European accession.

François MABILLE

So Médecins du Monde also knows how to further change beyond our borders. DUGA carries out its activities with a subtle nod to politics based on three pillars: defence of minority rights, contribution to public healthcare and education policies, and social activism that involves the very nature of the Bosnian state.

Yaseen MALIK,

a representative of MCWAK, a Pakistani association MCWAK originally (i.e., in 1997) was an informal group of local doctors involved in a Médecins du Monde project. MCWAK operates in the desert regions of the Punjab, in southern Pakistan.

In 1995, a Médecins du Monde team made an offer to Bosnian mental health specialists – to set up a reception centre in Sarajevo for traumatised young people, with the purpose of identifying the services most suited to them. Five years later, DUGA was established with the goal of making a greater contribution to the development of Bosnian civil society and citizen participation.

At first, our group of doctors was called the World Healthcare Society. We adopted our current name in 2000, when the association was officially established.

In 2004, we signed a technical partnership contract with Médecins du Monde for a rural hospital project.

This was a prototype that we have reproduced in several other places, with a goal of serving the four million persons who make up our target population.

Bosnia still faces a crisis that is both economic and political in nature. Greater civic-mindedness is an absolutely imperative, particularly in the area of education. Along these lines, DUGA helps unprivileged children take part in association life and to better integrate the educational system. DUGA trains teachers and works alongside educational and healthcare authorities. Some parties are now suggesting that the humanitarian model is no longer suitable, and we are striving to urge greater involvement by the authorities.

MCWAK organises public-private partnerships, backed by the government and partner associations.

Our partners provide equipment for the hospitals and then ensure that it is used properly. On projects organised by the UN or OXFAM, particularly in food relief, MCWAK partners with other associations and the government.

DUGA wants to develop civic participation and equal opportunity. Social exclusion is a great concern. DUGA seeks to promote the development of all children and adolescents by allowing them to speak out. In Bosnia, the educational system can have a repressive effect

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on children having difficulties or minorities. Médecins du Monde has helped organise our fight against discrimination and in favour of children’s rights.

MCWAK’s governance is structured around an annual membership meeting, an executive committee, a secretarial staff, a president and a director. Most of its projects involve healthcare, education and advocacy.

Given the means at its disposal, the government is always a key partner.

MCWAK undertakes innovative initiatives that are evaluated on an annual basis. For example, we have

Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

Panel discussion n°1 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

opened a training centre for midwives. Médecins du Monde takes part regularly in evaluations and strategy sessions. This support is very important for our confidence, especially when we have to defend our projects to international bodies.

François MABILLE

MCWAK’s activities are quite varied. Here is a good example of how a project or initiative can lead to a modification of structures and their integration within a network of partners. This touches on the key issue of relations between private-sector and public-sector actors.

Kamel MOHANNA,

a representative of Amel, a Lebanese association Amel is a non-denominational Lebanese NGO. As such, its very existence in Lebanon may seem to be a contraction. Personally, I have kept up with Médecins du Monde since it was established, and I witnessed its break with Médecins sans Frontières. Going further back, I took part in the 1968 events as an active member of this radical left whose idols were Mao and Che Guevara. I also worked as a volunteer doctor with Palestinians. Rumours of my death circulated on numerous occasions and a journalist then wanted to tell my story. Thirty years later, my biography, L’épopée des choix difficiles (“The epic of tough choices”), has at last been published.

Indeed, deciding to set up a non-denominational NGO in Lebanon and refusing to swear fealty to political parties are tough choices to make. And yet, I had many offers. I was at times offered as much as several million dollars. Amel now plays a role of a catalyst in Lebanon. It is highly respected in the Arab world and internationally. This has meant making some sacrifices, financial ones in particular, and, in fact, I believe that humanitarian workers must suffer to better feel the needs of others.

Amel emerged from the Lebanese National Movement.

I used to work in the Palestinian camps, where I met Bernard Kouchner, who often expressed surprise that I always turned down all ministerial post offers. Amel was founded after the first Israeli invasion of southern Lebanon but began to expand with the second invasion, in 1982. We then set up field hospitals with the support of Médecins du Monde. It was then that the National Movement, its original party, folded. And yet Amel has survived. Our region suffers from many evils, including the lack of a strategic vision, the reign of non-constructive criticism and divisiveness, excessive top-down authority and an “all or nothing” mentality.

‘‘

... its work that an NGO proves its value each day.’’

In reaction to all this, Amel has taken on a positive view and steadfast optimism. “It’s easy to be a critic but hard to be an artist.” Amel casts its lot with the artists.

Humanitarian work suffers from excessive focus on technical issues. We need to refocus on commitment.

As things now stand, commitment and professionalism are at odds with each other on a daily basis. It is not possible to pay a doctor who takes part in a meeting, even though this is required by certain rules.

So commitment should be the primary focus.

Similarly, political affinities always take a back seat to the quality of work. It is through its work that an NGO proves its value each day, and that is Amel’s philosophy. We also promote contacts among young people, as that helps dissipates often deeply-rooted prejudices. In Lebanon, charge is hard. In my 37 years of commitment, I have opened almost 150 centres in my country. And yet I feel like an outsider, as I refuse to swear fealty to any group.

Humanitarian work must always take local know-how into account. Even without humanitarian action, life always organises itself. So we have to avoid any neocolonial leanings, which can sometimes contaminate even local actors. Partnerships must seek to reconcile know-how with knowing-how-to-be. Encounters are essential. There are things we can learn every day from people around us. Actors must also be given responsibility so that each of them can become, on his own scale, a humanitarian activist. Commitment must be the hallmark of humanitarian work.

François MABILLE

Amel has a very special position in the Lebanese political landscape and represents a sort of a cultural exception. This testimony also raises questions on the legitimacy of humanitarian commitment and the life choices that it means.

Ministerial involvement is a sensitive matter in France.

In times of crisis, when there is a change in govern-

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Panel discussion n°1 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

ment, associations are often approached, as their members have often opposed to the previous political authorities. However, such approaches risk depriving associations of their human resources.

Marcel KABANDA,

a representative of Ibuka France, Rwandan association Cooperation between Ibuka and Médecins du Monde was forged against the backdrop of the 1994 genocide. Ibuka keeps the memory of the victims alive, supports the survivors and seeks out justice. Médecins du Monde was in Rwanda during the genocide.

When it was founded, Ibuka worked with many NGOs and donors, as well as with the Rwandan state in the areas of housing, healthcare and education. However, it had no financial resources and acted mostly as a spokesperson for victim populations.

Ibuka linked up with Médecins du Monde beginning in 2004. It recently refocused its activities on treatment and managing mental traumas, which can be deeper than physical traumas, many of which, 10 years on, have healed. This was of paramount importance to the Rwandan people. Without suitable assistance, survivors might have remained on the sidelines while society was being rebuilt.

Médecins du Monde therefore offered institutional and practical assistance to Ibuka in setting up a mechanism for treating psychological traumas. Back then, the Gacaca courts required special initiatives so that survivors and former henchmen could live side-by-side.

This process is now coming to a close. Our action will therefore have to refocus on managing real life situations in the hills but also assisting children born of rape, who are now adolescents seeking truth.

In 2004, a mechanism was set up by Ibuka Rwanda, Ibuka France and Médecins du Monde. A steering committee met regularly to enhance the mechanism’s operation. Ibuka France acted as an intermediary who was able to understand the situation but whose geographical distance guaranteed it a certain perspective and was meant to forestall any radical decision. Ibuka France in a way embodied the voice of the diaspora, to help French partners better understand the situation. This positioning can generate some frustration, as it is far from the field and the action. But we value the powerful role it plays, that of friendship. Certainly, humanitarian work must move back towards a greater humanity.

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François MABILLE

Ibuka’s testimony presents a paradox: it is to France, a country unable to come to terms with its own history, that this association has turned in order to deal with its own trauma. There are different ways of coming to terms with history. France, unlike other countries, has always focused on the long term. This collaboration nonetheless offers France an opportunity to revise its practices. Trauma is necessarily a long-term issue.

Finally: members of the diaspora lead a difficult existence. In the 1970s members of the South American diaspora contributed, through their advocacy, to greater awareness of what was going on in their own countries. This had a profound impact on the notion of humanitarian partnership, for which intermediaries are essential. The role of diasporas is too often reduced to its economic aspect, whereas in reality it is much greater than that.

Comments from the floor A participant It seems necessary to bring up France’s role in the Rwandan genocide. That would be the first step towards a new way of coming to terms with history.

It would do honour to Médecins du Monde to initiate this step. France has also exported its Algerian torture practices to many other countries. The military personnel responsible for these operations have created new Villa Susinis in Buenos Aires, Santiago, Chile, and elsewhere.

A former British MP Galloway recently began a conference by affirming the importance of international solidarity. This is the spirit that must drive us. With this in mind, Médecins du Monde must commit itself to breaking the Gaza blockade. It is not acceptable to abandon 1.5 million persons to a fate that is less than human.

And let’s do away with this saviour complex. Helping others means helping oneself. The opposite is also true. One day we may ourselves have to call on this solidarity.

Ruchama MARTON, a representative of the Israeli association PHR In the Middle East it is NGOs who represent the Palestinian state. Hamas in Gaza and the Palestinian authority in the West Bank handle their respective regions.

Only NGOs maintain a link with the state and ensure the existence of a national framework. Israel has adopted a unilateral mode of decision-making. Politi-

Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

Panel discussion n°1 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

cal authorities are little by little being cut off from Israeli civil society. We may even have reached the point of no return, as political authority no longer bothers to obtain democratic endorsement. This undermines all the work of NGOs, which, since 1992, have, on the contrary, sought to bring political authority and civil society together in the region.

Kamel MOHANNA, representative of Amel, a Lebanese association Lebanon hosts 400,000 Palestinians. The stability of our country is linked directly to the Palestinian issue.

Any solution that does not offer a fair deal to the Palestinians will be unacceptable. The Oslo agreements are not being implemented. The West is losing credibility in the Middle East. Mahmud Abbas wants peace, no doubt about that. The Palestinian issue is also the main source of international terrorism.

Without a fair outcome, there will be no progress.

The region is suffering from intolerable pressures.

Médecins du Monde must also bear witness and affirm Palestinians’ right to a state. The Jews are our brothers. They are mentioned among the 18 communities of the Lebanese constitution. It is not possible to do humanitarian work without taking a clear stance on the Palestinian issue.

A participant The concept of separation, which is deeply rooted in Israeli society, is at the heart of the Palestinian problem. All forms of separation are dangerous. As a child in the 1950s my parents would take me to Gaza, which was then a pleasant seaside resort. Israelis and Palestinians no longer meet or talk with one another.

This is engendering fear and hate. Young Palestinians and Israelis aged 20 to 30 have never met anywhere but on a battlefield. Médecins du Monde must combat these separations in their practical aspects and seek to create new bridges.

Barbara TEN KATE, head of the Pakistani mission For Médecins du Monde, assisting the creation of a local NGO in Pakistan was a wonderful adventure. This type of project requires a long-term commitment to seeing through the various phases necessary. Médecins du Monde must design the project and identify local partners, ensure institutional development of the local structure and maintain technical support. To succeed at this, a commitment of at least 10 years is probably necessary.

Marcel KABANDA, a representative of Ibuka France, a Rwandan association France no doubt has a special way of dealing with history. While a state or a government may have been responsible for reprehensible actions, they must nonetheless be distinguished from civil society, with whom bridges can be established. Ibuka France wanted to use the relations of trust that it has developed with French civil society actors to bring it closer to Rwandan society. This can then be used to influence certain policies. Civil society’s involvement clearly influenced the state when it was forming its new model. Should Médecins du Monde take the French State to task? This is the responsibility of all civil society, and Médecins du Monde can make a contribution in its own way.

On another subject, I have never been in Palestine.

I know of this situation only through the media. It is nonetheless clear that mutual ignorance always stokes fear and hate. The creation of a Palestinian state would therefore be favourable to Palestinians, but also to Israelis. As things now stand, each side is threatened. The State of Israel is not at peace. New bridges cannot be built in such a tense environment.

On another subject, I wonder about the stance of the Amel and DUGA associations, which are part of civil society, but are also quite politically involved.

Kamel MOHANNA, a representative of Amel, a Lebanese association Everything is political. A distinction should be drawn between the “politics as usual” of elected officials and politics in the nobler sense. Amel has helped change

‘‘

... humanitarian action relies on partnerships to go beyond its framework and contribute more broadly to renovating civic solidarities.’’

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Panel discussion n°1 How four partner associations of Médecins du Monde in Rwanda, Pakistan, Lebanon and Bosnia were born and developed

Lebanon’s politics and culture. Each centre opened by Amel has had a knock-on effect on other NGOs linked to other parties, which have followed our example to take action in turn. Without development, there is no democracy. Lebanon is severely unbalanced between the centre and the regions. What we do is indeed political, but we act for the public good. NGOs must persuade political officials to recognise their existence and independence. Civil society refuses that its representatives swear fealty to parties.

We are a non-denominational NGO. Western democracies call themselves secular, and yet they seem to be obsessed by ethnic and religious issues. In our dealings with our Western partners, we are often the ones who insist that our actions promote municipalities rather than mosques. Politicians are always seeking to foster divisions in order to exert greater control.

We also implement policies but only those that further the human good, regardless of group association, in Lebanon or elsewhere.

Anka IZETBOGEVIC, a representative of DUGA, a Bosnian association Civil society must take part in drawing up the national strategic plans of their own countries. In doing so, we also stand up for equal opportunity and civic-mindedness and put ourselves in a position to offer actions under these plans.

A participant It is striking that as soon as we try to describe the partnership of local associations with Médecins du Monde, we very quickly get back to the complexity of local contexts. Similarly, humanitarian action relies on partnerships to go beyond its framework and contribute more broadly to renovating civic solidarities. By crystallising the notions of solidarity and proximity, partnerships return humanitarian action to its purest form.

A participant I don’t believe that ambitious projects distance us from the populations. All Médecins du Monde coordinators can testify that the highest-budgeted projects always have community components. This is currently the case in Zimbabwe.

Kamel MOHANNA, a representative of Amel, a Lebanese association During the Lebanese war, I was in charge of the Committee of Missing Persons, whose numbers are now estimated at 17,000. Back then, the abduction of a Westerner triggered a true media circus. Even today these 17,000 missing persons are still unknown. So a double standard is clearly at work here.

Bernard GRANJON Dewesternisation is not enough. Proximity is the key.

When I presided over Médecins du Monde, it often opposed the French government, particularly regarding the French peacekeeping force in Côte d’Ivoire.

Médecins du Monde was backed by its close links with civil society, which gave it a more rational view if the situation. Proximity is what should be developed.

Partnerships are only one way to do so. It also requires certain humility. Associations have very ambitious programmes with very large budgets, something that necessarily distances them from the population.

Médecins du Monde is a healthcare association and is fortunate to be one. However, in some situations, such as in Palestine, such a mission is no longer possible.

Médecins du Monde must take a very clear stance: when inhuman treatment is occurring – and Frenchstyle administrative torture is one form of this – healthcare becomes impossible. Healthcare providers must denounce intolerable situations that compromise the success of their healthcare missions.

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Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

Panel discussion n°2 When beneficiaries become actors: what is the best way to proceed?

Testimonies from Serbian, Guinean, Bengali and French partner associations

Presentation of the panel discussion Recipients of humanitarian services are often the best experts of their own situation. They possess extensive experience that associations should try to tap, as much to enhance the quality of their own work as to promote reintegration in society. Through the examples of Serbian drug users, Guinean inmates or penniless Bengali peasants, Médecins du Monde’s partner associations bear witness to the role that recipients can play alongside them.

In Belgrade, Serbia, VEZA acts to reduce addictionrelated risks, among other things by promoting access to clean syringes. VEZA trains various groups of both addicts and public services. By involving users in planning its activities, VEZA has become better known among its target population and this has helped it develop its projects. VEZA is thus helping to raise greater awareness of the risks incurred by drug use.

Bangladesh is hit regularly by serious natural disasters. The GK Savar association operates in the Bengal delta with the poorest peasant populations.

Rather than microcredit, which is unsuited to the projects of the poorest beneficiaries, it has set up a seasonal credit mechanism to allow breeders and farmers to finance their activities. This mechanism also involves women, who, in turn, make a contribution to improving the situation in the region.

KAD is trying to improve the disastrous healthcare situation of the Kindia prison, in Guinea. Among other things, it has set up focus groups composed of inmates, guards and the authorities in order to identify the prison’s basic needs and to respond to them. KAD involves inmates in organising the prison’s daily activities. In addition to various income-generating activities, some inmates are trained in first aid and, in turn, become healthcare-providers within the prison walls.

In the Marseille regions, Bus 31/32 acts to reduce risks incurred by drug-taking. To be effective in such a sensitive area, associations must necessarily be backed by “experienced professionals”, i.e., people who after having received assistance themselves, assist the association in its work. They possess irreplaceable experience that enhances both the skills of associations and the quality of their services.

Panel discussion The panel discussion was moderated by Bruno SPIRE, president of AIDES.

Bruno SPIRE

The AIDES association includes “HIV-concerned” persons, i.e., either those infected by HIV or worried about its risks. For several years now Médecins du Monde has helped set up numerous user associations. We will seek here to better understand the role of users as well as to provide an update on these partners vis-à-vis Médecins du Monde.

Tatjana STAMATOVIC,

a representative of VEZA, a Serbian association VEZA combats drug-linked risks in Belgrade, Serbia.

This programme was created with the assistance of Médecins du Monde. From the start, an expert took part in devising a strategy and carrying out an assessment of the situation. This helped shed light on the highly marginalised situation of drug-users in Serbia.

After an agreement with the Ministry of Health, the programme was launched in July 2002.

Once the team had been formed, work began in December 2002, in partnership with pharmacists. The objective was to provide drug-users with access to clean syringes. Some pharmacies, public-sector ones in particular, in some cases refused to sell this type of product, believing that to do so would be to endorse drug use. VEZA also used a van for awareness campaigns in the field and to inform drug-users of the places where they could obtain clean syringes.

From 2004 to 2007, Médecins du Monde helped us set up a mutual-assistance group of users. This group published an informational brochure and also conducts activities targeted to Roma drug-users, whose situations are especially serious, in that 70% of them are HIV-positive. A “Roma” programme was ultimately set up: in addition to making equipment available, a centre ambulant helped meet daily hygiene needs and to carry out screening tests. The “Reduce Syringe Sharing” programme was then taken over by an association of drug-users. VEZA made a big contribution to raising awareness of this issue, with support from Médecins du Monde.

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Panel discussion n°2 When beneficiaries become actors: what is the best way to proceed?

VEZA has also made its name better known. It has undertaken investigations into drug use, particularly at night-life congregation points. It has also staged awareness and prevention campaigns.

Dusan MIHAJLOVIC,

a representative of VEZA, a Serbian association Since 2006, VEZA has benefited from several sources of international financing. New centres have been opened in Belgrade, and the mobile unit’s activity has been stepped up. VEZA has also set up a training programme for rural persons, police officers, doctors and various populations. In 2006, VEZA worked with 1000 persons, a figure that has now reached 2000 persons, which is highly gratifying.

Advocacy is also part of VEZA’s daily activities. VEZA combats discrimination. Since last year VEZA has had nine social assistants who work with Roma populations as well as transsexuals and prostitutes, i.e. all populations who suffer greatly from discrimination. VEZA has also signed agreements with various ministries.

Serbian officials have now acknowledged the usefulness of our programme. VEZA has been invited to extend its training activities to public clinics. This was the first time that an NGO had received such an invitation. Our team is gradually expanding and is even attracting more and more young people.

Zafrullah CHOWDHURY,

a representative of GK Savar, a Bengali association Bangladesh has a population of 145 million, composed of 80% Muslims, 15% Hindus and 5% Christians. Almost all speak the same language, Bengali, but each community has its own special difficulties.

Bangladesh has troubled relations with its neighbours.

For water, it depends on China and India. India, which used to have a protective attitude, has gradually lost interest in our country, which is regularly hit by flooding and hurricanes. Famines, meanwhile, are becoming rarer, as associations such as Médecins du Monde have helped us alter our practices.

20 million persons live in the Bengal delta. All speak the same language, but are split into several communities living side-by-side. Each has its own social classes, which are always very divisive. The Bengal is a very powerful river that generates very heavy erosion. Land is regularly flooded before re-emerging a few years later. Individuals living in these areas lose all their possessions and later have to start

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from scratch, once the waters have receded. These people fight a constant battle, with no electricity, and no access to healthcare centres, schools or sewage treatment facilities.

GK Savar does everything it can to improve living conditions for these people. They all live in the hope of recovering the land that they lost. Microcredit is highly developed in Bangladesh, but the poorest people have no access to it, and it is very difficult to fund the investments that they need. Rather, microcredit seems to be a way for capitalism to become entrenched. Interest rates are often very high and payments are due each month. So this system automatically excludes fishermen and farmers, whose income is spread out over a particular season. For this reason, NGOs have invested very little in this region.

Ultimately, a seasonal credit mechanism was established, targeting the poorest people. To counter the lack of access to electricity, it has helped finance photovoltaic energy. In this region, some very simple investments could turn the situation around completely. For 60,000 euros, healthcare centres and a seasonal credit mechanism could be set up. Would Médecins du Monde be willing to help us with financing? Such a commitment could help strengthen our partnership as part of a relationship of peers. We must do away with any sort superiority complex. Otherwise, our partnerships won’t work.

Cellou BALDE,

a representative of KAD, a Guinean association Guinea, which has been independent for 50 years, did not meet Médecins du Monde until the 1990s, when it asked it to combat an outbreak of infections at the Kindia prison. Until then, Kindia was off-limits to foreigners. After the doctors left, the epidemic promptly resumed, and Médecins du Monde once again intervened. During these two episodes, Médecins du Monde saw how serious the situation was and decided to set up a permanent entity within the prison.

A highly structured NGO, with a Board of Directors, an Executive office and a focus group was then set up. This organisational set-up was meant to ensure total transparency with inmates, guards and public authorities. Once the structure was set up, Médecins du Monde granted it a subsidy. It is time to take stock of this partnership. The authorities are very satisfied with what has been done at Kindia and has authorised us to disseminate several photos of the prison.

Kindia prison was built in 1918. For a long time, the state did not invest in maintaining it, and the walls blackened with filth and were even sticky to the touch.

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Panel discussion n°2 When beneficiaries become actors: what is the best way to proceed?

Inmates are crowded into holding areas. The region is subject to heavy flooding, and the upper slab of the building is threatening to give way at any moment. In many cells, ceilings have caved in, and electrical wiring is bare. It is so dark inside the buildings that some inmates lose their sense of sight. Others get their water from the bottom of a hole into which sewage is dumped, among other things. One thing KAD has done is connect the prison to the municipal water system.

Established in June 2001, the Association operates in the areas of healthcare, hygiene, the environment, literacy and rehabilitation. Following up on Médecins du Monde, it trains inmates in first aid. This has helped improve the situation of some inmates, including one serving a life sentence. The focus group assesses the prison’s needs for basic products such as soap and light bulbs. Classes are offered in English, French or Arabic, depending on the inmates’ wishes.

The prison is experiencing a serious problem of malnutrition. How do you provide medical treatment to a starving man? Kindia receives inmates from the entire country. No establishment has a comparable set-up, and sick inmates are often sent to Kindia with no regard for our capacity to care for them. For the most serious cases, KAD offers suitable treatment. Moreover, each time there is labour unrest, the state sends even more inmates, and that makes things even more complicated. KAD has installed ovens so that inmates can make their own bread. A sewing workshop generates some income, with the support of the German embassy. KAD also promotes inmates’ rehabilitation by supporting them after their release.

The partnership with Médecins du Monde has been fruitful. Médecins du Monde has assisted us in our project, supported us financially and steered us to other sources of funding, while respecting our independence.

This is a partnership model that is worth emulating.

Béatrice STAMBUL,

a representative of Bus 31/32, an association based in Marseille Bus 31/32 has long chartered a bus that collects syringes in the Marseille region. At first, Bus 31/32 was a daughter to Médecins du Monde but is now a sister.

Bus 31/32 has made special efforts to involve users in our activities. This is essential in reducing risks.

Ten years ago, Mohamed Hamla, Médecins du Monde’s first “experienced professional” (as opposed to graduate professionals) passed away. My experience in harm reduction convinced me that to work for others you must work with them. A doctor’s skills are useless if they do not call on the patient’s skills

as well. As a psychiatrist by training, it was through contact with users that I discovered the world of drugs. Everywhere in the world, harm reduction requires giving knowledge its due and integrating into the community framework. The slogan of the international network of drug-users sums this up well: “Nothing about us without us”.

Since its founding, Médecins du Monde has committed itself to community healthcare programmes. It has always chosen to work with users. This approach changed my life by allowing me to work in a more humane, but also more effective, manner.

Users’ expertise of their own situations must be acknowledged. Working in contact with user associations is therefore absolutely essential. That’s the only way we can work.

‘‘

Partners’ autonomy must be respected by assuming a humble position.’’

Bruno SPIRE

AIDES also seeks to involve users in its activities.

From our very start, we adopted the principle of never setting up foreign offices or sending “missionaries” outside the country. We thought that was too close to colonisation. Nor is AIDES a donor, even though it does help its partners obtain funding.

AIDES seeks to pass on the expertise that it has gathered in France to partner associations in other countries, on their request. AIDES is open to all forms of partnership. The only criterion is a commitment to fighting AIDS and hepatitis. AIDES seeks to reinforce the skills of associations, in terms of scientific knowledge, accounting or association governance.

Some partners have since become major actors in access to healthcare, such as Arcade in Mali. These activities are part of the Afrique 2000 network which includes associations of various sizes.

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Panel discussion n°2 When beneficiaries become actors: what is the best way to proceed?

Partners’ autonomy must be respected by assuming a humble position. At the same time, our objective is to promote social transformation. To do so, we have to take a firm political stance internationally. Within the Afrique 2000 network, we work with partners who do not at all share our concerns in terms of advocacy of defence of minorities. However, we hope that contact with us will make them revise their stance.

Afrique 2000 is a so-called “low threshold” network, i.e. quite accessible. AIDES has also wished to develop a “high threshold” network of associations committed to international advocacy. The PLUS Coalition includes four founding entities in Morocco, Mali, France and Quebec with a political objective of advocacy. AIDES also helps its partner associations to compile criteria for membership in this new structure.

Comments from the floor A Médecins du Monde speaker AIDES’s relationship with Médecins du Monde is now much more than a mere partnership.

The three speakers have described the relations of their associations with our structure well. We give them know-how; they give us knowing-how-to-be.

Some of them also assist us in other countries to develop new programmes, such as in Afghanistan, Tanzania and Burma. However, such projects are often on the initiative of Médecins du Monde. We are therefore willing to listen to the proposals that you will submit to us.

Dusan MIHAJLOVIC, a representative of VEZA, a Serbian association We have all sorts of needs. Serbia is lagging far behind, even behind other countries in the region. In the field many organisations are invisible in spite of what they say.

Tatjana STAMATOVIC, a representative of VEZA, a Serbian association VEZA must further strengthen its organisational set-up to make it more operational and initiate new programmes. Our next goal is to raise awareness among people outside of Belgrade. But this will require a highly structured organisation. Médecins du Monde has helped us set up a clinic that treats 200 methadone-dependent patients, but there are 5000 persons requiring treatment.

The current programme is of high quality but too limited.

We want to open new centres, and Médecins du Monde’s assistance would be invaluable. We would also like

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to open private areas for drug-addicts, to keep them from injecting in plain sight, in the presence of children.

However, there are great legal obstacles to doing so.

Cellou BALDE, a representative of KAD, a Guinean association In 2005, Médecins du Monde identified Guinea as a priority country. Even so, it has still not entered Guinea, with the exception of the prison. The Guinean population is unable to obtain healthcare in spite of the medical infrastructure in place. Médecins du Monde’s intervention is therefore quite necessary.

Zafrullah CHOWDHURY, a representative of GK Savar, a Bengali association Médecins du Monde’s involvement must be sustained.

A $3 per capita commitment to a new project would allow us to develop schools and a photovoltaic power grid and thus ensure the region’s independence.

Healthcare access is a basic issue. Medicines must be more widely available at a lower cost. At the same time, drug use is increasing in Bangladesh, as well.

The HIV epidemic is well contained, as means have been deployed to do so, but it is very difficult to treat children suffering, for example, from pneumonia.

An audience member What role did VEZA’s advocacy play in changing the government’s stance on the issue of drug-addition?

And, on another subject, Bangladesh has very solid expertise in reducing risks incurred by natural disasters. We have a lot to learn on this subject.

An audience member What has been done in Guinea is remarkable. This programme could be extended to other prisons, particularly in Conakry, or to mental health establishments. It is interesting that microcredit can have perverse effects.

Dusan MIHAJLOVIC, a representative of VEZA, a Serbian association Advocacy is one of the association’s most recent activities. It would not have made sense to conduct campaigns without being somewhat well known. Drug-use is nonetheless increasing, and the people are becoming more aware of it. So conditions were favourable to new initiatives in this area. A national HIV strategy has thus been drawn up. We are working on a new version for 2010-2015, in tandem with other NGOs.

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Panel discussion n°2 When beneficiaries become actors: what is the best way to proceed?

Zafrullah CHOWDHURY, a representative of GK Savar, a Bengali association Microcredit carries very high interest rates, from 35 to 40%, and has done nothing to set up any hospitals or schools. It has served only to create new banks, and the funds raised have never reached the poorest people. Peasants bring in their harvest just once per year and cannot meet weekly repayment schedules.

Seasonal credit therefore looks like a better move. Our recovery rate there is 98%. Microcredit should therefore not be considered a tool in fighting poverty.

Cellou BALDE, a representative of KAD, a Guinean association In Guinea, we have not set up any mental health programmes. Our priorities are maternal and infant care. Practitioners often undertake Caesareans free of charge, but post-operatory treatment is then very expensive.

Zafrullah CHOWDHURY, a representative of GK Savar, a Bengali association Our three organisations are very different and Médecins du Monde undoubtedly takes a different approach to each of them. In Bangladesh, however, it seems necessary to act in the longer term. A pilot programme would not be enough.

An audience member The problems that Bangladesh and Serbia are experiencing will no doubt get worse. In Serbia, the government must adopt policies that aim specifically at reducing the prevalence of drug-addition, without creating new social inequalities. In Bangladesh, climate change will lead to more intense natural disasters and the displacement of millions of people.

Microcredit indeed seems to serve only the cause of the individual and thus feeds divisions. In Egypt microcredit helps trade but not production.

An audience member In the south, healthcare beneficiaries are increasingly becoming co-providers themselves of healthcare, and they also get involved in association governance.

What about France, particularly as involves Roma or undocumented aliens?

A speaker from Médecins du Monde The three associations who have spoken constitute three different community participation models. The programmes rely on the populations that they target.

What you have said is proof that harm reduction is a universal concern. In the field, some people often take the opposite view. Once users have accepted it, the risk-reduction approach can transform social practices. Healthcare cannot be conceived independently of a commitment from its beneficiaries.

An audience member Participation by AIDS victims and drug-addicts has always been quite enriching. How can this experience be used to extend these practices to new populations?

Tatjana STAMATOVIC, a representative of VEZA, a Serbian association According to UNICEF, 70% of drug-addicts who have HIV contracted the virus through used syringes. Drug consumption is rising worldwide. Drug-users must be protected by understanding their needs. A distinction should be drawn between the fight against drug-use and the fight against the risks incurred by drug-use. In Belgrade, many persons, including doctors, accuse VEZA of promoting drug use. Our association does not pass judgement; it only tries to limit addiction-related risks.

Zafrullah CHOWDHURY, a representative of GK Savar, a Bengali association It’s true that microcredit never serves productive investments. On another subject, in Bangladesh, poverty is such and the educational system is so weak that drug-use is the natural result. Even so, Bangladesh is the only country that will manage to reach its millennium objectives by 2015. Our activities are therefore effective and we are therefore asking for even greater investments.

A speaker from Médecins du Monde How should beneficiaries be integrated into the governance of our projects? In France, many associations have set up initiatives of this type. In Marseille, there is a centre that is self-managed by homeless persons stricken with psychosis, guided by Médecins du Monde. In Latin America, this is also a great concern and should be in France, as well. To create a relationship of equals, it is necessary to reconcile the two methods of subject and object, in which the target of an activity takes part in the activity, with a goal of reducing the risks that patients acknowledge exist in their own situation. These questions affect all of our activity sectors.

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Panel discussion n°2 When beneficiaries become actors: what is the best way to proceed?

‘‘

Participation by beneficiaries must not be just to improve programme quality but also influence policies on the national level.’’

Cellou BALDE, a representative of KAD, a Guinean association At the Kindia prison, the focus group is composed of prison inmates and guards. They visit all holding cells to gauge needs and cases of illness. The Executive Office then decides how to allocate resources.

With regard to income-generating activities, inmates also assess their needs in the area of production and submit them to the Executive Office. KAD also supports inmates when they re-enter society.

An audience member The participative approach also has its limits. Patient skills must not be reduced to lay knowledge that is being ignored by governance. In Quebec, associations have the backing of very strong organisation, with users closely involved, but their impact on society in terms of legislative changes is quite marginal. The participation of beneficiaries only helps improve the quality of activities, not to social transformation.

Jean-Pierre LHOMME, president of the French association GAIA The person’s role and recognition of it in medical practice is essential. A risk-reduction approach can apply to all areas, particularly prison life and prostitution. This approach consists above all in involving beneficiaries in designing the activities that are targeted to them.

An audience member For 12 years Médecins du Monde was close to Ejército de Liberación Nacional, the Mexican Zapatista movement. At first we both stood up for the rights of Indians in southern regions. This was nonetheless a highly complex partnership, like a balance of power in some ways, in which Zapatistas could make unilateral changes to the programme, which made our negotia-

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tions difficult with donors. Zapatistas took advantage of their knowledge of the people and a language that we had not mastered. They imposed their whims on us. Activities ultimately worked, but only after a very complex process.

Dusan MIHAJLOVIC, a representative of VEZA, a Serbian association The way in which we have involved users in our actions has also helped make us better known, including among drug-users.

An audience member Participation by beneficiaries must not be just to improve programme quality but also influence policies on the national level. For it is the beneficiaries who must then carry our fight to the political stage, backed by their legitimacy. How can we promote this?

Cellou BALDE, a representative of KAD, a Guinean association For the moment, Guinean inmates can, at best, be partners in a dialogue but not true political actors.

Dusan MIHAJLOVIC, a representative of VEZA, a Serbian association Our current campaign has met mostly with indifference. In Serbia, we have a hard time getting access to ministry meetings for our beneficiaries. They can make proposals but those proposals are seldom adopted.

Zafrullah CHOWDHURY, a representative of GK Savar, a Bengali association The women we train know full well that there’s no use talking to a minister. They therefore focus on concrete actions. As far back as 1970, Bangladesh affirmed the need to entrust greater responsibility to women. Since then, women have undertaken greater advocacy.

An audience member Not only must beneficiaries be involved but, more ambitiously, they must help strengthen civil society and set up beneficiary associations, even though such associations seldom have the ear of the political authorities. The reason for this is such associations have an ambiguous status, as they often include persons regarded as delinquents. Médecins du Monde must first of all help structure these associations, even if it does not share their objectives, under an empowerment model.

Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

Panel discussion n°3 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

Presentation of the panel discussion Even in a globalised world, national policies remain influential. Among other things, they dictate the conditions in which humanitarian organisations operate. Torn between a desire for independence and the need to play the political game in order to contribute effectively to social change, several of Médecins du Monde’s partner organisations present their point of view and share their experiences.

In Israel PHR (Physicians for Human Rights), has to deal with a violent state that does not hesitate to disseminate propaganda. Its radical stances have put it in an opposition mode, from which it systematically denounces the state’s lies. If this independence makes it a fully responsible association, PHR is currently seeing its financing and working conditions under threat.

Nobody’s Children Foundation emerged from a former Médecins du Monde mission. It acts with abused children and, from its establishment in 1991, has taken part in the emergence of a post-Soviet civil society in Poland. In spite of the obstacles of an authoritarian government and a traditionally conservative society, the Foundation promotes children’s rights. However, it has limited resources, and only the Government has the means to undertake the activities that are necessary on a nationwide scale. The Foundation there operates by working with the government and trying to exert influence on it.

The AMES association stands up for women’s rights in Guatemala. While it maintains total financial independence of the Government, the Association regularly participates in the political dialogue and contributes to parliamentary bills. Generally speaking, AMES promotes women’s participation in the political dialogue at the workplace and in their everyday lives. These multi-party negotiations involving business leaders, trade unions and the state help advance human rights in Guatemala.

And these rights cannot be reduced!

The example of Iniciativas Sanitarias illustrates the importance of relations with political authorities. For a long time, this Uruguayan association was restricted to a stance of resistance to the conservative government.

It was active in promoting women’s’ rights and tried to reduce the very high rate of mortality caused by illegal abortions. A favourable climate during the last elections

suggested that abortion might be legalised. The association’s former director has even joined the Ministry of Health, which is proof of a profound shift in the government’s stance on this association’s activities.

Gaïa Paris includes two former Médecins du Monde missions involved in reducing risks incurred by druguse in Paris. State assistance was essential to this small-scale entity, but its Ministry connection has nonetheless reduced its margin for manoeuvre, particularly in the area of innovation. It is now in partnership with larger structures, such as Médecins du Monde, that Gaïa conducts its most innovative activities.

Panel discussion The panel discussion was moderated by Michel WIEVIORKA, a French sociologist and administrator of the Maison des Sciences de l’Homme (humanities) foundation

Michel WIEVIORKA

I have had the opportunity to work alongside Médecins du Monde in the past. Its commitment and the quality of the data that it produced on AIDS, which humanities research was until then unable to deal with, impressed me greatly.

Associations’ political independence is crucial. While economic globalisation is undeniable, it has not spread to the area of human rights. States and borders still exist and every country is different, and this affects the associations’ working conditions. Independence is a form of purity but it can come at a cost.

While some states may sometimes support NGOs, others throw up obstacles. Our various witnesses will present here their associations’ relations with political authorities.

Ruchama MARTON,

a representative of PHR, an Israeli medical association An organisation working in the area of human rights is, by definition, a radical political organisation. PHR is a non-partisan association, even though its commitment is political in nature, given that it wants to enact social change and combat the oppression of Palestinians and all minorities.

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Panel discussion n°3 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

A radical group always works outside of the consensus. In PHR’s case, this has been a deliberate, though not always easy, choice. For 22 years, PHR has managed to maintain its radical positioning, while bringing together Jews and Palestinians, women and men. We spend a lot of time understanding one another. We prefer discussion to voting. While this takes longer at first, in the long term more is accomplished by convincing one’s partners than imposing the majority view on them.

We are positioned differently from the very powerful Israel Medical Association. A radical organisation seeks to understand the root of evil to better combat it.

That is what we devote our efforts to. It would probably be more popular to conduct traditional humanitarian activities, and radical struggle is indeed a long-term combat. A radical medical organisation must therefore combine humanitarian action with political action.

PHR also seeks to disseminate an alternative to government propaganda. Israeli political authorities, for example, claim that Palestinian ambulances transport combatants, in order to legitimise attacks on these vehicles. We always denounce these claims through our official spokespersons. We even refuse the government’s name for what we call “the occupied Palestinian territory”.

Our positioning thus shifts constantly between cooperation and auto-segregation. Because of our proximity, we must constantly safeguard our independence of the political regime. Cutting off all contact with political authorities would isolate us and make us unable to impact the political situation. It is always reassuring to join a majority or a consensus.

This also leads to a dilution of responsibilities. To take one’s place within a hierarchy is give up a portion of one’s own power. In an organisation, individuals ignore the end result of their actions and focus on execution. Independence is therefore essential. PHR wants to retain its radical positioning while continuing its contribution to social change.

PHR is currently being attacked from all sides in Israel. Parties, NGO and right-wing media receive funding from throughout the world and disseminate their messages. Arrests are becoming more frequent. Our convoys cannot reach Gaza. PHR has even been accused of treason and its funding has been threatened. Since July 2009, PHR has been targeted by numerous accusations aiming to discourage its donors. PHR therefore needs support.

Many of its activists are in prison on trumped-up charges. The world must be better informed of the Israeli situation.

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Maria KELLER HAMELA,

Nobody’s Children Foundation, a Polish association

The Nobody’s Children Foundation took over from a Médecins du Monde mission that treated abused children. When it was established in 1991, just after the collapse of the Soviet bloc, our association also wanted to take part in rebuilding civil society. However, back then the state regarded NGOs as disruptive elements, in spite of their popularity. One of our paediatricians, for example, invited Danièle Mitterrand to visit our association during an official visit to Poland.

In spite of government disapproval, Mrs. Mitterrand came to lend her support to our cause.

Even in the area of children’s rights, the political context still plays a role. For example, one member of parliament felt that his father had raised him well by beating him. Poland is also both an ex-communist country and a very Catholic society, where children’s rights can conflict with family law. Many families feel that standing up for children’s rights is a form of interference. The Foundation believes that children can also be protected through primary prevention initiatives.

The Foundation has set out several basic rules on its relations with politics. Its members must belong to no party. If they do they withdraw from governance. In the area of funding, state assistance must not exceed a certain percentage of the budget. Our role consists in initiating actions and demanding change. However, we do not have the resources to operate our programmes nationwide. That is the government’s responsibility and it is therefore indeed necessary to work with it in order to steer it towards relevant activities. The government recently fully appropriated a project initiated originally by the Foundation. This was a true source of satisfaction as it made a direct contribution to the welfare of many children. We have also changed children’s points of view, and they now refuse practices that their elders considered normal 10 years ago.

Michel WIEVIORKA

Standing up for human rights beyond assistance to individuals also means influencing the state through an attitude of cooperation or resistance, in order to contribute to social change. Apolitical dynamics are therefore not enough.

Rosa ESCOBAR,

a representative of AMES, a Guatemalan association Guatemala is a highly non-egalitarian country, and most of its people are extremely poor. AMES was

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Panel discussion n°3 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

established in 1986 as part of the Women’s Autonomous Movement. At first, all the association had was dreams, but through hard work and commitment, it has grown. It also benefited from the solidarity and generosity of a woman who provided it 1000 dollars in seed money. The miracle continued with AMES winning a car in a lottery. It acquired more resources by selling clothing, and AMES was able to begin operations while remaining independent of the Government. AMES is revolutionary in that it aims to change society. It is present on the national and international levels and combats violence against women and fights for equality between men and women.

AMES promotes women’s participation in the political process through a process of empowerment. Guatemalan women cannot live in dignity until their rights are fully recognised. To be effective, AMES remains truly autonomous both economically and politically. Its tools for survival offer an interesting view of the situation. In order to retain its independence, it accepts on government funding. AMES continues to fight for women’s access to healthcare and birth-control.

The state recognises the very practical work that AMES does. AMES takes active part in the political dialogue and we are always weigh in on projects that affect us. Our independence also allows us to freely denounce all practices we are opposed to. While cherishing our independence, we also believe it is important to take part in forums. Otherwise, it would be impossible to publicise our views. While our members retain their freedom of belief, our operations are unaffected by any political or religious membership.

It is important to acknowledge the work of each organisation and civil society, as well as the state. It is in appreciating each entity’s role that we can act successfully. Alongside other organisations, we try to put forth unified proposals before coordinating our activities with the state. We have also set up negotiating bodies in factories while adhering to the principle that human rights should not be negotiable.

This experience allows us to better keep up with international legal shifts and their implementation. To be successful, it was necessary to bring together the state, business leaders and trade-unions. Médecins du Monde also played a role, alongside other associations, in coordinating our activities. Its intervention was crucial, given that governments are always sensitive to pressure from international entities.

Michel WIEVIORKA

This intervention raises a key issue: how do we negotiate the non-negotiable? For associations are often

torn between the need to participate in a process and the wish to modify it fundamentally.

‘‘

The idea that human rights is far above the political fray is quite out of date. Political commitment is essential.’’

Cecilia STAPFF,

a representative of Iniciativas Sanitarias, a Uruguayan association Iniciativas Sanitarias was established in 2001. It gathers various healthcare professionals concerned by high rate of maternal mortality in Uruguay, which is due in part to illegal abortions. We first developed a strategy of reducing risks targeting the least safe abortions, while complying with values of professionalism and confidentiality, as well as human rights.

Legalisation of abortion first became an issue in Uruguay in the 1990s. In 2004, the arrival of a doctor at the head of a progressive government suggested that changes might be in store for legislation, but the President opposed the bill in 2004 and once again in 2008. In reaction, several professionals grouped together various entities in order to come up with a risk-reduction strategy. With strong institutional support, this document became a clinical guide for women experiencing an undesired pregnancy. A centre was established at the Maria Rosa hospital, a renowned gynaecological establishment, with the support of university doctor-professors, from which we are able to conduct our activities. We have also tried to assess its results.

On the political front, the President’s opposition has led us to make a distinction between texts favourable to depenalisation of abortion and those describing risk-reduction activities. The latter were included in a law on women’s health. The strategy set up in 2008 is thus now enshrined in law. In March 2010, the new President affirmed that he would not oppose legalisation of abortion, which triggered a vast public debate.

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Panel discussion n°3 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

Iniciativas Sanitarias meets many women on a daily basis. They have many reasons for ending their pregnancies. Our primary concern is their health, and not moral issues, and none of our practitioners takes the liberty of passing judgement. Meanwhile, the participation of the medical profession gives Iniciativas Sanitarias true credibility. The Association is also seeking to set new standards for medical practice, to re-establish a certain justice in the doctor-patient relationship and to promote recognition of women’s independence. Our former director has joined the Ministry of Health, where he manages programmes tied into these issues. This is a key advantage for our cause.

Depenalisation of abortion is now our top priority.

Our association has also begun a new partnership with Médecins du Monde that is opening new prospects for the future. We hope to extend our work to other regions in the world and strengthen our ties with the Ministry. Our actions have helped reduce abortion-linked maternal mortality to nil in Uruguay.

Michel WIEVIORKA

This testimony is a fine illustration of the way that a governmental orientation can influence association activity. The idea that human rights is far above the political fray is quite out of date. Political commitment is essential.

Jean-Pierre LHOMME,

President de Gaïa Paris, a Parisian association Gaïa Paris manages two medical-social establishments that emerged from two Médecins du Monde missions. The first coordinates the first French syringe-exchange programme, and the second manages the methadone bus, which plays a crucial role in drug substitution.

Our contacts with the state are essential. Our cause is now enshrined in public health laws, under reduction of drug-related risks. Our negotiations have at times placed us in complex situations. We have always respected the values of Médecins du Monde, particularly from the financial point of view, as our state subsidies have never made up more than half of our resources.

Our cause is now framed by legal standards and deals simultaneously with the two fields of public health and individual health. In the latter area, we have greater difficulty in putting forth our point of view, as an isolated association has greater difficulty in developing innovative practices. In reaction to this, we are currently drawing up a convention on injection education with Médecins du Monde.

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In the area of drug use, the Direction Générale de la Santé (a French government health agency) and the Ministry of Health have laid down new budget restrictions. To enhance the effectiveness of allocated resources, public authorities have initiated mergers of associations, in order to reduce the number of their partners. This trend further compromises our uniqueness and our desire to innovate.

Relations with the state are therefore necessary, as the state guarantees that our activities will continue and will remain relevant. At the same time, such relations naturally raise some difficulties. We are torn between two positions. We must avoid operating in the sole sterile framework of public healthcare and also avoid being reduced to a state “endorsement”.

Professionalism seems to be the best rampart against these two threats. Our work with our beneficiaries has also protected us from state influence.

Comments from the floor Un participante An audience member The Guatemalan government is sometimes violent.

How do you manage a relationship that is always under the implied threat of violence? As for Uruguay, the situation seems to have improved greatly. How does Iniciativas Sanitarias intend to take its cause to neighbouring countries like Peru?

Rosa ESCOBAR, a representative of AMES, a Guatemalan association Guatemala has been through many changes of governments. It is now possible to bring up human rights without being threatened directly. While repression is less open it does still exist. Business leaders are also very violent. The threat is constant.

Cecilia STAPFF, a representative of Iniciativas Sanitarias, a Uruguayan association Legalisation of abortion would widen women’s access to treatment. As for Peru, agreements have been entered into with local organisations. Indeed, our strategy is compatible with all legal frameworks.

An audience member An NGO’s relations with the state are necessarily complex. What is Médecins du Monde’s stance in France on issues such as the Roma and asylum-seekers?

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Panel discussion n°3 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

A representative of Médecins du Monde Several members of Médecins du Monde have already spoken on this point. Historically, Médecins du Monde has had a co-constructive relationship with the French state. We took part in drafting the Aubry laws against exclusion, as well as their offshoots. This positioning was made possible back then by a favourable political situation.

Cecilia STAPFF, a representative of Iniciativas Sanitarias, an Uruguayan association Public opinion has also shifted in Uruguay. Healthcare issues offer a certain advantage, in helping to get past religious and ethnic affinities. Issues of healthcare and mortality affect everyone.

In 2010, the political and humanitarian contexts changed. Regarding the Roma, Médecins du Monde is, for the first time in its history, in a position of resistance. MdM was the subject of legal action for illegal occupation of land in Bobigny, France. Médecins du Monde nonetheless accepts and assumes responsibility for this stance. We have also joined up with the Délinquants Solidaires association, alongside Secours Catholique and the Fondation Abbé Pierre, in the hope of effecting a change in the situation of asylumseekers. Médecins du Monde is thus in a position of resistance, while continuing to develop innovative medical policies. So its relations with the state seem to me to have arrived at a point of maturity.

Michel WIEVIORKA Humanitarian and social causes must indeed be combined within society. In Israel, however, such issues are becoming quite complex, as they are, at once, political and social, domestic and international.

Cecilia STAPFF, a representative of Iniciativas Sanitarias, a Uruguayan association What strategies do associations use in dealing with victims of repression?

Rosa ESCOBAR, a representative of AMES, a Guatemalan association We have special processes for vulnerable women.

With time and psychological support, they can then bear witness to what they have experienced. We also try to meet them at their workplace or in their everyday surroundings.

An audience member Can public opinion make it possible to overcome government opposition?

Maria KELLER HAMELA, Nobody’s Children Foundation, a Polish association It is necessary to bring about laws in the existing political framework. At the same time, we are seeing a shift in values. Bodily punishment is less and less accepted in Poland. However, such changes are only possible over the long term.

‘‘

Healthcare issues offer a certain advantage, in helping to get past religious and ethnic affinities.’’

Ruchama MARTON, a representative of PHR, an Israeli medical association In Gaza, these issues take on special relevance. This is probably the world’s most complex context. In Gaza, each child is sensitive to the political situation.

“Post-traumatic” treatment would make no sense, was we in the middle of the trauma. The crisis is here.

Detonations and flyovers of supersonic aircraft are everyday occurrences. Threats are constant, from air, sea and land. Schools, hospitals and houses have been destroyed.

All children are necessarily affected by this situation, just as their parents are. Most fathers are unemployed and begrudge themselves for not being able to support their families, which only exacerbates their feelings of despair and anger. For them, life at home is a hell without hope of redemption. They have neither money, nor employment nor training. This naturally generates violence. Mental health treatment might very well do some good.

Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

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Panel discussion n°3 What sort of political independence for Israel, Polish, Guatemalan, Uruguayan and French partner associations?

Currently, Gaza is clearly the territory that most needs humanitarian assistance. Men often believe they don’t need psychological support, but that’s not true. Everyone – men, women and children – needs assistance.

The only mental health institute in Gaza is powerless in dealing with the task. Médecins du Monde’s assistance would therefore be highly appreciated. The government claims that this situation began in 2007, but has in fact been intolerable since 2005, and has been very difficult for 43 years now.

Jean-Pierre LHOMME An NGO’s relations with the state are always decisive in its orientations. Human rights are universal. They apply to all states and both for men and women.

Ruchama MARTON, a representative of PHR, an Israeli medical association Médecins du Monde must avail itself of its influence with the French government. Offering humanitarian assistance is necessarily a political decision, as this would mean taking a stance vis-à-vis the victims.

US support for Israel is one of the main drivers of fundamentalism in the region. This circle of violence absolutely must be broken. Hamas and other violent groups have emerged in this context. Each attack on Palestine creates new fundamentalisms.

Cecilia STAPFF, a representative of Iniciativas Sanitarias, a Uruguayan association More discussion must be given to these issues. We must promote and publicise our cause in order to attract more women and know them even better.

Maria KELLER HAMELA, Nobody’s Children Foundation, a Polish association We must vigilantly safeguard our independence. Politicians and governments come and go, but the state remains. We have to come up with an ideal positioning between independence and the ability to have a significant impact on society.

Ruchama MARTON, a representative of PHR, an Israeli medical association PHR has never accepted Israeli subsidies. The government has offered us a lot of money to take care of immigrant workers, but that would have diverted us from our primary vocation. It is now trying to keep us from entering Gaza. Doctors who enter occupied territory now face three years’ prison. PHR is an organisation of both men and women who fight for women’s issues. Women are no doubt the most vulnerable refugees.

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Forum’s minutes - Panel discussions «Our partners take the floor» - June 5, 2010 - Doctors of the World France

Drafted by Ubiqus – Tél. 01.44.14.15.16 – http://www.ubiqus.fr Publisher : Doctors of the World France / september 2010

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