Gabriele Eminente

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INTERVIEW WITH Gabriele Eminente 
(General Director of Doctors Without Borders Italyhttp://www.medicisenzafrontiere.it/)

Premise

The global health system should ensure care and treatment with ‘neutrality’ and ‘impartiality’ all over the world; people who need health assistance should get it whether they are poor or rich; increasing the overall levels of health around the world: that should be the end goal of a good and ethically-filled global health system. Too often, however, many people, especially in developing countries, don’t even get the most basic emergency medical services. Why? The lack of facilities, inadequate organizational models, lack of human and financial resources, a system ever more profit-oriented are some (not-exhaustive) of the factors. 'Doctors Without Borders' (MSF in Italian) was born in 1971 in order to respond to this deficiency. Since 1971 it has implemented an ‘enviable’ organizational system; its network stretches over nearly 70 countries worldwide, with about 30 thousand field-workers ready to give their support in the neediest countries. Neutrality, independence and impartiality are the principles that make the model of MSF unique in the health system landscape. So, what are the main features of M FS’ s organizational model? In which countries MSF is concentrating its efforts now?  What are the main obstacles MSF meets when operating in under-developed countries? ‘Ebola:’ was the emergency well-addressed? Gabriele Eminente, General Director of MSF Italy, answered to these and other questions.

Gabriele Eminente: Gabriele Eminente was born in Naples in 1963. He graduated in Economics and Management at the Bocconi University in Milan.  He entered the non-profit sector, after he had worked for over 15 years in the consumer goods and telecommunication sectors. He was the General Director of  Amnesty International Italy (the most important international non-government organization in the field of human rights) in the 2004-2008 period. Gabriele Eminente began working for Medici Senza Frontiere Italia in 2008 as Director of the Human Resources Department; since September 2013 he has served as General Manager in MSF Italy.

Doctors Without Borders: Doctors Without Borders/Médecins Sans Frontières (MSF) is a private, international, independent, medical humanitarian organization made by 23 independent national offices operating under a single statute. Five of these offices, localized in Bruxelles, Paris, Amsterdam, Barcellona and Ginevra, make the operational decisions for MSF; the others are responsible for managing human and finance resources. MSF provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. MSF’s actions are guided by medical ethics and the principles of independence, neutrality and impartiality. MSF was founded in Paris in 1971; now it’s the most important medical humanitarian organization. In 1999, MSF got the Nobel Peace Prize. It now operates in 67 countries with about 30 thousand professionals providing assistance to people in crisis around the world.

Doctors Without Borders Italy: The story of MSF in Italy start in 1992 when the local movement strongly denounced the problems of famine in Somalia where one out of ten of the population died. MSF Italian office was legally formed in 1993 and became stronger in 1994, when it faced the emergency in Ruanda. In 1998 MSF became an Onlus (non-profit social organization); in 1998 MSF Italy got legal status by the Ministry of Health and  in 2002 became a Non-Governmental Organization (NGO), legally recognized by the Ministry of Foreign Affairs.


INTERVIEW - (December 2014)
The interview was made in December 2014 and published in March 2015 - The original interview was in Italian
Subject
: MSF organizational model; MSF peronnel recruitment; MSF's Strategies, policies and plans; scenery on humanitarian assistance; obstacles to operating in poor countries


 
 

Highlights 

  • MSF International has  5 operational centres (which decide where and how to operate) e 14 national offices (which are in charge of fund raising, personnel management, public relations inside the national boundaries),

  • The personnel selection in MSF is very careful and involves three phases: 1) spontaneous applications by the candidates; 2) validation of suitable candidates; 3) attribution of candidates to the various missions.

  • Money is not the main driver for people who want to join us. People are driven by other, deeper motivations: concern for people’s health, willingness to help needy people, the search for new challenges, the desire to gain international experience.

  • We are meeting rising problems in ‘conflict areas.’ Traditionally, we have been considered as an independent organization. That is not true any longer! Many groups in conflict now attack us, threaten the effectiveness of our interventions, the lives of our patients and that of our field-workers.

  • The emergency of Ebola was badly managed  especially in the first phase, when the international authorities didn’t recognize the existence of an actual epidemic risk. For several months MSF and other humanitarian organizations have addressed the emergency without the international support.

  • It’s not good news to say, but what I think is that there will be a growing need for MSF in future.

 
 

Question 1: Good Morning Gabriele; You’re the General Director of ‘Doctors Without Borders’ in Italy (MSF Italy). Could you explain us what’s MSF, what are its principles and how does it operate?

Answer

Yes, ‘Doctors Without Borders’ is an international humanitarian organization which delivers emergency health care in needy countries; its mission is based on three principles:

1) Neutrality: MSF is neutral because it does not take any particular sides or intervene according to the demands of governments or warring parties;

2) Impartiality: MSF is impartial because it offers assistance to people based on need and irrespective of race, religion, gender or political affiliation;

3) Independence: MSF is independent because most of its financing resources come from private donors and are well diversified: we depend neither on public resources, nor on few particular donors.

How is MSF structured and how does it operate?

MSF’s organization model is very peculiar: we don’t have a ‘Parent Company’ as in other international organizations; but we have two kinds of offices:

1) 5 operational centres, in France, Belgium, Spain, Switzerland and the Netherlands;

2) 14 national offices (soon to become 16).

The 5 operational centres (the first five offices to be founded in the 70s) are responsible for making operational decisions; in poor words, these are the structures which decides, by mutual agreement, which missions to undertake. The 14 national offices, instead, have very specific responsibilities within their own country, with regard to fund raising policies, communication strategies, relationship with the institutions and the management of human capital (these are the offices where professionals are recruited and managed).  MSF Italy is one of these 14 offices.

 

Question 2: What’s the role of MSF Italy in this international network?

Answer

As I said before, MSF Italy is one of the 14 national offices of MSF International: fund raising, relationships with local institutions and the recruitment and handling of human resources are our main activities. In 2014 MSF Italy collected 48-50 million euros: 20% will finance no-core activities (i.e., the management of personnel, communication campaigns, administrative activities and so on…); the remaining 80% will finance core-activities, that is, activities on the field.

MSF Italy’s headquarter is in Rome (there’s another supporting office in Milan), where  60 people work as employees. Then there are field-workers, with fixed-term contracts, lasting from 1-2 months to two years, depending on the missions. These professionals can do one or more missions in various countries often characterized by completely different conditions.

 

Question 3: ‘The human capital’ plays an extremely important role in MSF. How does MSF’s recruitment process work? What specific qualities and skills should a candidate meet? How much is the average salary of MSF’s workers?

Answer

The personnel selection in MSF is a very careful process and involves three phases:

1) spontaneous applications by the candidates;

2) validation of suitable candidates;

3) attribution of candidates to the various missions.

In the first phase (spontaneous applications by the candidates) we select the CVs sent spontaneously by healthcare professionals. In the second phase (validation of suitable candidates), the candidates undertakes an assessment group and an individual interview (both made in the Headquarter in Rome); The candidates are assessed based on their technical skills, potentials and motivations. In general, 10% of the curriculums pass the first screening and, among these, only 7-8 candidates are then judge suitable as field-workers. Since then they are inserted  in our Database and called for the missions they can best suit.

What’s the salary level in MSF Italy?

One thousand euros per month! That is the basic salary offered to field workers in the first mission with MSF. Someone could consider such a level too low for professionals who operate in the field of health in problematic and often dangerous countries. Yes, it’s true, but we have to consider that MSF is a humanitarian organizations based on the spirit of volunteerism; so salaries for both administrative workers and field workers are lower than those offered in comparable roles in private companies. ‘Money’ is not the first and only driver for people who want to join us in our ‘battles!’ People are driven by other, deeper motivations: concern for people’s health and survival, willingness to help needy people, the search for new challenges, the desire to gain international experience.

 

Question 4: How many people work for MSF Italy? Is the number of field-workers growing? In which countries is MSF increasing its presence?

Answer

Well, there are about 60 employees in the Headquarter of Rome (a small number, compared to similar organizations with a similar budget). and 360 field-workers. The latter is a high-turnover category: each year 10% of our field-staff need to be replaced. To be sure, currently, there are 400 people who are considered suitable for missions (this year 360 of them have embarked on a mission). What’s the trend? Unfortunately, the number of emergencies in the world is increasing and so is the number of field workers.

In which countries MSF is increasing its presence?

Currently, Doctors Without Borders operates in 67 countries; some of these absorb a significant portion of MSF Italy’s financial and human resources. Which are these countries?

1) 2014 Ebola emergency: With regard to 2014, many resources have been used to address the emergency of Ebola: Liberia, Sierra Leone and Guinea;

2) Traditional presence: more in general, there are other countries where MSF has a more stable presence: Democratic Republic of the Congo, Pakistan, Afghanistan, Haiti, South Sudan, the Central African Republic;

3) Conflict countries: many of MSF’s field workers operate in countries affected by stable conflicts, countries where often the intensity of the conflict and its consequences have increased in the latest years; in particular, I’m talking about Syria and neighboring countries (Lebanon and Jordan), and Ukraine;

4) Occasional emergencies: think of the Typhoon Haiyan which hit the Philippines last year.

5) Emergencies in Italy: finally, some of our field-workers have been operating in Italy for more than 2 decades; this is to handle health emergencies due to migratory flows.

 

Question 5: In the latest years MSF has carried out missions in various countries: in Libya (civil war) and in Somalia (nourishing emergency) in 2011; in Haiti (earthquake), in Pakistan (flooding) and in Niger (nourishing crisis) in 2010; in 2009 MSF come back to Afghanistan. What are the main obstacles facing MSF when operating in these countries?

Answer

By definition we work in problematic contexts. But what I want to stress more now are the rising problems we are facing when operating in ‘conflict areas.’ Traditionally, we have been considered as an independent organization by the groups in conflict (so we have never been attacked). That is not true any longer! Many groups in conflict now see us as an organization with vested interests; they attack us! They  threaten the effectiveness of our interventions, the lives of our patients and that of our field-workers. That is what has happened in countries like Syria and Iraq, as well as the Central Republic of Africa and South Sudan, where our facilities have suffered looting and robbery.

Then, there are problems that are specific to the single mission; let’s take the emergency of ‘Ebola:’ the risk of infection, especially outside the structures (where doctors do not wear the proper anti-infection covers), is higher and more dangerous than for other diseases. Finally, there are other obstacles which differ from country to country (i.g., lack of infrastructure, lack of logistics and so on) and often depend on the event that has generated the emergency.

 

Question 6: You have just mentioned the case of Ebola. Have mistakes been made by international institutions in addressing this emergency?

Answer

Yes, mistakes were made…They were especially made in the first phase of the emergency, when the epidemic broke out in April 2014 and international authorities didn’t recognize the existence of an actual epidemic risk. For several months MSF and other similar humanitarian organizations have addressed the emergency without the international support. We had to wait four months (till September) for an effective international mobilization and the intervention of foreign countries and international organization to address the spreading of the epidemic.

 

Question 7: Is MSF activity set to grow in the future?

It’s not good news to say, but what I think is that there will be a growing need for MSF in future. Why? There are more than one reason:

1) the traditional areas of intervention will not decrease; I’m talking about countries hit by conflicts and epidemics, as well as countries which lack the structures to deliver effective programs of health assistance and vaccination.

2) At the same time, there are new emerging needs; let’s think about the effects of Climate Change in terms of natural catastrophes (e.g., destructive typhoons, flooding etc….). These are ever more frequent with a growing demand for emergency-health assistance.

3) there is a growing number of ever larger urban conglomerates; there are now dozens of megacities in the world that host more than 10 million people; many of them are places which suffer extreme poverty (Dhaka, Kinshasa, Lagos and many Indian megacities), where phenomena of violence and the rapid spread of diseases are by now a common feature. These are areas with a growing demand for health assistance.

In conclusion, more and more people around the world are going to need health assistance over the next few years, and Doctors Without Borders will do its best to respond to this challenge.

 

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