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Medecins Sans Frontieres to Leave Tibet

[WTN-L World Tibet Network News. Published by The Canada Tibet Committee. Issue ID: 2002/12/16; December 16, 2002.]

Tibet Information Network
TIN News Update / 16 December 2002 ISSN: 1355-3313

The independent aid organisation Medecins Sans Frontieres (MSF, or Doctors without Borders) has made the controversial decision to pull out of Tibet at the end of the year after 14 years of working with Tibetans on humanitarian and medical assistance projects. A respected research and treatment project on Kashin-Beck (Big Bone) Disease and other MSF medical programmes will continue in Tibet under the auspices of the European branch of the newly created charity Terma. The MSF water sanitation project will be continued by another charity, the Save the Children Fund. A spokesperson for MSF, which won the Nobel Peace Prize in 1999, said: "The MSF flag will no longer be flying in Lhasa in January."

Christopher Stokes, Director of Operations at MSF in Brussels said: "We're closing our operation in Tibet for operational and human resources reasons but we want to keep the door open to possibly go back. Tibet is a hard environment to work in an MSF-style way. We're aiming to shift our focus to treatment for people with HIV/AIDS in China." Some of the more than 50 MSF staff based in Tibet, mostly Tibetans - including technicians who work on the water sanitation project as well as medical staff - are likely to find work with other non-governmental organisations (NGOs) in the region. The Tibetan staff for the Kashin-Beck Disease project are being kept on by the charity Terma. The decision to pull out of Tibet was said to have been made following a reshuffle of MSF operational strategy in the area, linked to difficulties with continuity of staff and the transfer of management of MSF's Tibet projects from Lhasa to Beijing. MSF staff were reportedly been told by management that the reason for the decision was that MSF should be engaged with emergency relief not long-term aid and development. However the decision remains controversial within MSF.

MSF has developed a reputation for activism as well as medical assistance projects since it was founded by a group of French doctors in 1971. Relations between the authorities in Tibet and MSF have frequently been tense, partially due to the charity's stated mandate of "undertaking advocacy positions when dealing with specific abuses of endangered populations". In June 1997, two senior members of the MSF team had their permits briefly withdrawn - Chinese officials are said to have commented that the two experts had been in Tibet for too long. The two were later granted partial access to the region after senior MSF officials flew to Lhasa to discuss the issue. In the past few years, the authorities in Tibet reduced the geographical scope of MSF's operations and there have been difficulties for the charity in reaching agreement on the implementation of projects.

The difficulties with the authorities experienced by MSF over the years reportedly contributed to the final decision of the charity to leave Tibet. A member of MSF staff who has worked in Tibet said that the implementation of Beijing directives on payment for health care, known as the "co-operative medical system" (CMS) in rural areas, had led to increased pressure on MSF, particularly from the mid-1990s onwards. He said: "The authorities in some cases attempted to use us to implement these policies and further constraints were imposed on our work." At least once, MSF was told that permission to implement projects was conditional on their agreement to implement the CMS system, which the authorities stated was their first priority.

MSF had argued for more basic systems to be put in place such as management of essential drugs. The same member of staff also said that policy directives from Beijing were not adapted to the situation in Tibetan areas, and that the lack of a "community approach" had caused difficulties in communication about health care concerns. Incidents of corruption by the local authorities have also been a concern for MSF - requests were made by local officials during the charity's period of operation in Tibet for money to buy vehicles such as Land Cruisers rather than for the provision of health care.

The authorities in Tibet maintain a strict control over the activities of all foreign NGOs and aid projects in Tibetan areas. Tibet has one of the smallest concentrations of NGOs in the world, prompting concerns that the withdrawal of MSF will have an impact on Tibetans who have benefited from their projects.


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