Domestic humanitarianism: the Mission France of Médecins Sans Frontières and Médecins du Monde

Hanrieder, Tine; Galesne, Claire Article — Published Version Domestic humanitarianism: the Mission France of Médecins Sans Frontières and Médecins du Monde Third World Quarterly Provided in Cooperation with: WZB Berlin Social Science Center Suggested Citation: Hanrieder, Tine; Galesne, Claire (2021) : Domestic humanitarianism: the Mission France of Médecins Sans Frontières and Médecins du Monde, Third World Quarterly, ISSN 1360-2241, Taylor & Francis, London, Vol. 42, Iss. 8, pp. 1715-1732, https://doi.org/10.1080/01436597.2021.1916393 This Version is available at: https://hdl.handle.net/10419/233974 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. 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If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by/4.0/ Third World QuarTerly 2021, Vol. 42, No. 8, 1715–1732 Domestic humanitarianism: the Mission France of Médecins Sans Frontières and Médecins du Monde Tine Hanriedera,b and Claire Galesnea aresearch area international Politics and law, WZB Berlin Social Science Center, Berlin, Germany; bdepartment of international development, london School of economics, london, uK ABSTRACT What are the boundaries of humanitarianism? This question is controversially debated among humanitarian practitioners and scholars, given ever-changing spaces and temporalities of human suffering. This paper explores an understudied site of this controversy: the domestic humanitarian engagement of Médecins Sans Frontières and Médecins du Monde, two NGOs widely regarded as epitomes of liberal international humanitarianism. Their Mission France started in the 1980s to support vulnerable populations in France through medical aid, socio-legal support, and political activism. It has provoked fierce internal opposition ever since, in the name of an inherited vision of humanitarianism as impartial emergency aid. Drawing on organisational documents, archi - val sources and key informant interviews, we analyse how these conflicts gave rise to an unstable settlement around the diagnostic function of Mission France: Leaders aimed to make the assistance function of Mission France secondary to the advocacy function of drawing attention to health inequity, thus avoiding any long-term substitution for state services. However, the political strategizing demanded by this approach clashed with local volunteer preferences for immediate aid and claims to political neutrality. This conflict about the hierarchy of humanitarian values in the NGOs’ home country sheds new light on the contentious politics of humanitarian witnessing and assistance. Introduction In 2017, Médecins Sans Frontières (MSF, English: Doctors Without Borders) opened a day centre for unaccompanied minors in the suburbs of Paris (Médecins Sans Frontières 2018). In Germany, Médecins du Monde (MDM, English: Doctors of the World) provide medical care and social counselling to people who do not have access to health, while publicly denouncing exclusion from healthcare (Ärzte der Welt 2017, 34–37). In the response to the Covid-19 pandemic, MSF and MDM, like many humanitarian NGOs, provide aid to the underserved in countries around the globe, not only the global South (Kenny, Grant, and Tondo 2020). These activities differ from the dominant conceptualisation of humanitarianism as a practice of ARTICLE HISTORY Received 30 March 2020 Accepted 8 April 2021 KEYWORDS Humanitarianism health policy international nongovernmental organisations France Médecins Sans Frontières Médecins du Monde © 2021 The author(s). Published by informa uK limited, trading as Taylor & Francis Group. CONTACT Tine hanrieder [email protected].uk department of international development, london School of economics (lSe), houghton Street, london, WC2a 2ae uK Supplemental data for this article is available online at https://doi.org/10.1080/01436597.2021.1916393. This article has been republished with minor changes. These changes do not impact the academic content of the article. https://doi.org/10.1080/01436597.2021.1916393 This is an open access article distributed under the terms of the Creative Commons attribution license (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1716 T. HANRIEDER AND C. GALESNE emergency aid in distant poor or conflict-ridden countries (Barnett 2011; Redfield 2013). They also differ from the dominant image and self-conception of the ‘French Doctors’, which were founded in 1971 (MSF) and 1980 (MDM) as internationalist organisations seeking to bring relief to distant sites of suffering. What does this reterritorialization tell us about the politics of humanitarianism and about conceptions of humanitarian spaces? In this paper, we analyse the contentious evolution of the ‘domestic outposts’ of MSF and MDM: their program in France called ‘Mission France’, in order to understand how the cultural repertoire of international humanitarianism is invoked, adapted, and resisted in spaces inside well-resourced welfare states.1 We focus on MSF and MDM, whose French engagement started in the late 1980s and has sparked intensive debates about the aims and limits of humanitarianism and its relationship with the welfare state. Drawing on key informant interviews and archival and online data about Mission France, we retrace the contentious genealogy and implications of a distinct humanitarian strategy marked by diagnostic interventions, political advocacy, and the pledge not to become a substitute for welfare state services. We show that MSF and MDM could invoke their symbolic capital as emergency fighters and thus the fact that their sheer presence has become a marker of humanitarian crisis. This diagnostic function of their engagement – the will to document and witness suffering – has taken centre stage in Mission France as its leaders have attempted to keep the assistance function in check. Pledging not to take over state functions – ‘non-substitution’ – has become a core tenet in a humanitarian strategy that has made immediate aid a tool in the service of political diagnosis and advocacy. This humanitarian strategy has led to considerable investment in non-medical skills such as social work, legal and political expertise, as well as research and documentation skills for the purpose of diagnosis and advocacy. Yet in both organisations, even though to different degrees, these practices, and often the very existence of Mission France, have remained contentious. In particular, the non-substitution principle has proven difficult to maintain in practice. It has created conflicts between organisational strategists favouring time-limited interventions on the one side, and employees and volunteers on the ground favouring continued assistance on the other. The continued presence of Mission France is thus as much the result of political strategy as of the organisational dynamics it unclenched in local clinics throughout the French territory. Furthermore, in spite of the political clout and growing portfolio of activist and long-term engagement by both NGOs, ‘doing politics’ remains contentious as many humanitarian actors are protective of a core medical identity. Our reconstruction of Mission France contributes to a growing literature on the tensions and contradictions within humanitarianism, whose protagonists constantly question the purpose of humanitarian action and the boundaries between humanitarianism and politics, between acute help and long-term development, or between medical and non-medical forms of humanitarian work (Barnett 2011; Redfield 2013; Krause 2014; Rambaud 2015). We make two main contributions to these debates. First, we shed new light on the symbolic and diagnostic function of humanitarian missions. Scholars have emphasised that witnessing and speaking out (témoignage) are central to MSF and MDM practice (Fassin 2008), yet also pointed out that witnessing is held to be secondary to the actual relief work (Redfield 2006, 10).2 By contrast, the leaders of Mission France made its diagnostic function the core raison d’être, being utterly strategic about their symbolic impact. Second, the dynamics in Mission France clinics, whose personnel would not always comply with the strategy of time-bound interventions, highlight the importance of local staff’s incentives and agency. This THIRD WORLD QuARTERLY 1717 observation contributes to research on the importance of ‘citizen aid’ and grassroots human - itarian efforts (Fechter and Schwittay 2019), but stresses that these localised forms of humanitarianism do not necessarily operate separately from established humanitarian institutions. They can also change these institutions from within. Given that the scholarship on MSF and MDM almost exclusively focuses on these organisations’ international work, our study helps to understand a distinct configuration of their activities when they harness their international reputation in the domestic policy arena. Furthermore, many international humanitarian NGOs – not only MSF, MDM, but also Save the Children through their work in the uK, Partners in Health through their work with uS Native Nations,3 or an entire international ‘humanitarian aid machinery’ (Haaland and Wallevik 2019, 1869) present in European refugee camps – are increasingly present in their home countries in a context of multiple social and health crises. Our study contributes to understanding the importance of such reterritorialization for humanitarian identity especially for liberal international NGOs, which seek to establish coherence and purpose on the basis of a universal notion of humanity as a value beyond politics (Barnett 2020). MSF and MDM, while embodying a specific type of ‘French universalism’ (Taithe 2004), are also global reference points for the universalist, medical model of international humanitarianism (Krause 2014). Their struggle to navigate blurred boundaries between foreign and domestic sites of intervention, and between medical aid and political engagement, also points to the tensions and limits of liberal humanitarianism more generally. The remainder of the paper is divided into three parts. The first section situates our argument in the humanitarian literature and introduces the case study and data. Next, we reconstruct the origins and justification of Mission France, which has provoked considerable resistance in the name of humanitarian identity, in spite of compassion with domestic populations. The third section shows how the French doctors strived to solve this dilemma by emphasising the symbolic weight of humanitarian missions, advocating for political change instead of becoming a substitute for universal health coverage. This strategy met its limits in the face of grassroots actors whose commitment to continued aid often ensured that local missions outlived their initial rationale. We conclude by reflecting on the implications of this study for humanitarianism in a post-covid world of debordered health and social policy crises. Humanitarian politics in the welfare state Humanitarianism, ‘the desire to relieve the suffering of distant strangers’ (Barnett 2009, 622), is constantly evolving. Its varied permutations include, but do not exhaust charitable and abolitionist movements in industrialising Europe (Haskell 1985), the co-emergence of domestic charity and international humanitarianism in late 19th century Britain (Roddy et al. 2015); European reconstruction efforts between the two World Wars (Baughan 2012; Hilton 2012), contemporary refugee aid around the globe (e.g. Lewis 2019; Lupieri 2020), faith-based international aid (e.g. Sadouni 2007), and the codification of Western international humanitarianism since the mid-20th century (Krause 2014). The diversity of humanitarian practices is reflected in a rich interdisciplinary literature, which has analysed the contentious boundaries and politics of humanitarianism from different angles. The distinction between humanitarianism, human rights advocacy and development (Barnett 2011), between emergency 1718 T. HANRIEDER AND C. GALESNE missions and longer-term engagements (Redfield 2013; Krause 2014), the forms of violence to be addressed by humanitarian NGOs (Bradley 2020), and the risk of erecting a medical government that takes over state functions (Debrix 1998; Falisse 2009) have all sparked intensive debates – both in scholarly writing and within humanitarian NGOs (Rambaud 2015). Mission France: a contested reterritorialization of international humanitarianism Our study of Mission France builds on this work on humanitarianism as a contested field of practice, and as a project whose specific local shape is always a configuration of concrete political, cultural, and organisational dynamics (Baughan 2012; Redfield 2013; Taithe 2019). By looking in-depth at the genealogy of Mission France, we move beyond the usual territory of studies of the ‘French doctors’, MSF and MDM, given that most scholarly accounts focus on their overseas work (Taithe 2004; Vallaeys 2004; Redfield 2013). Only few studies mention, and even fewer explore in depth, their humanitarian work inside France. Among them is the historian Izambert, who in her study of MSF and MDM’s engagement for migrant health in France, considers the NGOs’ work as a form of domestic social activism (Izambert 2018b). Therefore, the international origin and humanitarian identity of these NGOs does not figure prominently in the study as Izambert’s ambition is to trace the role played by MSF and MDM in extending healthcare access to undocumented immigrants. By contrast, the ethnographies of Fassin (2007; 2012) and Ticktin (2011) scrutinise how foreigners receive ‘compassionate humanitarian’ support by the French state. They highlight that state humanitarianism involves a problematic medicalisation and de-politicisation of suffering – for example when ‘the right to asylum is replaced with humanitarian reason’ (Fassin 2012, 141). In the words of Ticktin, this implies that ‘caring’ for vulnerable populations takes precedence over trying to ‘cure’ them by addressing the causes of their sufferings, thus contributing to maintaining inequalities (Ticktin 2011, 84). Our interpretation of Mission France seeks to make sense of both dimensions – the rights advocacy highlighted by Izambert and the humanitarian ‘aid’ imaginary emphasised in the works of Fassin and Ticktin. We zoom in on the normative tensions of Mission France and show that it has been accompanied by controversies about the boundaries of humanitarian space and valuable humanitarian work, and that the desire not to become a substitute for welfare state services has given rise to a distinct strategy of demonstrative intervention, political advocacy, and socio-legal action. This humanitarian strategy not only differs from many activities in poorer countries, where international humanitarian NGOs are sometimes factually erecting medical government (Falisse 2009; Redfield 2013). It furthermore sheds new light on two key features of international humanitarianism: the role of diagnosis and witnessing, and the relationship between NGO leaders and actors on the ground. Diagnosis versus aid, national strategy versus local engagement First, the study of Mission France reveals that the diagnostic role of humanitarianism has taken centre stage in the domestic context. From the beginning, as the creation of French clinics by MSF and MDM was criticised to be disproportionate to the need on the ground, local actors started collecting data on the dire health conditions and experiences of exclusion of the populations they served. Diagnosis thus legitimises assistance, and making suffering visible by documenting it has become a steady companion to Mission France activities. This THIRD WORLD QuARTERLY 1719 observation resonates with Fassin’s emphasis on witnessing as a major strategy in humanitarian psychiatry (2008) and with Redfield’s account of witnessing (témoignage) in international humanitarian projects (Redfield 2006). However, the diagnostic strategies of Mission France also differ from these accounts in two main respects. First, in Mission France, witnessing and documentation was not only a medicalizing and de-politicizing strategy like the representations analysed by Fassin ( 2007, 2008). It was also a tool of political advocacy that documented social policy failures in the name of equal rights – and thus informed explicit contestation of any sort of two-tier health care with a tier of ‘humanitarian citizens’. Second, we show that over time, humanitarian diagnosis moved from secondary to primary importance. Instead of being a companion of assistance, the diagnostic component of domestic projects became a strategic priority taking precedence over direct assistance. The credo of not substituting state services led MDM, and even more so MSF, to make deliberate use of their symbolic power and the political effect of their sheer presence inside France as a demonstration of social policy failure. In a strategy of prioritising advocacy instead of permanent aid, local missions were instructed to remain temporary and only operate to achieve the effect of demonstrating need. The second feature that our study sheds light on is the relationship between professionalised and institutionalised humanitarianism on the one hand, and grassroots or ‘everyday’ humanitarianism on the other. Many studies emphasise that international humanitarian NGOs have become bureaucratised and professionalised and thus follow managerial or political strategies as much as a field-driven will to help (Krause 2014). By contrast, a growing literature on bottom-up, privately funded and citizen-driven aid emphasises a parallel world of humanitarian action that seeks to keep a distance from established actors such large NGOs, multilateral organisations, or government agencies (Taithe 2019; Fechter and Schwittay 2019). Our study shows that attributes of grassroots humanitarianism, in particular the emphasis on spontaneous and localised support (Lewis 2019), can also affect the practices of big NGOs. We show how employees and volunteers on the ground pursued priorities that diverged from top-down political strategies. Much of the longevity of local MSF and MDM clinics in France can be attributed to the tenacity of volunteers and employees who did not subscribe to the strategic and diagnostic function of their missions. Method and data The following sections reconstruct these dilemmas in more depth. We ground our analysis on primary and secondary data. They include archival materials and publications of MSF and MDM, key informant interviews with (former) heads of Mission France, and personal notes and memoirs by several protagonists. Due to our interest in the historical emergence and evolution of Mission France and the ideological and organisational debates over domestic programs, we selected key informants mostly at the management and executive levels as our interview partners.4 Our interview partners can be classified into three groups. The first two group are experts who were directly involved in the management of Mission France at the national or regional level, and who had not worked for the NGOs abroad. Their narrative emphasises the role of the French state and healthcare system, while they rarely refer to humanitarianism, which they tend to be critical of. The second group also were directly involved in the management of Mission France at the national or regional level, but who were former international humanitarians. . Despite 1720 T. HANRIEDER AND C. GALESNE their international experience, they rarely draw a parallel between humanitarianism at home and abroad. The last group of interviewees also consists in former international humanitarians who afterwards worked in France, but at the headquarters and not on the field. Even if they highlight the differences between humanitarianism at home and abroad, they are much more prone than the second group to reflect on the meaning of humanitarianism at home for humanitarianism in general. In addition to interviews, we consulted the websites and archives of both organisations. The documentation service of MSF sent us the NGOs’ annual reports and the minutes of the board of directors in digital format. As for MDM, Author 2 visited their library service in Paris, where the archives of Mission France (including annual reports for the years 1994–2000, project reports, internal communication and strategy papers, external studies, and advocacy documents) are stored. From MDM’s website, we retrieved the most recent annual reports of the organisation (2008–2018) and annual reports on healthcare access and exclusion in France for the years 2009–2018. Last, humanitarians produce considerable reflexive work on their practice (see Abu-Sada and 2012; Brauman 2006). Hence, we consulted the outputs of MSF’s affiliated research centre CRASH (Research Centre on Humanitarian Actions and Knowledge), the journal Humanitaire, which was funded and edited by MDM until it ceased publication in 2015, and books and articles written by former members of the organisations. In the following empirical sections, we strive to do justice to this rich corpus of data by providing long quotes from the interviews and the archives. Due to space restrictions, we could not do it for each of our empirical arguments and in those cases, we provide the corresponding quotes and their analysis in Supplementary Appendix 1c. Given that the aim of the empirical analysis is to allow a first theorisation of the meaning of humanitarianism at home for humanitarianism at large, the empirical analysis mostly focuses on the commonalities between MSF and MDM Mission France. When justified though, the differences between their respective Mission France are highlighted. Debating the boundaries of humanitarian work When in the second half of the 1980s, MSF and MDM decided to open domestic missions on French territory, this may have seemed like an obvious step: It was a reaction to domestic exclusion and dramatic health inequity. Yet this project met considerable resistance within the organisations as it challenged the dominant conception of these NGOs’ missions as international aid providers. This section analyses the specific drivers of humanitarian engagement in their domestic setting and shows how the rationale for domestic interventions sparked heated debates about humanitarian identity. A clear humanitarian cause? The head of MDM’s Mission France throughout the 1990s told us the ‘mythical’ origin of the program: Initially, at the very beginning of Mission France […], actually, the many fathers of Mission France say the same thing: they passed by, they were rue de la clef [name of a street], they saw this man who left the hospital and had an undried plaster cast, while it was raining cats and THIRD WORLD QuARTERLY 1721 dogs, his plaster cast was disintegrating, and they were saying to themselves: ‘but what is that? In our country, which is so rich, we let this lad outside under the rain with his plaster cast that is disintegrating, what is happening?’ And they said to themselves: ‘we cannot tolerate it, so we are going to do something’. (Interview 10) Hence the decision to start Mission France was driven by the outrage, if not the shame felt by MDM’s doctors, who could not bear the fact that in such a rich country as France, homeless people were not properly cared for (but rather stigmatised, see Brücker, Pierquin, and Henry 1994). The quote above echoes a story told by Alain Deloche, one of the founders of MDM’s France, in his memoirs. He notably recalls that his mother tirelessly asked him why he went so far away to help people, whereas there were also poor people in France (Deloche 1993). Similarly, the creation of MSF’s Mission France was based on the observations that some people could not access the healthcare system and the willingness to address this situation that humanitarian doctors judged abnormal and unacceptable (Interview 3; Interview 7). Thus put, the classic humanitarian ‘will to act’ (Taithe 2004) provided an unambiguous impetus to become active inside France. Beyond the humanitarian drive to act, there were also organisational and pragmatic reasons to opt for a domestic mission. First, professional leadership played an important role in both NGOs. At MDM, Alain Deloche was one of the founding members not only of Mission France but also of the NGO, and its president. In this endeavour, Deloche benefitted from the support from another founding members of MDM, Bernard Kouchner. At that time, Kouchner was starting a political career and managed to convince François Mitterrand to visit MDM’s first clinic in Paris, thus putting to the fore the issue of healthcare exclusion and MDM’s Mission France (Izambert 2018b, 96). As for MSF, the program was supported by Rony Brauman, then president of MSF France. Professional leadership continued to play a role in the development of Mission France since both MSF’s and MDM’s national programs mostly expanded throughout the 1990s when they were respectively led by the same persons for almost a decade, who were strongly attached to the programs. Second, the problem identified by the humanitarians – unmet healthcare needs – was one of the symptoms of a bigger issue gaining prominence in the public debate in the late 1980s: exclusion (Brücker, Pierquin, and Henry 1994; Benamouzig 1998). As the director of MSF explained to us, the issue of new forms of poverty was given widespread media coverage following publication of the Wresinski report on poverty and precariousness in 1987 (Interview 3),5 thus turning it into a public and a political issue, while this had not been the case beforehand (Interview 8). Given such public sentiment, it was straightforward to justify Missions France’s establishment with reference to nearby distress. The impulse to act was further undergirded by pressure from donors and heightened competition for private donations. For instance, Coluche, a popular comedian and entertainer, created the Restos du Coeur in 1985. This association provides free meals and food aid for poor people in France. It became increasingly difficult for the French doctors to justify their restrictive international focus, all the more that they started receiving letters from their donors in the 1980s urging them to pay attention to poverty in France and not only abroad (Izambert 2018a). It is, however, unclear to what extent fundraising played a significant role in the further development of Mission France as this aspect was not mentioned in our sources after this initial phase. In addition, given that the relationship between MSF and MDM had a competitive dimension, leaders of both NGOs felt propelled to prove their relevance by 1722 T. HANRIEDER AND C. GALESNE engaging in domestic sites. As Rony Brauman puts it: ‘The fact that MDM started (a program in France) was not irrelevant in explaining our willingness to do it (to open a program in France)’ (Interview 3). Policing the boundaries of humanitarianism However, from the outset the domestic engagement also met resistance within both NGOs. Criticisms challenged the value of Mission France from various angles. First, many critics did not consider France a valid humanitarian site as the severity of the health needs of MF’s target population was debated very controversially. Not all members of the two NGOs agreed that healthcare exclusion was really alarming in France. For instance, in the 1987–1988 annual report of MSF, one could read that: Stormy discussions and serious disputes had been required to reach an agreement within Doctors Without Borders about the indisputable fact: that some people are excluded from healthcare, in the country of social security. No need to talk about this debate, except to emphasize that the majority of us, focusing on far-away distresses, had been blind for a brief or longer period, to distresses that grew at the corner of our streets. (Brauman 1988, 8) Humanitarians’ blindness to nearby sufferings might be explained by two factors. The first one is an idealisation of the French healthcare system when abroad, and, as a result, an impossibility to come to terms with its shortcomings. This idealisation is captured by the following quote from Bernard Kouchner, who is a founder of both MSF and MDM: From afar, faced with the bare essentials, misfortune, destitution, in poor countries, in the face of extreme difficulty, we dream of the smooth running of French hospitals, the efficiency of French medicine and the social protection system of our country, which an exotic experience of more than 20 years allows us to consider as one of the best in the world. The shortcomings of this support system are all the more unacceptable, especially for us, upon return from our faraway missions. (Kouchner 1987, 144) The second reason is related to this faith in the French healthcare system: When not abroad, humanitarian doctors worked as part of this public healthcare system, where they felt that they cared for all the patients coming to the hospitals (Interview 2). As explained to us by former MSF president Jean-Hervé Bradol, many MSF members realised that in the hospitals they worked in, the administrative staff barred access to people without proper documentation (Interview 2). Yet even as the proponents of MF managed to render visible discriminatory practices and factual exclusion (Interview 7; Deschamps and Luciolli 1990; Médecins du Monde 1995, 6), staff at both MSF and MDM kept challenging the domestic engagement with arguments related to the identity of the NGOs. Both MSF and MDM were predominantly founded by physicians (Vallaeys 2004) and dominated by physicians as well (Redfield 2013; Krause 2014, 93). This medical identity shaped which kind of humanitarian work was considered valuable. In France, the NGOs set up activities both to address the vulnerabilities of their patient population and, as explained in more depth in Section 3, to make the state fulfil its responsibility. Yet beyond medical care, the NGO provided social and legal counselling to their patients. Indeed, healthcare was not the priority for most of the patients, some being homeless or undocumented. In those situations, curative medicine was of limited impact THIRD WORLD QuARTERLY 1729 crisis, as citizens and NGOs look for new ways to counter humanitarian emergencies in all parts of the world, including industrialised countries, we will see further difficult compromises between the impulse to help and the wish to hold governments to account. Acknowledgments We thank our interviewees for their time and insights and the archival services of MSF and MDM for their support. We are grateful for the valuable comments provided by the editors of Third World Quarterly and the two anonymous reviewers. Previous versions of this paper were presented at the 2019 International Studies Association Annual Convention, the WZB Global Governance Colloquium, and a workshop on Medical Dominance in Global Health (WZB). We thank all participants at these eventsespecially our discussants Katie Laatikainen, Yves Guichaou, and Miriam Bradley, Nina Reiners, Nitsan Chorev and Joachim Blatter. Disclosure statement No potential conflict of interest was reported by the authors. Funding This work was supported by the Volkswagen Foundation with a Freigeist Fellowship. Notes on contributors Tine Hanrieder, Dr. rer. pol. 2012, university of Bremen, is Assistant Professor in Health and International Development at the Department of International Development at the London School of Economics (LSE) and head of the research group Global Humanitarian Medicine, Research Area International Politics and Law, at the WZB Berlin Social Science Centre. She works on global health, medicine and labour, and humanitarianism. Claire Galesne, M.A. M.A., is a political scientist and health researcher. She is a former research fellow at the research group Global Humanitarian Medicine, Research Area International Politics and Law, WZB Berlin Social Science Centre. She specialises in migration and health policy and the politics of humanitarianism. Notes 1. In both organizations, the term Mission France was and is mostly used as a generic term referring to the activities of both organizations. Only where we refer to one NGO exclusively do we make this explicit through further qualification. 2. A notable exception is MSF’s Access to Medicines Campaign, launched in 1999, which for many members of the organization is a digression from its core mission to help in the field (Redfield 2006). 3. See https://www.savethechildren.org.uk/what-we-do/uk-work and https://www.pih.org/ country/navajo-nation (both accessed 29 November 2020). 4. Table 1 in Supplementary Appendix 1a provides additional detail on the interviewees and their position within both NGOs. 5. Joseph Wresinski (1917–1988) was a priest and key figure in the fight against exclusion and illiteracy in France. He founded the association ATD-Quart Monde (All Together for Dignity- Fourth World), an association fighting against poverty. 6. For later changes in international strategy see the conclusion. 7. ‘Ne risque-t-on pas, ensuite, de faire de la “politique” – un mot qui pour certains est incompatible avec le principe de neutralité dont l’association se réclame ?’ (Neuman 2019). 1730 T. HANRIEDER AND C. GALESNE ORCID Tine Hanrieder https://orcid.org/0000-0002-9818-8683 Claire Galesne http://orcid.org/0000-0003-1940-9300 Bibliography Abu-Sada, Caroline. 2012. In the Eyes of Others: How People in Crises Perceive Humanitarian Aid. Doctors Without Borders/Médecins Sans Frontières (MSF), Humanitarian Outcomes, and NYu Center on International Cooperation. Ärzte der Welt. 2017. Jahresbericht 2018. München. Barnett, Michael. 2009. “Evolution without Progress? Humanitarianism in a World of Hurt.” International Organization 63 (4): 621–633. doi:10.1017/S0020818309990087. Barnett, Michael. 2011. Empire of Humanity. A History of Humanitarianism. New York: Cornell university Press. 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