On certain days I ask myself if we were right to get involved in Bunia in the first place. There are hundreds of NGOs here, many of whom are now thinking of leaving. Since 2003 this temporary community has built hospitals, reunited families, dug wells, and completely overturned the economy. People have given up farming, or their original trade, to work for much higher wages as drivers or store-keepers for the NGOs. Now the war is over, and the honeymoon period is coming to an end – and as the population take stock of the situation, they understandably start to question the ethics of NGO intervention.
This is not to say that the population disapprove of the NGOs. The majority remain hugely appreciative of the work of MSF, but there is a perception that we have undertaken these dramatic interventions without ever considering the long term effects of our actions. A Congolese colleague from another organisation said to me “You (MSF) have broken a health system that functioned adequately before hand, and now that you are leaving, the population will be left worse-off than they were before”. To some extent this reflects a very human tendency to forget what things were like beforehand – the fear of an unknown future causes us to romanticise the past. But whether or not there is any truth in his observation, the fear of being left without healthcare is widespread amongst the community. It is essential that we acknowledge and address this fear, because the transfer we are trying to achieve is not just a transfer of medical activity, but also a transfer of the community’s confidence to a new health structure.
I guess I do believe short-term humanitarian interventions can have some lasting benefit, as long as we accept the responsibility of assessing their potential impacts from the start, so that we can try to maximise the positives and minimise the negatives. But in such unstable situations the future is very hard to predict– the original Bon Marché project was expected to last 3 months, and here we are 7 years later. Could they have envisaged that this intervention would reveal a huge unexpressed demand for paediatric care, ultimately requiring a doubling of the capacity of the hospital’s paediatric service? We start these interventions on the basis of imperfect information, and then have to constantly reshape our goals according to the findings that emerge. If at least we do this with transparency, in genuine collaboration with the community and partners – with an awareness of those unmet needs and unexpressed fears – we stand a chance of building something that the community will wish to maintain.