For the head of Doctors Without Borders, impatience is a virtue

With little fanfare earlier this summer the humanitarian group Doctors Without Borders did something it had never done before. It reelected its international president.

Dr. Joanne Liu, a 50-year-old French-Canadian who practices pediatric emergency medicine, had seen her first three-year term whiz by, subsumed by the civil war in Syria and the West African Ebola outbreak.

She was tempted to seek a second term: to continue working on the refugee crisis, ensure the world learns the lessons of the Ebola crisis, and improve access to medical care for people in need.

But given the challenging internal politics of MSF — the acronym is derived from the French version of Nobel Peace Prize-winning organization’s name — could she muster a two-thirds vote to hold the job?

After a crash course in leadership — in the form of the “Game of Thrones” — Liu threw her hat in. She was uncontested.

Liu recently had a few days off in Montreal, where she still works occasional shifts at Sainte-Justine, a children’s hospital affiliated with the University of Montreal. STAT spoke to her from there by phone; the transcript has been edited for length and clarity.

Congratulations on being reelected. Is it true that this is the first time an MSF International president has been elected to a second term?

This is the first time someone sought a second mandate.

Why is that?

I’m not sure. I think most of my predecessors, some of them just said it was a bit “enough” after the sort of breakneck pace. I think with those kinds of … top jobs that if you take it, you do accept that you somehow put aside part of your personal life.

My impression is that MSF is as hard on its leadership as it is on people outside that it’s critical of.

That’s an understatement.

What do you mean?

There’s a tradition of strong debates in MSF, and there’s a tradition of deconstructing arguments. It’s a bit like a “Game of Thrones.”

You watch Game of Thrones?

I never used to watch it. But someone gave me the first season and said “You need to watch that if you want to go for a second term.”

That’s hilarious. But it’s also probably good advice. Do you like it?

I think “like” would be a big word.

You mentioned that your first term was overtaken with emergencies. The West African Ebola outbreak started shortly after you took office. That must have been a baptism by fire?

When I started, end of 2013, was full-swing Syria. One of the things I did was I went to Syria to work as a physician for a few weeks. It was pretty much undercover. People didn’t know me. It was a great mission. We were still having international teams [in Syria] back then. It allowed me … to understand the daily reality of the people.

One of the big [pieces of] advice I got before I got the job was “Don’t talk about anything you don’t know.”

To be a credible speaker on anything, you’ve got to be there.

So Syria and then Ebola. You were telling the world: This is a much worse situation than you are recognizing. The world has to respond now. You publicly chastised Dr. Margaret Chan, the director general of the World Health Organization. You were asked to address the UN. What kind of relationships did this set up for you with outside organizations?

I believe that Ebola has been a game changer worldwide. Because I think that Ebola intertwined security with health in a very graphic, understandable way for the general public.

So that’s the legacy of Ebola and we’re going to have to deal with that.

We [MSF] have been [responding to] Ebola for decades now. But really at the outset, we knew this was different.

We just couldn’t find the words and find the argument to make people understand that it was different. And we, like everybody else, were a bit fooled when there was this lull in the number of cases in April [2014], when everybody went underground.

By the end of May we knew we were in deep trouble.

And yet it took until the beginning of August before the WHO declared it a global health emergency. My impression of you is that you’re a person who is impatient in the best way. How do you make sense of that?

I don’t think it makes sense.

I’m someone who declared when I was in my mid-30s that impatience was not a shortcoming. When I think of all my colleagues at Sainte-Justine who work in the ER, I think that’s a common denominator — a certain impatience. If you’re not impatient, you will not get things in a timely way for patients.

I think on the system, per se, I think this is why the world was shocked as well … that in terms of international governance, we realized that [WHO] is not fit for purpose, meaning it’s not fit to save lives.

After Ebola, people said: We need to be able to respond to a global biological threat, a global pandemic in a timely fashion to prevent what’s preventable. But then what happens is, as you move away from the trauma of the event, people forget.

This is where we are right now.

The WHO will be electing a new director general next year. Do you think that might be an opportunity to refocus attention on fixing the problems?

It would be a pity to not do that.

They should have a plan to fix some of the things and be ready to fight that battle. I think it’s really, really important that WHO position itself right and be ready to put patients and the fate of patients right at the core.

It’s a bit like 25 years ago when we started to report medical errors. Oh my God. You’d put in a report and everybody would be looking at you, and you had to go and stand up during morbidity and mortality rounds. And you really thought that you were the pariah of the hospital.

Today it’s basic stuff. Everybody understands that it needs to happen. … We need to learn from our errors and we need to fix what was conducive to make the error happen.

We need to do it on a big scale for the world.

I know there were people who were hoping you would run for the WHO director general job. Did you consider it?

I think I have a job to finish in MSF.

Does that mean you might consider it down the road?

We’ll see where life takes us.

I just think that you need political courage to get those kinds of jobs. And whoever’s going to be there, I hope will have the political courage to do it.

Your only agenda should be people’s health. And if the next leader does have that, then maybe we might get somewhere else.

Do you think the world community really wants a strong WHO?

Oh, that’s another question. (Laughs)

Can we talk about airstrikes on field hospitals, because that must be preoccupying you and your organization? It seems like every few weeks we’re hearing about a field hospital being hit and civilian patients and medical personnel being killed.

The UN Security Council even passed a resolution in May, reminding states that under international law, they are obliged to protect medical and aid workers. But it contained no new sanctions and there have been strikes since. What can be done?

I think a lot can be done.

We decided to take a very, very strong stand after the attack in Kunduz [Afghanistan, on Oct. 3, 2015], but that being said, we’ve had a project called “medical care under fire” for several years. … We’ve been basically doing an inventory and keeping a log book on all the attacks.

The reality is we don’t have figures before that gave us a benchmark. Everybody says: “It’s more.” … I cannot say it’s more but it’s happening and we don’t want this to be the new trend and the new norm.

Everybody knows there are rules of war. And people are aware of the Geneva Convention — the International Humanitarian Law. But why do we have this kind of disrespect for what used to be a no-go zone? I think it’s because we are waging war without limits today.

For Syria, if you go and look back, straight from the beginning, civilians were not spared. And as well medical assets have been targeted, straight from the beginning. It was part of a strategy.

We always have accepted that there was humanity in wars and that we were trying to spare the civilians.

I think we need to safeguard that part of humanity — our common shared humanity. This is why for us it was important to pass the UN Security Council [resolution] — although I don’t think it’s going to change much unless it is implemented by … the permanent UN Security Council countries, because four of them are a part of the coalition that is bombing hospitals.

The reality is it’s to prevent full impunity. It’s the only thing we have — naming and shaming and avoiding full impunity.