WHY I QUESTION MSF AND ITS UNDERUTILISED PLATFORM

I am sometimes challenged for raising concerns about the fundraising activities of Médecins Sans Frontières (MSF), one of the most respected humanitarian organisations in the world.

Let me be clear about what I am and am not saying.

MSF does extraordinary work. Its teams are active in some of the most dangerous and neglected places on earth - Gaza being a recent and painful example, where the Israeli government has effectively barred them from operating despite urgent need. In Malawi, MSF has been raising funds and delivering medicines to treat malaria. The dedication of its staff is not in question.

The systemic consequences of what they do, however, deserve serious scrutiny.

The Devastating Debt Trap

To understand the systemic issue, we must look at where these organisations operate. Malawi is one of the poorest countries in the world, heavily indebted to the World Bank, the IMF, and a range of other international financial institutions.

Some of this debt reflects poor domestic decisions; some reflects events beyond any government's control, such as Tropical Cyclone Freddy, which struck the country twice in 2023. Whatever its origins, the burden is devastating.

Consider the reality of Malawi's finances:

• The country spends more on servicing its international debts than it allocates to health and education combined.

• Overseas aid accounts for up to 60% of its foreign currency income.

  
  

These are funds urgently needed for medicines, school materials, fees to international bodies, and basic infrastructure like water and electricity.

The Substitution Problem

This economic reality is the context in which international NGOs operate. When an organisation like MSF arrives in Malawi bringing foreign currency and personnel to deliver healthcare, something else happens alongside the obvious good: the government is quietly relieved of an obligation it would otherwise have to meet from its own resources.

"Every dollar spent by a foreign NGO on health or education is, in effect, a dollar the Malawian government does not need to find, and can redirect towards debt repayment."

The result is a deeply perverse arrangement. International voluntary organisations are - whether they intend to or not subsidising a country's repayments to the very international financial institutions that helped create its poverty in the first place.

I want to be precise here. I do not believe MSF is naive about this. The organisation's senior leadership almost certainly understands the structural dynamic at play. They proceed anyway, because the people in front of them are suffering now, and turning away is not an option.

That is an honourable position. But it is not sufficient.

The Power of an Underutilised Platform

MSF was awarded the Nobel Peace Prize in 1999. It commands global attention, moral authority, and the trust of donors in dozens of countries. That is an extraordinary platform, and right now, it is being underused.

What if MSF and similar organisations deployed that platform not only to treat the symptoms of poverty, but to challenge its root causes? Imagine the transformative impact of them actively lobbying at:

• Davos

• The annual IMF and World Bank gatherings in Washington

• The WTO and other bodies that shape the rules for poor countries

  
  

They have the credibility to force these questions onto agendas where they are currently unwelcome. They have the donor base to build a movement. And they have the evidence, accumulated over decades, to make the case powerfully and with authority.

"Treating malaria in Malawi is genuinely good work. But if the structural conditions that keep Malawi poor remain unchanged, that work will need to be repeated indefinitely."

The more effective intervention - harder, slower, less visible, but ultimately more consequential - is to go after the system itself.

A Broader Critique of the "Fourth World"

Just to make sure, my criticism is not solely levelled at MSF. It applies to all NGOs that operate across many parts of the poor world - what I call in my book the Fourth World.

Often acting with the best intentions, they intervene without realising that the very act of intervention excuses the national government from discharging its obligations. It becomes a perverse system where top government officials accommodate NGOs, allowing the state to carry on creating debts for projects that will never benefit the vast majority of its people.

If we want to see real change, NGOs need to return to core principles:

• Target the poorest directly.

• Back the people, don't push them.

• Work collaboratively for the benefit of the intended beneficiaries.

• Leave inflated egos off the table.

  
  

Only by addressing both the immediate suffering and the systems that cause it can we break the cycle of indefinite intervention.