Paul left the construction industry for a career change to the voluntary sector in 1993, when he joined a small voluntary relief charity driving trucks in Bosnia. After that he worked in logistics and later in project management in Eastern and Central Europe, West Africa, Central and SE Asia. In 2002 Paul Joined MSF as an experienced programme manager, and worked as Head of Mission in Angola, Congo (Brazzaville), Sudan, Congo (Lubumbashi) and the Middle East.

In 2007 Paul took a break from overseas operations and worked in the UK as a freelance business development advisor close to home in West Sussex. His clients included small and medium-sized charities and social enterprises, and he helped them with governance and management structure, but mostly with fundraising. At this time he also spent four years volunteering on the board of trustees of MSF UK, the last year as chairman, representing the UK association on various MSF international platforms. Paul returned to the field for MSF in April 2011, accompanied by his wife Sarwat, who is a medical doctor with more than 20 years experience in public health in developing countries. He has two daughters, both of whom live and work in London.