Few Canadians have heavier global responsibility—and a lower proﬁle at home—than Joanne Liu, the international president of Médecins Sans Frontières (Doctors Without Borders). Raised in the Quebec City suburb of Charlesbourg, Liu is the second Canadian to lead the medical humanitarian aid group, and the ﬁrst from any country to serve two consecutive terms. She spoke to Maclean’ssenior writer Paul Wells about the issues that have dominated her tenure: two Ebola outbreaks, huge numbers of migrants crossing international borders and a sustained and deadly 2015 bombing attack on an MSF ﬁeld hospital in Afghanistan by the United States military.
Q: How does one become an international humanitarian physician from Charlesbourg?
A: I remember when I was young, there were three Lius in Charlesbourg and they were my two uncles and my father. There were not many visible minorities. I promised myself that I would leave there as soon as possible.
A: Yes. Because it was so hard back then. Like, ﬁrst day at school, came back, blood. And my mum looked at me, said, “What happened?” And I said, “They told me I had a flat nose.” I think now it’s a completely different dynamic and it’s much more diverse. But I think this was part of the drive to just say, I’m going to move on.
Q: If I understand correctly, it was some news images from Biafra that really got you interested in medicine as a vocation.
A: It was the ﬁrst time we were seeing a crisis live on TV. And I remember very well when I was young, your parents threatened that if you do not ﬁnish your meal, you’re going to end up like those kids in Biafra.
Afterwards, I think the drive increased when I was a teenager. One of the books I read was the book by Camus called The Plague. And I still love that book. One sentence really stuck with me, when the doctor is being asked, What is driving you? You know, people are dying around you, you don’t have anything to give them. You’re not even a Christian. How do you manage? And the doctor answers, I never got used to death.
I just said my promise to myself was I’ll never get used to death. It, for me, was just sort of the promise for life, basically.
Q: How did you get involved in MSF, and why did you want to run the joint?
A: When I was in Canadian Crossroads at 18 years old in West Africa, I just said, oh, that’s it, I’m going to go back and work in developing countries. Every single decision for studying was geared to make sure I would have an exportable job and be able to work in a developing country. And what I ended up doing is pediatrics because there’s so many children in developing countries. But I said, I want to be able to go into war zones. So I ended up doing trauma medicine at NYU in New York.
Q: I heard that your ﬁrst trip after you became MSF president was into Syria. Is that right?
A: I was elected in June 2013, and I started my mandate in the fall—2013 was the crisis in Syria, and I said, I need to go. I practised as a full-time ER doc until October 2013. So I said, I’m going to go as a doctor. I went undercover and worked for two weeks in northeastern Syria. We didn’t tell the staff; it was one part for my security, but the other thing was I just wanted to be able to work and be with people and just hang out with them and be in the ER.
Q: What were the things that you were hoping to do as president?
A: My running campaign slogan was “the patient ﬁrst” back then. We were opening a lot of ofﬁces around the world and I said, Where is the patient we care for in this growth? The second thing was I wanted to make sure that MSF was using everything that the 21st century has to offer in terms of technical medicine. The thing is, Ebola happened and it basically hijacked my ﬁrst 18 months as international president.
Q: What was that like, raising the alarm and the rest of the world not paying much attention?
A: It was a challenge. A lot of people told us back then that we were basically somehow crying wolf. We have to remember the summer of 2014 was the start of the war in Ukraine. There was a lot of attention as well on the Gaza Strip. At one point we just said, we’ve got to go. We’re going to visit the countries, and after that we’re going to go on an advocacy tour.
We went there for a couple of weeks. And it was like a disaster. At one point we realized that we were not enough. We couldn’t do it. And so we took the very, very difﬁcult decision of saying, all the good people we have in our Ebola centre, we’re going to take you away and we’re going to put you in a training place in Brussels. Because if we want to scale up, we’ve got to train people. We ended up training everybody—governmental people, CDC [Centers for Disease Control and Prevention] people, military.
Q: There’s another Ebola outbreak underway, but there is a vaccine developed in Winnipeg that is making a big difference.
A: Right now in [the Democratic Republic of the Congo], we have vaccinated more than 100,000 people. We are doing clinical trials. And despite that, we don’t have the upper hand on the Ebola epidemic in DRC. The Ebola epidemic is a very, very, very humbling thing to tackle.
Q: The next really big crisis that you faced was the U.S. military strike on the MSF hospital in Kunduz, Afghanistan.
A: Everybody knew us—the Taliban side, the governmental side, the U.S. side, everybody. And everybody knew that if you were sick, if you had a broken bone, the place to be cared for was the Kunduz Trauma Centre. Five air strikes on the main building, where we had the emergency, the ICU and the two operating theatres. Forty-two people died, 14 of our colleagues.
Q: This took a considerable amount of time during the night between the ﬁrst attack and the last one, and MSF was trying to contact the U.S. military while this was going on?
A: It lasted for about an hour, but we contacted people in Kabul, in the Pentagon, everywhere, and we said, are you aware that you’re bombing us? And that did not stop. You have to understand that our staff witnessed our patients burn alive in their beds. They tried to operate on our head of the hospital, and he died. So, yeah, tough. Tough moment. We were terribly angry.
Q: Do you believe that was intentional?
A: We asked for an international, independent fact-ﬁnding commission and we didn’t get it. The U.S. did an investigation, which was not independent. And basically, the conclusion was [that it was] a mistake at three levels: personal, technical and centre of operation.
Q: President Obama called you. How did that call go?
A: President Obama gave his sympathy to the families. One of the things is, I actually never thanked the president. What I said is, I acknowledge that you’re giving sympathy to the people who have lost a loved one, the 42 families, and I will relay the message. And the reason why is, I could not thank someone who killed 42 people, bottom line. So that was it. People were really upset about that. I still think it was the right thing to do.
Q: Afterwards, MSF started to say in its public communications, the doctor of your enemy is not your enemy. Is that something that you’d thought you would have to remind people of?
A: No. When this happened, a lot of people said, but wait a minute, weren’t you treating injured Taliban? And I’d say, we’re treating injured people. And it is clear, the international humanitarian law is that a combatant who is injured is a patient, and a patient is a patient.
Q: Your people are a target more and more frequently.
A: I think that we see that there’s a bit of an erosion of some of the basic rules [around medical humanitarian aid]. And it comes with the war on terror.
Q: The third big preoccupation of your time as president of MSF has been the migrant crisis.
A: We’ve been working with migrants and refugees since the beginning of our time. The reality is in 2011 there were 40 million refugees and we never called it a crisis. There’s a couple of new challenges—the fact that we’ve seen the migrant be criminalized for just fleeing where he comes from: war, poverty, economic meltdown. And in the past, people were accepting that [as a] refugee or migrant, you have rights. It’s not because you crossed a border that you’re not entitled to basic rights, which are protection and dignity. Simple. Today we are basically flouting those commitments.
The other thing that we’ve seen as well with this is the criminalization of people who bring solidarity or aid to people; like the French guy who welcomed some migrants into his house. Now he’s in court. A few weeks ago, Italy said we will give a ﬁne for boats that are bringing migrants into our country. It is as if you will give a ﬁne to an ambulance when they bring a patient to a hospital. There’s something that I think we need to take stock of, the fact that we are not living up to the very, very basic, what I call common humanity, that we have.
Q: People who are nervous about cross-border migration say if too many people come, they swamp social services, there are strains on public security—that the country’s ability to absorb newcomers will be compromised.
A: It needs to be safe, regular and orderly. We agree with that. We just want people to be treated with dignity. I think we need to remember the fact that nobody will put their children in a dinghy if they don’t have a good reason. And the reason why people do that, where people are ready to put their life at risk, is because they’re dreaming of a future. There will be no wall tall enough to stop a parent [from that].
Being outspoken about [the migrant crisis] has been really tough because we became unpopular. And in some places, in some countries in Europe, people are demonstrating in front of our ofﬁce, asking for MSF to stop. This had never happened to us.
Q: Another aspect of this global debate over how to handle cross-border migration is the UN’s Global Compact for Migration, this multilateral attempt to essentially remind people of basic humanitarian standards. But it has been severely criticized, including here in Ottawa, as an attack on national sovereignty. How do you see it?
A: It was an imperfect text, and it should have been much stronger on the provision of, basically, the right to access to care when you’re a migrant—universal health care access. So this is why we ﬁnd it funny when, here, we make a big fuss about it. Because of the Canada Health Act, everybody has access to it, including migrants.
Q: Let’s talk about Canada’s role in these conflicts. What would you like to see more of from Canada?
A: I think there are some places, especially with the withdrawal of the U.S. in many multilateral platforms, for Canada to step in. Last year tuberculosis was a topic at the United Nations General Assembly. We wanted the Prime Minister to come because we thought it would have been a very easy topic to champion. This, for me, is a missed opportunity.
Q: What can each of us do as individual Canadians?
A: You know what? You have a great opportunity. We are in election time. So this is the time that you have to make them promise a lot of things. Go for it. Because you’re a constituent of a country. You’re not like a migrant, where you lost everything.
Q: What, concretely, would that entail?
A: We could champion more things in terms of health. And I think, in terms of global health, Canada could play a much stronger role.
Q: You talked about the retreat of the United States from multilateral roles. Do you think that that’s something that will endure beyond the next election cycle?
A: There seems to be a trend. And I think it’s unfortunate, but I think it’s an opportunity. Other countries need to step in because there’s room.
Q: The other countries that seem eager to step in include Russia and China. Is that a problem?
A: I think we need to have diverse voices. And that includes Russia, China and Canada.