MSF's Joanne Liu Still Believes War Has Rules

war torn areas and developing countries facing epidemics. It's been in the news lately because of a US led air strike last fall that destroyed an MSF run hospital in Condu's Afghanistan, killing over forty people. My guest today is jo Ant Leu, the international president of m SF since two thousand thirteen. Founded by doctors and journalists in nineteen seventy one, m SF differs from the Red US and that they speak frankly about the injustices they witnessed in

the area as they serve. That's what it has brought, is this medical act with the fact that we speak out on what we witness. How would you describe the mechanism of how the organization works? For example, where you go where you don't go. I'm assuming there's places you don't go because you don't feel safe there. You can't be guaranteed safety. Obviously in recent months you in places where you thought you were saving you weren't. So how

what's the decision making process about where you going? Why? Well, in terms of our basic mandate, it's to bring medical humanitary an aid two population in distress either stilling to read to mandate disaster, which could be conflict arm conflict most of the time, or natural disaster. And so we end up working from war zones like South Sudan, the Central African Republic, or in the Middle East right now

in Syria and Yemen. Two places where there's an earthquake like we've seen in Haiti, or in response to an epidemic like we are seeing with measles in the Democratic Republic of Congo. So this is the range of where we act. And you mobilize predominantly local forces in terms of the medical community in a certain area, or you

bring in outside medical assistance. Are both, so we do both and today met San San Francaire doctors without borders to present a workforce are about thirty to thirty five thousand people overall national and international, and the ratio is for each international we have about ten national worker. We're working about seventy countries and we have an income budget

of one pointry billion. So in a country nine that of ten people are local, are are indigenous if you will, now when you mentioned that you have thirty to thirty five thousand medical professionals worldwide at any given time. They are people who work in the medical community who come and volunteer. If you they have other jobs. Correct, they're not full time staff of the national staff are often full time staff. Sometimes you you you do that for a few years as a full time and then after

you just go back to your professional life. You grew up in Canada, yes, in Quebec, yes, And when you were going to medical school, was this something you considered an option? Did you think about this kind of relief work? Well, actually, I'm one of those very non original people who when I was a teenager, I wanted to be a doctor's

without borders. So this is something that that has started when I was a teenager around about thirteen fourteen years old, and and in my quest for meaning in life, I've

read several books. I think like any other teenager we all read then in the Auto Motorcycle and then started Yeah, and I read one book that was called lepen Almond and the Peace in the World, and it was basically a testimony of a physician and work overseas with MSF and I remember reading it and I just said, Wow, this is so cool, and I said, this is what I would like to do. But sometimes you know, you're a teenager and you make those kind of of statement

for yourself, but it takes a while to materialize. But I'm someone who always deeply believe in in community life and and working for the common public good. So I end up working and doing international corporation relief work when I was eighteen years old in Africa, and when I came back and said, this is it. I'm going to go into medicine. I'm going to go and work in developing world and that's what I'm gonna do. And I'm

going to do that with Alcos Without Borders. It went to McGill in Canada and then came down to New York and you were trained at Yeah, I went on in my pz R at the n y U. And at that time were you only going to school or were you taking off sort of speaking, doing some of this relief work while you were in school. So during my training, I end up doing what we call elective medical elective overseas, so I end up going in different places.

For example, I went to Haiti, I went to Kenya, I went to Chad and I end up as well working up north because I always told myself that if I was willing to go in the middle of nowhere in the war, I should be able to go in places where they don't have enough doctor in my country. So I always until recently, I always did some work up north in Canada. What was the first spot he went to where you did either disaster related or war

related medical relief work. Right after my first year of premed, I really wanted to get exposure, so I went around and begged to go somewhere. And I've told people I'm going to do whatever, you know, clean the floor. I just want to go. But why do you think that is? What was it in you? Do you understand yourself why you wanted to go do that? Hi? I think that um being the daughter of a migrant as something to

play about it. I'm awfully grateful for everything I've gotten in life and the fact that I got access to education, and somehow, I guess I always wanted to give back and I wanted to do something meaningful. I'm someone of action. I'm a bit some people say I'm a bit hyperactive. So that was a fit for me. Your parents emigrated from China, Yes, and they were in the restaurant business. Yes.

Do you have siblings as well? Yeah? They all professional people as well the profession, but not in the medical field. And you're the one doctor in the family. And so what it was? What was the first place you went after Premiate? I went for for three months in Chad during the war. It was wartime between Libya and Chad, and I work in what we call a dispensary and and did primary healthcare. But we were doing deliveries and I remember doing those three months. I end up doing

fifty deliveries. The reality is, when I look back at it, I'm like, oh my god, I didn't know what I was doing really when I once I finished my training, But that's what I wanted to do. And you were there for three months. And when you left, were you spent or you upset or were you energized? And you wanted more, see more energized. I've I just said, this is exactly what I want to do, but I want to do it with I want to be skilled to

do that. You want to go back and finish your training? Yeah, was there ever a time you did this when you said to yourself, it's too much for me. I don't think I can handle this. So they've been tough moment And it's not all rosy. I think it's when you try to work and you feel yourself so much in danger, and then you are as well thinking that you are putting other people in danger. And that's what happened to

me when I was in Chichenia. We were on the attack on a regular basis, that's one thing, but the threat of being abducted was so huge back then, and we knew that if something were ever to happen to the staff, the MSF staff, then we will pull out. So we were praying for not having anything bad happening to us because we knew they were delivering really needed aid. On the other end, it was so nerve wracking out

of fear. Yeah, it's and and and and I hate that because I think I was This is so self centered and compared to what all those people are going through. Come on, get a grip on yourself, go through that. So when you were there, but kind of work did you primarily do? MSF was running something Nick, It was a very difficult time because we were supporting hospital that we're basically undercover because it was such a difficult environment to work. But you thought that that was at one

point more than you could bear. It was tough. It was my soldiers and war. I mean, you're exposed to some pretty tough thing and and and in some other places. Is it's just and I don't particularly like to talk about it, but because I really do think it's what we go through is difficult. But the reality I just go through for a couple of weeks of a couple of months in my life. I never chanced to leave, and I leave and I just go back to my life.

But I know that Chechen or Congolese people are back then or today, Syrian or Yemen people are going through that and they cannot go anywhere else. Yeah, So you went back to Montreal, and where do you plug it and go back to work? What do you do? You're in in office for for MSF? No, No, no, when when when I was doing this this this is really a lot of film work, not as an international president. I was going back to my work doing e er.

I remember when I came back from Therefore into that in two thousand and three and two tho four, Every single child I saw, I kept telling the parents, this is a really well filled child. I had more difficulty to adjust back home than to go to the field.

Your focus is pediatrics, correct, You're a pediatrician. Every time I see a representation of what is horror to me abroad, I see children suffering, I see children starving, I see children dying, I see children injured, and I was wondering if that became a particularly I don't want to make the whole conversation about suffering and misery, but you seem tough, and were you always tough? Did you have to become

tough to do this job. You have to be the tough side, for sure, and you need to focus on what you can save in terms of life and not focus on your loss. I'm saying that because I think it was two thousand and twelve and there was a big famine in some of and people were crossing over the country to come to Kenya that that camp and it will walk for weeks. And I remember that in one day I lost six children. And I work in

the tertiary healthcare center in Montreal. We see eighty thou people on a yearly basis and we see six deaths over the year, and so in in only a few hours, I had seen that. And and I think that this this is the huge difficulty. It's the confrontation with death. And it was the same thing about Ebola and why a Bola was so difficult at the human level, it's the confrontation on a daily basis with death. We are trained to save lives and what we did with the

Bola is of our patient. We lost them. And I always told myself, whatever I can do to make sure that we cannot repeat history, in my very modest capacity, is that we try to do it. I think it's completely abnormal that we have somehow found out about the virus in nineteen six but despite that, more than four years afterwards we had no treatment, no vaccine, and no rapid dynastic tools. And that's unacceptable that we had to face that. And I think today this is the challenge

about everything the century has to offer to us. We need to put our act together because we have other threats today that I think we can somehow troubles should a head of time. And this is something about well, I think that antibiotic resistance is a big one. It's you know, we keep you know, fantasizing about what it would be the next bio threat, the next pandemic. It's

actually already here. So we're gonna basically save our grandparents from their triple bypass and they're gonna die for the pneumonia because we would not get the right antibiotic to

save them. When you say the antibiotic resistance, we have built up people's tolerance to antibiotics and now we have we have nothing left or we're running out of bullets to kill these organizing And this is what I Bola start us is like something may happen in somewhere in the distant world that we don't even know where to put on the map, but it will have replaying effect and your comfortable New York City life and you you

went through that with Bola. When you are going back and forth to these hot spots, if you will, or whatever term you want to use, your going back and doing all this good work and you're coming back to Canada finish your training. What year and what goes into the decision for you to get into the administrative level of MSF. I made the conscious decision that's that's what I wanted because I believe that today we need more

leadership in terms of health issues. But back then I didn't have a precise idea that I would do that. And then the position open up and I ran for it and I got elected. So what year was that? It's June. So actually my mandate is coming up for term now, and you are eligible to do it again or you don't get a second term, you need to run. You're gonna run? Are you going to run? Most likely? I thought we were going to get your campaign announcement

on our show How Exciting Um? What is around the world? What would you say or the primary causes of the problems that you see? Are they purely political? Is it diet? Is it food? Is it a hygiene? Is a cleanliness? What are the things you think can happen that will change the situation you've come across in the world. Well, I'm not sure I'm that competent to answer this very complex question. I remember once I was asked, if you had one wish, what would you wish for the world,

and I would said enough water. That's a problem. It's a huge issue because if you don't have enough water, then you don't you can do agriculture, you can feed yourself, but as well after that you can clean yourself and you cannot prevent infection. And so I really to think that if you want a thriving society, you need to

be fed. In the work that you did in certain areas of the world, particularly in Africa where there was drought, where there was persistent drought, were you led to believe by people you work with that climate change was a big part of that. I think it plays a role, and I can see to which extent, but we know that it's it's a game changer before disaster strikes. MSF places doctors as well as water and sanitation experts in high risk areas. Their website reports that they've treated their

first patient from Hades two earthquake within three minutes. Listen to the Here's the Thing archive where Dr Robert Lusting talks about what he would do to solve the world's obesity problem. I would think very strongly about limiting access of sugar beverages to infants and children like zero. Take a listen at Here's the Thing dot org. This is

Alec Baldwin and you're listening to Here's the Thing. My guest today is Joanne Leeu, the international president of Medicine San Frontier or Doctors Without Borders, the international aid organization that provides medical relief to countries in need. In two thousand eleven, unable to secure permission to provide care for undocumented migrants, MSF pulled out of Thailand. They had been

there for thirty five years. We don't like to think of ourselves as being a permanent presence because it's need basis. But the reality there are some conflicts that have been

ongoing for decades. But if we look at our portfolio of countries where we are, it's basically a third of where we work it's in conflict area, about the third of it it is in post conflict area, and and about the third it's it's it's it's roughly in what I call table environment, where we work more in terms of either access to healthcare or for epidemics or for pandemic like HIV and So the reality is it's context like democratic complique of Congo. We've been there for decades

south so that I was visiting it this far. We've been there since nine three because we haven't found a political solution to what happened. We wish we could leave, but every year there's more needs, so or there's sustained needs. Where you talk about AIDS, which society has been attempting to deal with the AIDS epidemic for h thirty five years, now more than thirty five years. What needs to change for AIDS to turn around? No, I think there is.

There's been a deceleration in a few areas. But the reality is what we're facing is people have forgotten about about it. There was a full generation who were really aware about AIDS and how it was transmitted, and and now there's the new generation didn't go through the eighties and nineties, so safe sex is not as much of an imperative as what it was in our generation. There

someone else's problem. Yes, So that's interesting because the fastest growing population that is getting infected or young adult nowadays. So I'm talking about I know the figures for for example, for Canada, but we know that that there's the young and the developed world. Yeah, yeah, it's just because that new generation didn't go through for us. You know, the real issue for a's right now. It's it's about making sure that that is going to stay as a priority.

A disease has been in the landscape for such a long time, to keep the imperitive, to continue to find the right tools and treatment. The is still looking for example, for combined therapy in surrupt for children that is palatable after so many years. Still we're fighting for that. We're doing that work. Well, we are somehow I msself doing it through our research and development developing your own drugs.

We have actually have helped the creation of what we call Drug Fund Elected Disease Initiative, And what they do is they developed combined therapy of our existing drugs or developed new drugs from the Elected Disease And so we have asked them to look into combined therapy for children formula for AIDS. UM. I'm assuming you don't do any work in the United States, or do you MSF is in the United States. Well, we have looked into it. One of the things that we've been on the regular

basis questioning ourselves is about check as disease. And because of the immigration pattern here, there's a lot of people from out America that I have this disease. But described the disease. It's a disease that basically has no huge effect when you get infected initially, but down the road you've got heart failure. It's through a type of mosquitoes. But and it's it's the family of of of the parasite. This is the same family of the sleeping sickness. It's

it has he has like similarities. Tell me in the time that we have left, um, where were you when you heard about condos? Where where were you at the time that that attack occurred. I was in a plane and actually I was just lending and I was coming back from from South Sudan and and basically I got the message through email because people couldn't reach to me.

I wasn't a plane and all that. So, but I've heard that our hospital has been attacked and wouldn't know that the number of casualty, And so I think for for the audience, I think we we we have to be clear that conduced was a tragic, unprecedented event for MSF Doctors Without Borders organization in forty four years of existence. We never had such a big loss in terms of patient and staff in one attack. Conduce for me, and I think for many of my colleague there's going to

be a pre CONDUCD in the past Conduce. And I know Conduced fairly well because I was there during the winter of twenty fifteen, actually visited our project, and because there was some weather issue, I end up staying there for almost ten days, so I end up rounding patient, getting to know our staff, and I remember distinctly about Conduced, how impressed I was and and how I thought Conduced was so special, And I remember my words when I came back, I said, Conduced is the jam of the

northeast Afghanistan. We have managed to create a medical, humanitarian neutral space where everybody from both sides I think that it's safe to come and be cared for, and they know they're going to get high level of care. And both sides were coming, Yes, both side were coming. And it was not this little bush hospital. It was existing since twenty eleven. We had a hundred beds. We scale

up our r c U to AID beds. It was better occupancive more than most of the time and people were walking days to come and be care in our trauma center because they knew it was one of the good place to be cared for. And so I remember because it was so striking. We managed to create this atmosphere where we have the surgeon, the intensive is the physio, third prisonmental health together every day doing rounds together and rounding the hundred patients together. We managed to do that.

We had as well um digital X ray. I remember in the morning we will review all the admission of the night before. It was really an impressive center. And for some reason, I remember that I thought it was so special that I just said, I don't know how long it's gonna last. And I've been with him SF almost twenty years now and I've seen so many trauma center that one was special. Who we built the facility, someone had built it, a new occupied it or msfort

built build it, and it just built it. There was only like a sort of a central building. But we had to read the roof and everything and make it a hospital basically. Ah And that's what we did. In twenty eleven, after few years of negotiation with both parties and the local authorities, the Afghans and the Americans back there was the two tribes there exactly, and when you would have these people come to the facility both sides, as you say, would you separate them? It's a different necessarily,

And that's interesting. That's interesting you asked this question because I asked the same question when I went there, because I thought it was so pick elier. And now now people were patients. Yeah, people were patient, and that's what we keep saying. You know, a combatant is a patient. Now, how many staff members were in the building at the time of the attack, well, about a hundred, and how many survived, Well, we we lost fourteen them, so fourteen died.

And how many of the patients died? And the roughly when a hundred patients? We we we we we had we had forty two. So that's the math of forty two minus fourteen. So that's basically it. There have obviously been discussions and they have been calls for an independent investigation as to what happened. And what is your view on that now and what do you think is likely

to happen or not happen. Our take on this is that I think it's difficult to be the prepetors and the judge at the same time and being completely impartial about about the findings. We don't have access to the investigation, the American investigation. We have access to the briefing that that got released a few thousand words of a three report, and we have still a lot of questions. And basically what I want to know is what has led to that and making sure that history will not repeat itself.

And what I'd like to compare to it's to medical error. I'm a physician. Medical errors happened in my hospital, and we all know that the party is involved. Never do the investigation, and the goal of this is to make sure that will do and create change that will ensure that will not repeat the same type of mistake. And you want the United States military to do the mortality and morbidity study on this, and they're not going to. No,

they've done the investigation, but it's investigation. I would say, with respect to the procedure and all that it's not against international humanitary and law, but we operate in those very difficult environment because as a medical humanity and organization we are under the assumption that the international humanity and

law are respected. What does it mean? It means that healthcare access is protected and of guarded in war zones, and it means that population can come to the hospital, but once they are in a hospital, we don't attack a hospital. We don't attack patient. We don't like that care take care. We don't attack healthcare worker. And I do believe that when you struggle for your life in the I see you, you should not have to say that you might get a bomb on your head. And

I think that we have that shared humanity. I think everybody can understand that if you bring you six month old child in and why you because it's sick, You don't want to have to care to just say am I going to get a bomb in my head? It's it's just basic thing. What is the current position of the United States government as to what happened? The date of the attack was winning again October thre so it

was not that long ago. And in the ensuing weeks, did they not say that they suspected that there were terrorists inside that group or was it did they say it's completely an accident, or did they admit that they deliberately attack that facility because there were targets inside that building. No, the investigation is saying that there were errors errors at different level human level, technical level, procedural level. And we hear that we do grant the fact that the US

a stick and responsibility for what happened. And I think this is something that we have to acknowledge as an august because you have to understand that we're very upset and and and it's it's one thing in addition to our morning. We are upset and we have anger. That being said is I just want to make sure that it won't happen again. So how can I make sure of that? The government indicated that they're willing to work

with you established productcols that it won't happen again. So this is this is what we are right now into into a dialogue dialogue with them. Does it proceeding to your satisfaction? A think we had our moment, this moment and I think right after the end, and again I think there was a lot of emotion in that. But I think now we are re establishing good channel of communication towards the status of the facility and conduce now

it's reopen or is this smashed the pieces? Well, the thing is it was a really precise attack and so it's the main building. It's been attacked, and so that building, I always say it's been burned to the bone. And I'm saying that because I've seen it with my eyes.

I've seen it before in February and March twenty fift and I've seen it again when I went for the commoration day forty days after the attack, and I went through a lot of difficult things since I'm my position, but I think it was one of the toughest one because many of our staff I've survived, but they've been injured.

And when I was there, I met with all our injured staff, and I met as well with all the families of our staff we have died, and I sat and I listened to them, and I would always always remember one of my staff, one of our emergency inners, who got one of his arm amputated during the attack, just look at me and just said, you have told us over and over again that conduced from my center as a safe place. We believed you. And then he

looked at me. He wiped tears on his right cheeks with his right arm, and he just said, did you know that we will get balm? And I looked at him, and I just said, you have some right to ask the question, and the only answer I can tell you is, until October three, I thought that conduced from a center was a safe place. And what we are fighting today we're fighting for that. We're fighting two safeguard and maintain that medical humanitarian neutral space in war zones and for

m SF. The stakes are so high because that's some of our core ay that we gave, but as well what we realize nowadays in conflict area like Yemen, Syria, South Sudan, Central African Republic, there's very few ends on actors, and if we change the rule of the game of protecting neutral medical space, it's going to be total chaos. I really do think that it's part of our shared humanity to safeguard that. I still believe that wars rules

in medicine. San Frontier won the Nobel Peace Prize. John Orbinski, MSF's president at the time, said the following in his acceptance speech. Silence has long been confused with neutrality and has been presented as a necessary condition for humanitarian action. From its beginning. MSF was created in opposition to this assumption. We are not sure that words can always save lives, but we know that silence can certainly kill. This is Alec Baldwin and you're listening to here's the Thing two.