Duncan McLean • Researcher at the Médecins Sans Frontières Research Unit on Humanitarian Stakes and Practices (UREPH) in Geneva (Switzerland)
Christine Jamet • Director of Operations for Médecins Sans Frontières – Switzerland
This Focus opens with an article on the place of research within Médecins Sans Frontières, taking us headfirst into the tensions and dilemmas that are engendered by collaboration between researchers and aid actors. Written by two representatives from each side of the question, underpinned by a reflective approach conducted with some of their colleagues, their contribution provides a balanced starting point for discussion.
In the world of international assistance, unsolicited visits by researchers – whether sent from the headquarters of the organisation or from other structures – have long generated conflicting perceptions. There are visits that are managed tactfully and have genuine benefits on the improvement of operations; others that are seemingly irrelevant and simply to be endured (falling more under “humanitarian tourism”) and then others still, the worst kind, that are all the more destructive as they compel teams to expend enormous energy in an attempt to limit the damage.
The misrepresentations that, in the humanitarian sector, may surround research-oriented activities increase the risk of falling into one of the caricatures described above. If they are experienced to varying degrees by a number of aid actors, both local and international, the example of Médecins Sans Frontières (MSF) offers a telling illustration of the underlying tensions between research and humanitarian aid which are not always easy to solve.
“How to ensure research relevancy, an often complex and slow-moving process to initiate, in a domain that by its very nature is action-oriented and focus on tangible and frequently short-term results?”
Let’s start with an obvious point of friction that can be summarised as follow: how to ensure research relevancy, an often complex and slow-moving process to initiate, in a domain that by its very nature is action-oriented and focus on tangible and frequently short-term results? This paper will attempt to dissect this and other similar tensions. A reflective approach was deliberately chosen, essentially informal exchanges with colleagues and the authors’ own experience(1)Unless otherwise specified, all citations are taken from internal discussions with MSF colleagues, chiefly around what constitutes research in the humanitarian sector, related challenges and how to improve such collaboration. The authors would like to express their appreciation to all respondents for the opinions freely shared.. The consequent narrative is organised around three broad themes: the inherent challenges in reconciling research and humanitarian aid, the varying outcomes that can emerge and practical elements to keep in mind when embarking on research endeavours.
A few caveats to mention briefly. Within MSF, “operational research” refers to any type of research, irrespective of methodology, “as long as the findings are expected to have practical implications and the focus is on the patients and communities” the organisation supports(2)Médecins Sans Frontières – Switzerland, “Operational Research Policy”, internal document, April 2019.. Broader research themes with an indirect impact are however also addressed. For example, this might include aspects of the aid system itself or cross-cutting topics such as forced migration or health policy, all of which challenge this element of practicality but are arguably no less relevant. An obvious bias should also be mentioned from the start: a paper that explores the challenges of ensuring relevancy, written in part by a member of a research unit embedded in an MSF operational centre, will not necessarily question its existence, even as that existence needs to be regularly justified.
An accidental consensus?
Whether focusing on operational research or broader themes, an obvious question to tackle is what does research in the aid sector in fact mean. Think tanks and analytical departments have long since attached themselves to operational actors, and the humanitarian landscape is littered with research initiatives.
MSF is certainly guilty of this trend; its decentralised model of governance has resulted in multiple reflection centres throughout the movement. Yet despite the heated disagreements that can emerge internally, the rationales for their existence are remarkably similar. From inspiring “debate and critical reflection on field practices and public positions” to stimulating “reflection and debate” more broadly on a variety of humanitarian topics, the keywords hardly vary(3)Centre de Réflexion sur l’Action et les Savoirs Humanitaires (CRASH), Médecins Sans Frontières – France, https://www.msf-crash.org/en/crash; MSF Analysis Department, Médecins Sans Frontières – Belgium, https://msf-analysis.org/about-us. Directly in line with this, MSF – Switzerland’s reflection centre states that its aim is to “improve the way MSF projects are implemented in the field and to participate in critical thinking on humanitarian and medical action”(4)Research Unit on Humanitarian Stakes and Practices (UREPH), Médecins Sans Frontières – Switzerland, http://www.msf-ureph.ch/en.
Some understandable hints of cynicism emerge. Not all within MSF consider the organisation “a credible actor in terms of research”(5)An understandable misapprehension as MSF’s own guideline for operational research states that it is “not a research institution”. However, the guideline goes on to note MSF’s “unique position as a primary user of research outcomes as well as a research implementer and funder entails ensuring that the most relevant questions are asked and answered in the best possible way, with rational use of resources”. Médecins Sans Frontières – Switzerland, “Operational Research Policy”…, op. cit., the assumption being that its credibility lies elsewhere. Alternatively, broader reflections have not escaped the “over-specialisation” of the humanitarian sector. For many of those managing field operations, “daily analysis is not research, it’s part of the job description”.
More common however is a recognition that the pressures of fulfilling the social mission can lead to “frustration at never having enough time to go further” and that “a reflective capacity is not a luxury”. The implication is around a need to step back from “reactive positions and take some distance or perspective”. Buzzwords such as “critical thinking” and “debate” become less banal.
The accidental consensus on the role that research can play in the humanitarian sector starts to fall apart when trying to pin down a definition. For those in MSF there is a frequent reference to operational research, described at times – as we have pointed out – as “any type of research intended to benefit a population”. More broadly still, research has been said to include “anything that implies the generation of knowledge beyond day-to-day work, if you want to disseminate, this becomes research be it quantitative, qualitative, or clinical”. In concrete terms this means research should be based on the “real difficulties related to our programming”, whether contextual (environment, security), structural (organisation, resources) or indeed operational (choices, constraints). For some, if you are dealing with these aspects, “anyone can be a researcher”.
The latter statement might be overly generous, but the overall responses are a useful starting point when trying to reconcile the particularities of research in the humanitarian sector with what has traditionally been associated with academia. The latter includes many of the elements just alluded to – collecting and analysing information for the purpose of increasing knowledge or understanding. Some form of credible or recognisable methodology could certainly be added. And at least as far as MSF is concerned, a rationale that is directly or indirectly of benefit to the populations being supported.
The reflective analysis mentioned at the outset of this paper was by no means intended to be representative of the broader humanitarian environment. However, the responses were revealing of trends that certainly extend beyond the case of MSF, particularly in identifying common challenges of an effective collaboration between research and humanitarian aid.
Foremost among the opinions expressed were misunderstandings around purpose. “Translating research into practice while integrating results into humanitarian action” is no easy task, and the “added value” is not always obvious. If the potential impact is dubitative or just difficult to explain, doubts over who is actually benefiting from the research can emerge. When research is ostensibly serving “populations and frontline practitioners”, perceptions of “individual interest or pure academic purpose” are unlikely to facilitate the process.
“Reconciling or at least mitigating this ‘temporal question’, especially for an organisation with ‘a culture focused on results’ is a perpetual obstacle.”
The “different speeds between research and humanitarian action” cannot be emphasised enough, including what was described as “irreconcilable expectations of immediate and quantifiable evidence with long-term qualitative studies”. The challenge can also be expressed in more practical terms. Certainly, it is difficult to prioritise resources for research during an emergency and all the while maintain “rigour and quality”. But if the impact is perceived as questionable with limited visibility for duration, necessary field preparations will hardly be reinforced. Reconciling or at least mitigating this “temporal question”, especially for an organisation with “a culture focused on results” is a perpetual obstacle.
Administrative challenges have also become more prominent, even if for good reason, with “data protection, legal aspects, ethical review boards – on site and external – making research initiatives more complex to implement in terms of preparation”. That governments are more central and require engagement, often including some form of partnership, is necessarily time-consuming and potentially delicate. This is further complicated if partners are adversarial, and results have the “potential to run counter to dominant narratives”. In contexts where authoritarian or repressive ruling structures are already suspicious or hostile to humanitarian actors, access and permissions are likely to be harder to obtain.
The above elements largely put the onus on the researcher to adapt to field constraints, with operational priorities regularly adapted to changes in context and needs. The “lack of long-term commitment” by the organisation for the duration of the research was likewise pointed to as problematic. This can be amplified by the “inevitable turnover in the field” making research projects difficult to sustain. A clear and relevant research question can mitigate this risk partially but cannot compensate entirely, especially when combined with elements of purpose and duration in a potentially obstructive environment.
Some concrete illustrations
Keeping in mind the described challenges, a sampling of one of the author’s own research, primarily via MSF, provides an illustration of both positive and negative outcomes. Analysis of access to healthcare for Burmese migrant workers in Thailand in the early 2000s revealed economic marginalisation and overt discrimination (hardly a revelation) but also medical needs nowhere near MSF’s threshold for emergency intervention. Similar internal research on negotiation strategies vis-à-vis Maoist insurgents during the Nepalese civil war highlighted how little leverage MSF had (and, arguably, how little it mattered) in attempts at improving conditions of access. In both cases research output was at best mildly informative, the impact on a population in need superfluous(6)Médecins Sans Frontières, “Burmese migrant workers in Thailand: a situation analysis”, internal document, September 2003; and “The Nepalese civil war: a background analysis”, internal document, September 2004..
Delving into the “impact of violence on medical and humanitarian services in North Kivu” seemed also an arguably clear research objective, especially pertinent given the potential confusion of peacekeeping and humanitarian mandates. In practice, and closer to the ground, the purpose became obscured by a daily reality. Obvious to almost all interlocutors was the persistence of violent crime and State collapse, requiring aid agencies to operate “under the same constraints, and incur the same risks, as those to which the population were subjected”(7)Duncan Mclean, “Violence and its humanitarian impact: The case of Kivu”, MSF Analysis, Reflections on Humanitarian Action, 16 January 2017, https://msf-analysis.org/violence-humanitarian-impact-case-kivu.
Publication being the most obvious means to disseminate research beyond an internal audience, the inherent temporal issues already noted between research and humanitarian action become more pronounced with rigorous editorial and lengthy peer review processes. Attempts at highlighting the risk of civil disorder and a potential return to conflict in West Africa during the height of the Ebola epidemic in mid-2014 revealed the opposite, an arsenal of public health tools that could be “misused for political gain” and solidify the position of the ruling elite. Possibly insightful at the time of research, common knowledge by publication in late 2015(8)The politics behind the Ebola crisis”, International Crisis Group, Africa Report No. 232, 28 October 2015..
Based largely on pre-1975 archives held by the International Committee of the Red Cross, administrative restrictions were not an issue when exploring the history of the discourse of perpetrators of wartime attacks on medical structures. Pertinence to field operations was likewise not an issue, and the lengthy publication process was mildly inconvenient but had little impact on the conclusions(9)Duncan McLean, “Medical care in armed conflict: Perpetrator discourse in historical perspective”, International Review of the Red Cross, 101(911), 2019, p.771-803.. Conducting similar research on contemporary events would however face major constraints. Authorities in Syria, Yemen and elsewhere would hardly be receptive to a detailed field-based exploration of rationales for targeting hospitals in their respective conflicts.
Even with a well-designed research framework, receptive (former) field staff and few obstacles to accessing primary sources, long-term commitment to research initiatives can fluctuate, sometimes unavoidably. In recounting negotiations to free Arjan Erkel from his abductors in Dagestan, the analysis suffered from the saturation of multiple preceding opinions and analyses, especially those that emerged after very public legal battles(10)Duncan McLean, “The shadowy theatre of kidnappings: An account of Arjan Erkel’s rescue”, in Michael Neuman and Fabrice Weissman (eds.), Saving Lives and Staying Alive: Humanitarian Security in the Age of Risk Management, Hurst & Co Ltd, 2016, p.127-143.. At best, the benefits can be limited to future reflection on the management of critical incidents, assuming willingness exists.
Some practical suggestions
The point of the above survey is not to pronounce the mentioned papers as failures. Rather to point out that of the myriad of challenges faced when attempting to reconcile research and the humanitarian sector, many of the pitfalls are as avoidable as they are difficult to predict. The points underlined – clarity of purpose, timeliness, administrative constraints and long-term commitment – are just some of those that featured prominently. Indeed, attempts at transforming a largely theoretical overview of State sovereignty, published in this journal, into relevant field research has faced the described challenges simultaneously(11) Duncan McLean, “Humanitarian implications of a re-assertion of State sovereignty”, Humanitarian Alternatives, issue 9, November 2018, p.38-50, https://alternatives-humanitaires.org/en/2018/11/13/humanitarian-implications-re-assertion-state-sovereignty.
Moving forward a number of elements could, at the very least, reduce self-inflicted and avoidable misunderstandings and at best reinforce a collaboration in what has been aptly described as two “permeable” worlds(12)Call for papers “Research and humanitarian aid: The challenges of a collaboration”, Humanitarian Alternatives, 20 January 2021, https://alternatives-humanitaires.org/en/2021/01/20/call-for-papers-for-the-17th-issue-of-humanitarian-alternatives. The following practical suggestions have largely been articulated by those managing humanitarian operations, although they are nevertheless convinced that field research can play a constructive role in better understanding the contexts in which aid operates and eventually im-prove the quality of assistance provided:
– Preparation is essential in linking the granular to the bigger picture. We must ensure that questions broached have the potential to “benefit populations and not only the researcher”. This includes “active participation” in defining objectives along with their eventual “communication and dissemination”. The message being that what is researched today will potentially help humanitarian operations in the future, “a fundamental link for people to know and understand”.
– Priorities are not irreconcilable but do deviate. While preparation includes “getting buy-in from the field”, it is important to re-member that as data is collected and interviews are conducted, “this is probably not a priority for anyone else”. The distorted and outdated image of “a researcher behind a questionnaire or a computer analysing data in an air-conditioned office” is to be avoided. Maintaining a connection with those managing operations daily, is also a means to “provide a reality check and certainly improve research implementation too”.
– Internal diplomacy is essential, external diplomacy even more so. Bureaucracy, validations and ethical considerations (including internal and national ethics review boards, along with data protection issues) should not be underestimated. Obstacles can be compounded if authorities are potentially hostile to your presence. Patient articulation of objectives is unlikely to accelerate the research process in its early development but will undoubtedly reduce risks in the later stages.
– Outcomes “should have recommendations and a practical purpose”. These can be humble, such as increasing internal knowledge and understanding, or be more grandiose, like changes in policy and practice. Either way, “realistic and transparent expectations are appreciated”.
– Directly linked to the outcomes is a recognition of the intended audience. Field operations might be primarily concerned with population and programmatic benefits, but indirect impacts that address “domestic and international policymakers, donors, belligerents, etc.” are likewise relevant and should be described as such.
Formal characterisations of research aside, this essay argues for a fairly wide net when casting for a definition insofar as the humanitarian sector is concerned. Attempting to generate understanding and knowledge is the minimum, combined with a methodology whose sophistication can be adjusted to the eventual means of dissemination. As almost all MSF reflection centres would seem inclined to note, provoking debate and critical analysis has an essential role. And as practitioners of humanitarian action are liable to note, can have a direct or at the very least indirect impact on the support provided.
Ducan McLean • After having managed operations with Médecins Sans Frontières in numerous countries, he is currently senior researcher at its Research Unit on Humanitarian Stakes and Practices (UREPH) in Geneva. Duncan has lectured on the history of colonialism and epidemiology and is on the editorial board of the Journal of Humanitarian Affairs.
Christine Jamet • A nurse by training, Christine started to work in the humanitarian sector in 1997, joining Médecins Sans Frontières in 2000. She has since managed a diverse portfolio of medical projects in both the field and in headquarters and is currently Director of Operations for MSF – Switzerland.
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|￪1||Unless otherwise specified, all citations are taken from internal discussions with MSF colleagues, chiefly around what constitutes research in the humanitarian sector, related challenges and how to improve such collaboration. The authors would like to express their appreciation to all respondents for the opinions freely shared.|
|￪2||Médecins Sans Frontières – Switzerland, “Operational Research Policy”, internal document, April 2019.|
|￪3||Centre de Réflexion sur l’Action et les Savoirs Humanitaires (CRASH), Médecins Sans Frontières – France, https://www.msf-crash.org/en/crash; MSF Analysis Department, Médecins Sans Frontières – Belgium, https://msf-analysis.org/about-us|
|￪4||Research Unit on Humanitarian Stakes and Practices (UREPH), Médecins Sans Frontières – Switzerland, http://www.msf-ureph.ch/en|
|￪5||An understandable misapprehension as MSF’s own guideline for operational research states that it is “not a research institution”. However, the guideline goes on to note MSF’s “unique position as a primary user of research outcomes as well as a research implementer and funder entails ensuring that the most relevant questions are asked and answered in the best possible way, with rational use of resources”. Médecins Sans Frontières – Switzerland, “Operational Research Policy”…, op. cit.|
|￪6||Médecins Sans Frontières, “Burmese migrant workers in Thailand: a situation analysis”, internal document, September 2003; and “The Nepalese civil war: a background analysis”, internal document, September 2004.|
|￪7||Duncan Mclean, “Violence and its humanitarian impact: The case of Kivu”, MSF Analysis, Reflections on Humanitarian Action, 16 January 2017, https://msf-analysis.org/violence-humanitarian-impact-case-kivu|
|￪8||The politics behind the Ebola crisis”, International Crisis Group, Africa Report No. 232, 28 October 2015.|
|￪9||Duncan McLean, “Medical care in armed conflict: Perpetrator discourse in historical perspective”, International Review of the Red Cross, 101(911), 2019, p.771-803.|
|￪10||Duncan McLean, “The shadowy theatre of kidnappings: An account of Arjan Erkel’s rescue”, in Michael Neuman and Fabrice Weissman (eds.), Saving Lives and Staying Alive: Humanitarian Security in the Age of Risk Management, Hurst & Co Ltd, 2016, p.127-143.|
|￪11||Duncan McLean, “Humanitarian implications of a re-assertion of State sovereignty”, Humanitarian Alternatives, issue 9, November 2018, p.38-50, https://alternatives-humanitaires.org/en/2018/11/13/humanitarian-implications-re-assertion-state-sovereignty|
|￪12||Call for papers “Research and humanitarian aid: The challenges of a collaboration”, Humanitarian Alternatives, 20 January 2021, https://alternatives-humanitaires.org/en/2021/01/20/call-for-papers-for-the-17th-issue-of-humanitarian-alternatives|