1 00:00:00,160 --> 00:00:04,720 Are we going to see higher rates of global malnutrition, higher 2 00:00:04,720 --> 00:00:09,840 rates of global outbreaks and epidemics, including greater 3 00:00:09,840 --> 00:00:14,080 malaria deaths, greater tuberculosis deaths, greater HIV 4 00:00:14,080 --> 00:00:17,440 deaths? Yes, yes, yes, yes, and yes we 5 00:00:17,440 --> 00:00:18,960 are. Full stop. 6 00:00:25,250 --> 00:00:28,170 Hello and welcome. I am Chigo Ahanania and I am 7 00:00:28,170 --> 00:00:32,400 stepping in to host this episode of Humanitarian Lens, a podcast 8 00:00:32,400 --> 00:00:35,040 of Doctors Without Borders USA TODAY. 9 00:00:35,040 --> 00:00:38,160 We are focusing on a critical issue that has a detrimental 10 00:00:38,160 --> 00:00:41,200 effect on the communities where we work, our patients, and our 11 00:00:41,200 --> 00:00:43,760 staff. Funding cuts for humanitarian 12 00:00:43,760 --> 00:00:47,920 aid and global health programs. It's been one year since the US 13 00:00:47,920 --> 00:00:51,160 government effectively gutted its international assistance 14 00:00:51,160 --> 00:00:53,880 programs, and the impact has been immense. 15 00:00:54,320 --> 00:00:57,320 The massive funding cuts and policy changes are reshaping 16 00:00:57,320 --> 00:01:00,360 international aid. Many local and international 17 00:01:00,360 --> 00:01:03,760 organizations have been forced to scale back or halt activities 18 00:01:03,880 --> 00:01:07,600 altogether, and communities are seeing fewer services. 19 00:01:07,920 --> 00:01:11,920 With me today is Doctor Javed Abdel Munim, an emergency 20 00:01:11,920 --> 00:01:14,840 physician and our MSF International president. 21 00:01:15,200 --> 00:01:17,320 Thanks for being with us. Thanks for having me to go. 22 00:01:17,920 --> 00:01:20,360 So let's dive right into it, why don't we? 23 00:01:20,640 --> 00:01:24,760 So Javed, these cuts were swift and create a lot of confusion 24 00:01:24,760 --> 00:01:27,920 with organizations that receive funding from the US government. 25 00:01:28,440 --> 00:01:31,520 You witnessed this first hand in Sudan where you are on 26 00:01:31,520 --> 00:01:35,400 assignment a year ago. Take me through the moment when 27 00:01:35,520 --> 00:01:39,720 you found out about these cuts and what was it like in our 28 00:01:39,720 --> 00:01:42,840 projects in Sudan. Yes, I was working in Khartoum 29 00:01:42,840 --> 00:01:46,200 as the medical team leader in on demand project and we had 30 00:01:46,840 --> 00:01:49,800 several sites and hospitals and we were doing emergency work in 31 00:01:49,800 --> 00:01:52,640 the communities around cholera and vaccinations. 32 00:01:53,800 --> 00:01:57,520 And the cuts were announced. And I, all of us were like, OK, 33 00:01:57,520 --> 00:02:00,160 some cuts have been announced. You know, you don't imagine 34 00:02:00,160 --> 00:02:06,680 it'll have an immediate effect. But within days, different 35 00:02:06,680 --> 00:02:11,960 organizations were coming to the office and asking for support 36 00:02:12,320 --> 00:02:16,200 because they'd, their funding had been stopped. 37 00:02:16,720 --> 00:02:19,600 And it was really surprising that it happened so quickly. 38 00:02:20,040 --> 00:02:25,120 And so the examples, I mean that I remember 1 was an aid kitchen, 39 00:02:25,120 --> 00:02:27,880 one of the famous Sudan aid kitchens. 40 00:02:27,880 --> 00:02:30,720 People should have heard of them because they've been nominated 41 00:02:30,720 --> 00:02:33,840 for Nobel Peace Prize and they're part of the emergency 42 00:02:33,840 --> 00:02:38,400 response rooms, the errs, which are civil society organizations, 43 00:02:39,280 --> 00:02:43,640 and the aid kitchens doing the meals in the hospital. 44 00:02:43,760 --> 00:02:47,200 One of the three hospitals where we worked had lost their funding 45 00:02:47,200 --> 00:02:51,880 and came in to ask for help. Another organization running a 46 00:02:51,880 --> 00:02:54,520 primary healthcare center. And you might think, well, 47 00:02:54,520 --> 00:02:57,360 that's not a big deal, but actually there were only about 6 48 00:02:57,360 --> 00:03:01,280 primary healthcare centers working at that time across the 49 00:03:01,280 --> 00:03:03,560 whole city. And this is a capital city of a 50 00:03:03,560 --> 00:03:05,840 country. And more population were coming 51 00:03:05,840 --> 00:03:07,920 back as the front lines were moving away. 52 00:03:08,800 --> 00:03:14,080 So the loss of one primary healthcare center, it was a big 53 00:03:14,080 --> 00:03:17,240 deal. And another organization came 54 00:03:17,520 --> 00:03:21,800 also saying we've lost our funding for the community 55 00:03:21,800 --> 00:03:25,120 midwives, which they had been running about 45 community 56 00:03:25,120 --> 00:03:27,280 midwives. What was really interesting 57 00:03:27,280 --> 00:03:32,840 about that project is those community workers had a chance 58 00:03:32,840 --> 00:03:38,920 to go across front lines. And so access at the time across 59 00:03:38,920 --> 00:03:41,840 front lines which ran through the city and across the river 60 00:03:42,120 --> 00:03:45,640 for the populations who were trying to come to our health 61 00:03:45,640 --> 00:03:48,880 services or have health services reach them, it was really 62 00:03:48,880 --> 00:03:51,440 crucial that this particular organization carried on. 63 00:03:51,800 --> 00:03:55,720 So, you know, that was just three examples that I can 64 00:03:55,720 --> 00:03:58,320 remember. And it felt really chaotic 65 00:03:58,320 --> 00:04:03,800 actually, because we had, you know, people are now thinking, 66 00:04:03,800 --> 00:04:05,680 well, were you able to support them, right. 67 00:04:06,200 --> 00:04:09,720 And I, I could and I couldn't because as in, in MSF, the way 68 00:04:09,720 --> 00:04:11,640 we work, right? Firstly, we're not, we're not 69 00:04:11,640 --> 00:04:14,920 affected by the cuts, right? We don't take government money. 70 00:04:15,640 --> 00:04:17,839 So you might think, well, it doesn't matter then. 71 00:04:18,399 --> 00:04:21,640 But you know, when you work in a health ecosystem, say here we 72 00:04:21,640 --> 00:04:25,720 were doing secondary care, maternity in a hospital, doing, 73 00:04:25,960 --> 00:04:29,280 you know, maternal health care in a hospital, doing pediatric 74 00:04:29,280 --> 00:04:33,000 nutrition care and doing emergency room in a, in a, in a 75 00:04:33,000 --> 00:04:36,400 trauma hospital. But other actors are around you 76 00:04:36,400 --> 00:04:38,640 doing all the other parts of healthcare. 77 00:04:39,120 --> 00:04:42,560 And, and, and when we at the end of the year, or you know, 78 00:04:42,640 --> 00:04:46,960 through October, November, December would have gone through 79 00:04:47,080 --> 00:04:51,080 our needs assessments and our project planning in the annual 80 00:04:51,080 --> 00:04:53,960 budget cycle. And part of your need assessment 81 00:04:54,320 --> 00:04:58,440 is to ask yourself who is doing what, where and when. 82 00:04:59,040 --> 00:05:02,560 And that tells you what needs are being met. 83 00:05:03,720 --> 00:05:06,920 And then you say, well, OK, well, we won't duplicate. 84 00:05:06,920 --> 00:05:09,480 We'll do this and we'll do that and we'll extend that or we'll 85 00:05:09,480 --> 00:05:12,000 go there. And we'd done that already and 86 00:05:12,000 --> 00:05:14,440 set ourselves up for the year. And we're just, I was already 87 00:05:14,440 --> 00:05:16,760 recruiting. I had open recruitments to go 88 00:05:16,760 --> 00:05:21,720 more into malnutrition, you know, so you're starting to 89 00:05:21,720 --> 00:05:28,520 execute your project annual plan and suddenly the whole needs 90 00:05:28,520 --> 00:05:31,680 assessment changes because the who's doing what, where and when 91 00:05:32,080 --> 00:05:35,480 was gone was completely different overnight. 92 00:05:35,840 --> 00:05:39,840 So it was really disruptive from from our perspective, but really 93 00:05:39,840 --> 00:05:47,160 also a sense of shock. And and you know, in MSF, you're 94 00:05:47,160 --> 00:05:50,200 used to being able to respond. You're used to being able to do 95 00:05:50,200 --> 00:05:52,960 the most you can. And yes, we did what we could, 96 00:05:53,400 --> 00:05:58,640 but to do a full blown programmatic shift, handbrake 97 00:05:58,640 --> 00:06:02,000 turn almost is even. We can't do that and we can't 98 00:06:02,000 --> 00:06:04,640 fill all the gaps. So for example with the aid 99 00:06:04,640 --> 00:06:07,320 kitchen, I can give you some money. 100 00:06:07,840 --> 00:06:11,840 Would that be helpful for the community midwife program? 101 00:06:12,120 --> 00:06:15,080 OK, let's see what we can do. What are the bridging measures? 102 00:06:15,080 --> 00:06:19,040 Who else could we call in? And even worse then Chigo was 103 00:06:19,040 --> 00:06:21,880 that it very quickly became apparent that this was happening 104 00:06:22,200 --> 00:06:28,120 across the country, right? So my staff members was saying, 105 00:06:28,120 --> 00:06:30,240 well, we're hearing this is happening in Madani and this is 106 00:06:30,240 --> 00:06:31,880 happening in Gadarif and in Port Sudan. 107 00:06:32,240 --> 00:06:35,120 And suddenly our advocacy manager within the program 108 00:06:35,120 --> 00:06:38,920 within the country was like calling and saying, I'm getting 109 00:06:38,920 --> 00:06:41,760 these reports and your counterpart has said this. 110 00:06:42,160 --> 00:06:45,360 So then we were a bit like, Oh my God, this is huge. 111 00:06:45,640 --> 00:06:49,680 And we needed to, at a minimum, just start documenting and 112 00:06:49,680 --> 00:06:55,000 create a, a database of what's fallen away, what's now what we 113 00:06:55,000 --> 00:06:59,840 call an unmet need, what service has gone suddenly, what could we 114 00:07:00,320 --> 00:07:04,000 react to and how and when? So it was quite dramatic. 115 00:07:04,840 --> 00:07:06,560 Yeah, I can. I can only imagine. 116 00:07:06,560 --> 00:07:09,240 And especially when you talk about how we usually have a 117 00:07:09,240 --> 00:07:12,560 plan, we make a needs assessment and this happened in January, 118 00:07:12,560 --> 00:07:14,680 just January last year. So you're just about to get 119 00:07:14,680 --> 00:07:18,160 started with your plan and boom, next thing you know you have to 120 00:07:18,600 --> 00:07:21,400 rewire re change like reassign people so. 121 00:07:21,720 --> 00:07:24,560 Can you fill the gap? Yeah, we just can't. 122 00:07:24,560 --> 00:07:26,320 Even if we wanted to. It was too big. 123 00:07:26,480 --> 00:07:28,480 That's interesting. And I want to go back because 124 00:07:28,480 --> 00:07:31,880 earlier you were saying, as we all know, MSF does not receive 125 00:07:32,000 --> 00:07:34,800 U.S. government funding. But even though it doesn't 126 00:07:34,800 --> 00:07:38,080 affect us directly, all these players, all these things that 127 00:07:38,080 --> 00:07:40,080 happen, they kind of fall down downstream. 128 00:07:40,320 --> 00:07:44,480 So my question for you is what are the concerns that you're 129 00:07:44,480 --> 00:07:46,040 hearing from our staff around the world? 130 00:07:46,040 --> 00:07:49,040 Because I'm sure this is affecting our staff in many 131 00:07:49,040 --> 00:07:52,160 different ways, which I would, I probably can't even imagine, but 132 00:07:52,160 --> 00:07:55,120 what would you say are the main concerns of our staff? 133 00:07:55,320 --> 00:07:59,200 We've been trying to do a mapping now across everywhere 134 00:07:59,200 --> 00:08:02,960 that we work to really understand if there's a country 135 00:08:03,320 --> 00:08:07,640 that has had its funding most cut or a theme that has been 136 00:08:07,640 --> 00:08:11,800 most cut. By theme, I mean, for example, 137 00:08:12,120 --> 00:08:16,400 vaccination or sexual and reproductive health or, or, or. 138 00:08:17,000 --> 00:08:20,080 And what we've found is that there are, yeah, there are 139 00:08:20,080 --> 00:08:24,200 certain thematics that are really exposed now by these cuts 140 00:08:24,200 --> 00:08:27,440 and that's partly because of the way they were funded. 141 00:08:28,520 --> 00:08:34,200 So I can give examples. So if you look at vaccination, 142 00:08:34,840 --> 00:08:39,559 you know, so we even in, even in, in Khartoum, right? 143 00:08:39,640 --> 00:08:43,679 And my project was doing was supporting vaccination programs 144 00:08:43,679 --> 00:08:46,840 with the Ministry of Health. We were doing whole segments of 145 00:08:46,840 --> 00:08:48,720 the state. Because you also have to 146 00:08:48,720 --> 00:08:52,400 remember, in many parts of the world, we're coming off the back 147 00:08:52,400 --> 00:08:57,160 of COVID where for a year, nearly two routine immunizations 148 00:08:57,160 --> 00:09:00,080 were not being done. And then you also have outbreaks 149 00:09:00,520 --> 00:09:05,000 and now you add a layer of war as in Sudan and you've got four 150 00:09:05,000 --> 00:09:08,680 or five years there of broken. And there are children who have 151 00:09:08,680 --> 00:09:11,160 0 vaccines who are five years old. 152 00:09:11,160 --> 00:09:14,280 And by 5 years old you've had multiple vaccinations normally. 153 00:09:14,720 --> 00:09:17,160 So what we were trying to do with the Ministry of Health 154 00:09:18,440 --> 00:09:22,440 with, with, with a, with a frontline a few kilometers away 155 00:09:22,440 --> 00:09:25,120 on three sides in the city. So you're, you know, you're 156 00:09:25,120 --> 00:09:31,040 under the shells was, was trying to do what's called a periodic 157 00:09:31,160 --> 00:09:36,160 intensification of routine immunization, A Piri, right? 158 00:09:36,160 --> 00:09:39,080 And that's really specific. And I want to get this across 159 00:09:39,600 --> 00:09:45,480 because when you do a Piri that that labeling activates a 160 00:09:45,480 --> 00:09:48,360 funding mechanism globally. That means the Ministry of 161 00:09:48,360 --> 00:09:52,760 Health can draw down vaccines. So when we're there partnering, 162 00:09:53,000 --> 00:09:55,800 we'll provide the staff, we'll provide the training, we'll deal 163 00:09:55,800 --> 00:09:59,720 with the needles, we'll provide the vehicles, we'll we'll pay 164 00:09:59,720 --> 00:10:02,160 the staff. Yeah, we did it all. 165 00:10:02,680 --> 00:10:04,120 But you have to get the vaccines. 166 00:10:04,120 --> 00:10:07,600 You're the Ministry of Health. So how can we do that 167 00:10:07,600 --> 00:10:10,280 vaccination program when the vaccines have gone, when the 168 00:10:10,280 --> 00:10:16,360 funding is gone, even we can't fix that, you see, And that's 169 00:10:16,360 --> 00:10:18,640 the issue now. So that's one thing that's gone 170 00:10:18,640 --> 00:10:21,200 away or going or at risk in many places. 171 00:10:21,200 --> 00:10:25,600 Another thing we've seen is nutrition, ready to use 172 00:10:25,600 --> 00:10:28,560 therapeutic food, plumpy nuts. Have you heard of those, those 173 00:10:28,600 --> 00:10:30,960 little sachets of peanut based food? 174 00:10:31,200 --> 00:10:36,120 That's a medicine that's a very complicated, very specific 175 00:10:36,120 --> 00:10:39,680 pharmaceutical medicine. That medicine, it's expensive 176 00:10:40,320 --> 00:10:45,320 and we as MSF have traditionally relied on the United Nations 177 00:10:45,320 --> 00:10:49,800 Agency for children because it's predominantly children that get 178 00:10:49,800 --> 00:10:53,640 severe acute malnutrition who need that medical food. 179 00:10:55,120 --> 00:10:58,840 UNICEF, they have been providing us because it's their job 180 00:10:59,160 --> 00:11:04,000 historically with large amounts of plumpy nuts, but now we have 181 00:11:04,000 --> 00:11:08,360 to start buying that because their funding has been cut by 182 00:11:08,360 --> 00:11:12,640 about 40%. So we're now having to spend 183 00:11:12,640 --> 00:11:15,560 more just to do what we were doing before. 184 00:11:16,560 --> 00:11:20,520 Now add in that the World Food Program, the United Nations 185 00:11:20,520 --> 00:11:23,720 agency for food, has lost how much? 186 00:11:23,800 --> 00:11:26,320 But when the World Food Programme goes away and food 187 00:11:26,320 --> 00:11:30,360 isn't being distributed in places of war, then malnutrition 188 00:11:30,360 --> 00:11:31,600 goes up. And then you have to do more 189 00:11:31,600 --> 00:11:35,440 malnutrition care, which is with the medical grade therapeutic 190 00:11:35,440 --> 00:11:37,480 food that I've just been talking about, Right? 191 00:11:37,800 --> 00:11:40,080 So there are therapeutic foods and there's food. 192 00:11:40,400 --> 00:11:44,440 So now food's gone away, so there's more malnutrition and 193 00:11:44,440 --> 00:11:47,000 therapeutic food. We're having to do more 194 00:11:47,000 --> 00:11:51,800 malnutrition care and pay for the medical grade therapeutic 195 00:11:51,800 --> 00:11:54,560 drug, which is the plumpy nut that we don't have to before. 196 00:11:54,920 --> 00:12:00,120 So yeah, we're not affected by the cuts, but where we work, the 197 00:12:00,240 --> 00:12:02,720 health ecosystem is affected by the cuts. 198 00:12:03,160 --> 00:12:05,040 So for us, that's another big one. 199 00:12:05,040 --> 00:12:07,480 And I think that's such an interesting point that you bring 200 00:12:07,480 --> 00:12:08,640 up. You've given us so many 201 00:12:08,640 --> 00:12:12,680 examples, like when we hear that MSF doesn't get government 202 00:12:12,680 --> 00:12:16,440 funding, where we always think, oh, it doesn't affect MSF, but 203 00:12:16,440 --> 00:12:19,040 inadvertently it does affect us because it affects the 204 00:12:19,040 --> 00:12:21,280 communities and the patients we work with. 205 00:12:21,280 --> 00:12:24,600 So somehow it does come back to affect us because now we have to 206 00:12:24,600 --> 00:12:26,920 do reassessment and see where we can support. 207 00:12:26,920 --> 00:12:29,400 Absolutely, absolutely. It just means all the needs 208 00:12:29,400 --> 00:12:33,320 around us have changed. And, and, and, you know, 209 00:12:33,600 --> 00:12:36,360 personally, at least from my vantage point now and my new 210 00:12:36,360 --> 00:12:41,160 role, you know, when when I look at this dossier and we've called 211 00:12:41,160 --> 00:12:44,440 it internally the changing humanitarian landscape, which is 212 00:12:44,440 --> 00:12:49,520 a relatively benign phrasing, I find, because it's changing, all 213 00:12:49,520 --> 00:12:50,920 right. But it feels a lot more 214 00:12:50,920 --> 00:12:54,680 existential than that. You know, it, it feels like an 215 00:12:55,000 --> 00:13:00,640 like a major sea change, you know, and, and, and especially 216 00:13:00,640 --> 00:13:03,480 it's colored by my experience of having been in Sudan a year ago 217 00:13:03,720 --> 00:13:07,560 when it happened. But it's a health ecosystem, 218 00:13:07,560 --> 00:13:09,800 right? So in every, in every health 219 00:13:09,800 --> 00:13:11,960 system, you need the people who are going to do Primary Health 220 00:13:11,960 --> 00:13:14,160 care, the people who are going to do secondary, the people who 221 00:13:14,160 --> 00:13:17,320 do vaccinations, the people who do public health, the people who 222 00:13:17,360 --> 00:13:21,840 do under public health, water and sanitation versus, you know, 223 00:13:22,360 --> 00:13:25,840 surveillance versus outbreak investigation. 224 00:13:25,840 --> 00:13:29,120 You know, there are so many different things in a health 225 00:13:29,160 --> 00:13:33,440 ecosystem and we we're one organization. 226 00:13:33,640 --> 00:13:38,040 We've never done all of those things in anyone system, right? 227 00:13:38,280 --> 00:13:41,480 We can do all of those things in any number of systems, but we 228 00:13:41,480 --> 00:13:44,040 can't do all of those things in anyone system. 229 00:13:44,240 --> 00:13:48,800 We can't be the totality of emergency health services 230 00:13:48,800 --> 00:13:51,720 anywhere. We're big, but you know, we 231 00:13:51,720 --> 00:13:55,680 don't, we can't do everything and we cannot fill the gap where 232 00:13:55,680 --> 00:14:00,400 governments have have sort of absorb their responsibility. 233 00:14:00,400 --> 00:14:03,600 And it's not just the US, it's the UK, it's Germany, it's 234 00:14:03,600 --> 00:14:05,120 Sweden, it's Belgium, it's France. 235 00:14:05,360 --> 00:14:09,560 They've all cut their overseas development assistance in this 236 00:14:09,560 --> 00:14:11,480 last year. Yeah, yeah. 237 00:14:12,480 --> 00:14:14,360 And I want to go back to something you said earlier, 238 00:14:14,360 --> 00:14:17,040 because we've been talking about the US funding cuts. 239 00:14:17,680 --> 00:14:20,600 Other countries who've been traditional donors have changed 240 00:14:20,600 --> 00:14:23,640 their policy to shrink resources available to respond to 241 00:14:23,640 --> 00:14:25,760 humanitarian and global health needs, right. 242 00:14:26,080 --> 00:14:29,840 So global health institutions such as Global Fund fight 243 00:14:29,840 --> 00:14:34,640 tuberculosis, malaria and HIV. The GAVI the The Vaccine 244 00:14:34,640 --> 00:14:37,320 Alliance have seen donors decrease their funding pledges. 245 00:14:37,800 --> 00:14:40,560 How does this impact the communities where we work? 246 00:14:40,560 --> 00:14:46,280 Oh, HIV, tuberculosis, malaria, SO3, big infectious diseases, 247 00:14:46,280 --> 00:14:48,760 you know, by far and away sort of the biggest killers when you 248 00:14:48,760 --> 00:14:51,920 put them all together, very preventable diseases. 249 00:14:51,920 --> 00:14:56,320 The Global Fund for Tuberculosis, HIV and Malaria, 250 00:14:56,560 --> 00:15:00,200 that's another fund that's seen huge shortages in the sort of 251 00:15:00,440 --> 00:15:04,560 cycle of funding in this year. And so they're operating in a 252 00:15:04,560 --> 00:15:10,520 deficit that means they again, even if we have been there, we 253 00:15:10,520 --> 00:15:14,000 as MSF tended OK, malaria slightly different because it's 254 00:15:14,000 --> 00:15:16,560 just so wide scale. We'll do nearly everything in 255 00:15:16,560 --> 00:15:20,680 HIV we've tended to go for sort of the most vulnerable of them 256 00:15:20,680 --> 00:15:25,000 vulnerable. So drug resistant HIV or 257 00:15:25,080 --> 00:15:31,800 pediatric children's HIV or HIV, TB, tuberculosis, Co infection, 258 00:15:32,080 --> 00:15:35,760 the difficult diseases to treat often in very marginalized and 259 00:15:35,760 --> 00:15:38,720 overlooked and vulnerable communities amongst all the 260 00:15:38,720 --> 00:15:40,800 vulnerable, right. So that's MSF. 261 00:15:40,800 --> 00:15:43,200 We're quite good at sort of going for the the most 262 00:15:43,200 --> 00:15:46,000 vulnerable of the vulnerable. So whilst we've been doing that, 263 00:15:46,000 --> 00:15:50,320 many actors have been doing more, more ordinary, more normal 264 00:15:50,320 --> 00:15:53,360 HIV treatment or more straightforward tuberculosis 265 00:15:53,360 --> 00:15:56,280 treatment. Now when all of those go away, 266 00:15:57,040 --> 00:15:58,520 again, it's a big world out there. 267 00:15:58,760 --> 00:16:01,680 We can't fill that gap. And I and I sat down with the, 268 00:16:02,280 --> 00:16:07,200 with the CEO of Garvi actually to try and, you know, try and 269 00:16:07,200 --> 00:16:12,080 really understand when they are facing such a funding shortfall, 270 00:16:13,040 --> 00:16:16,200 what choices are you going to make and who are you going to 271 00:16:17,280 --> 00:16:20,680 cut out of your portfolio? Because that should inform us, 272 00:16:20,840 --> 00:16:23,760 right? Because and, and the reason I 273 00:16:23,760 --> 00:16:26,920 needed to ask that very specific question and it comes down to 274 00:16:26,920 --> 00:16:29,040 technicalities, but it's real life, right? 275 00:16:29,440 --> 00:16:34,360 The technicality is that countries are layered into the 276 00:16:34,360 --> 00:16:37,680 income of that country. So you may have heard of low and 277 00:16:37,680 --> 00:16:40,320 middle income countries, right? And high income countries. 278 00:16:40,720 --> 00:16:46,960 So these funds normally tier price, so it changes the price 279 00:16:46,960 --> 00:16:51,520 of a vaccine or of a drug and how much you're allowed to get 280 00:16:52,120 --> 00:16:54,920 depending on whether you're a low or a middle income country 281 00:16:55,680 --> 00:17:00,560 or if you're stable or unstable or conflict or so these things 282 00:17:01,280 --> 00:17:05,240 are sort of dealt out with dealt, you know, you're 283 00:17:05,240 --> 00:17:08,280 identified as such by the powers that be, right? 284 00:17:08,680 --> 00:17:15,920 But an example is Lebanon. And if if one of these global, 285 00:17:16,160 --> 00:17:21,480 these mechanisms suddenly say, right, we have to prioritize and 286 00:17:22,000 --> 00:17:25,680 we're no longer going to give access to these drugs for middle 287 00:17:25,680 --> 00:17:27,880 income countries, we simply don't have the funding for that 288 00:17:27,880 --> 00:17:30,600 anymore. But you know, Lebanon has just 289 00:17:30,600 --> 00:17:34,840 been bombed and invaded last year. 290 00:17:35,360 --> 00:17:40,240 They're not countries that you suddenly say no more vaccines. 291 00:17:41,880 --> 00:17:43,520 That's a disaster waiting to happen. 292 00:17:43,840 --> 00:17:47,120 So it's it's things like these. So you've got these communities 293 00:17:47,120 --> 00:17:50,560 that are that are going to just be left vulnerable. 294 00:17:51,440 --> 00:17:54,360 But everything you say, all the examples you've given, these are 295 00:17:54,520 --> 00:17:57,200 seismic changes in the humanitarian aid world. 296 00:17:57,440 --> 00:18:01,920 So my question is what? What is MSF doing differently? 297 00:18:01,920 --> 00:18:05,440 Because certainly the need for humanitarian response is not 298 00:18:05,440 --> 00:18:08,040 decreased. So what are we as a myself doing 299 00:18:08,040 --> 00:18:09,880 differently or trying to do differently? 300 00:18:09,880 --> 00:18:12,560 It's a good question, Shigar, And I can answer this, I guess 301 00:18:12,640 --> 00:18:16,960 in two ways, which sound contradictory, OK? 302 00:18:17,400 --> 00:18:22,080 Because 1 is not much different. We're not doing much different. 303 00:18:22,400 --> 00:18:25,680 Because if I bring you back to what I've said about how we sort 304 00:18:25,680 --> 00:18:30,760 of decide at a very project level out there where we work, 305 00:18:30,760 --> 00:18:34,320 you do your annual scanning, you do your needs assessment, who's 306 00:18:34,320 --> 00:18:38,240 doing what, where when you plan, you plan your project, you get 307 00:18:38,240 --> 00:18:42,280 it signed off, budgeted and you start right, That doesn't change 308 00:18:42,280 --> 00:18:45,920 for us. So what will change is the 309 00:18:45,920 --> 00:18:48,200 process won't change, but maybe the outcome will. 310 00:18:48,520 --> 00:18:53,480 We could see it just a complete, complete change, you know, a 311 00:18:53,480 --> 00:18:55,880 handbrake turn and now doing something completely different 312 00:18:55,880 --> 00:18:58,480 in a different context. That analysis we're still going 313 00:18:58,480 --> 00:19:00,440 to have to do. It's now only January and so 314 00:19:00,440 --> 00:19:02,600 forth. Part of me and I won't get too 315 00:19:02,600 --> 00:19:07,400 technical, but the reality is we're, we're always going to be 316 00:19:07,400 --> 00:19:11,080 where we are trying to meet the greatest need in as best way 317 00:19:11,080 --> 00:19:15,000 that we can. So in one way, as I say, little 318 00:19:15,000 --> 00:19:18,680 changes for us, but but potentially it could be huge. 319 00:19:18,680 --> 00:19:23,840 As I said, imagine anywhere we are if, if vaccinations fall 320 00:19:23,840 --> 00:19:28,960 away and we we would have to programmatically ensure that we 321 00:19:28,960 --> 00:19:34,480 can always carry the capacity to do vaccinations now and in an 322 00:19:34,480 --> 00:19:36,960 outbreak we might. But routine immunization is 323 00:19:36,960 --> 00:19:41,400 something that wasn't generally standard unless we were doing a 324 00:19:41,400 --> 00:19:44,600 maternal and child health project, the process of 325 00:19:45,320 --> 00:19:48,520 generating our project plans and our sort of annual projections, 326 00:19:49,040 --> 00:19:51,080 nothing there would have changed because it'll be based on the 327 00:19:51,080 --> 00:19:52,280 needs assessments where we're at. 328 00:19:52,560 --> 00:19:56,120 I think there's potential for a huge change in the content, in 329 00:19:56,120 --> 00:20:00,200 the outputs in terms of what we do, yeah, it's actually a really 330 00:20:00,200 --> 00:20:04,520 difficult question to answer because are we going to see, as 331 00:20:04,520 --> 00:20:07,600 things pan out through the year and into the longer term, 332 00:20:08,960 --> 00:20:14,040 predictably higher rates of global malnutrition, higher 333 00:20:14,040 --> 00:20:19,960 rates of global outbreaks and epidemics, including greater 334 00:20:19,960 --> 00:20:24,200 malaria deaths, greater tuberculosis deaths, greater HIV 335 00:20:24,200 --> 00:20:26,600 deaths? Yes, yes, yes, yes. 336 00:20:26,600 --> 00:20:29,080 And yes, we are. Full stop. 337 00:20:31,840 --> 00:20:36,640 How will that change for us? We will carry on trying to do as 338 00:20:36,640 --> 00:20:40,120 much as we can, wherever we can, however we can. 339 00:20:40,480 --> 00:20:43,280 So that's why I say it's actually really difficult to say 340 00:20:43,280 --> 00:20:46,360 what's going to change for MSF. We're just going to have to do a 341 00:20:46,360 --> 00:20:49,560 lot more in a lot more places and we're going to have to make 342 00:20:49,560 --> 00:20:52,880 some really difficult choices internally, right? 343 00:20:53,080 --> 00:20:56,480 Yeah, no, I, I think it's great. Talk about the stability for us. 344 00:20:56,480 --> 00:20:58,120 But of course, the world is changing. 345 00:20:58,400 --> 00:21:01,960 And as all these funding cuts are happening, we're also seeing 346 00:21:01,960 --> 00:21:04,320 a world where things are becoming more costly. 347 00:21:04,720 --> 00:21:07,840 So how does that affect us as MSF? 348 00:21:07,840 --> 00:21:10,760 Like how does it affect the communities in which we work in 349 00:21:10,760 --> 00:21:13,040 essentially? It's already more costly for us 350 00:21:13,040 --> 00:21:14,720 to do what we would have done before. 351 00:21:14,720 --> 00:21:18,000 And I gave previously the example of of using the 352 00:21:18,000 --> 00:21:21,000 therapeutic foods for malnutrition, the peanut paste. 353 00:21:21,280 --> 00:21:24,680 So now we're having to spend money buying that, whereas the 354 00:21:24,680 --> 00:21:28,920 previous system was that we get that as a donation in kind from 355 00:21:28,920 --> 00:21:31,040 the UN Agency for children, UNICEF. 356 00:21:31,760 --> 00:21:35,000 So that that, so it's costing us more just to do what we did 357 00:21:35,000 --> 00:21:38,840 before, let alone we will need to do more of that in the 358 00:21:38,840 --> 00:21:41,760 imminent future. So that's what we're facing. 359 00:21:41,920 --> 00:21:44,840 Various funds like Garvey, the Global Alliance for Vaccines 360 00:21:44,840 --> 00:21:48,760 Initiative, Ministries of health would draw down vaccinations or 361 00:21:48,760 --> 00:21:52,040 money for vaccinations from them, You know, Global Fund for 362 00:21:52,040 --> 00:21:55,400 Tuberculosis, malaria, TB. If they're now operating in 363 00:21:55,400 --> 00:21:58,120 deficits and we're working in countries that can't access 364 00:21:58,120 --> 00:22:03,480 those, we may well have to do more of those programs and pay 365 00:22:03,480 --> 00:22:07,200 for those medicines. But we have to be really clear 366 00:22:07,480 --> 00:22:13,640 that there is no way ever we will be able to plug those gaps 367 00:22:13,720 --> 00:22:15,680 fully. Simply cannot. 368 00:22:17,000 --> 00:22:19,120 Thank you so much. You've handled some, I've hit 369 00:22:19,120 --> 00:22:20,320 you with some pretty hard questions. 370 00:22:20,360 --> 00:22:22,920 Thank you very much. But I do have, I do have this 371 00:22:22,920 --> 00:22:26,760 question for you. So in in your view, are there 372 00:22:26,760 --> 00:22:30,560 any communities or services that you see these funding counts 373 00:22:30,800 --> 00:22:34,360 impacting the most? Yeah, I mean, it comes back 374 00:22:34,360 --> 00:22:37,760 again to sort of marginalized or more vulnerable, I think people 375 00:22:37,760 --> 00:22:44,080 living with HIV, children, women and girls, sexual reflective 376 00:22:44,080 --> 00:22:48,000 health. You know, these are on one side, 377 00:22:48,600 --> 00:22:52,840 you know, people living with HIV, sex workers, even even men 378 00:22:52,840 --> 00:22:56,720 who have sex with men amongst the sex workers, you know, you 379 00:22:56,720 --> 00:22:59,800 could almost describe them as very niche and, and, and a small 380 00:22:59,800 --> 00:23:02,840 group in a society. And at the other end you've got 381 00:23:02,880 --> 00:23:05,760 all women and girls section reproductive health services. 382 00:23:06,040 --> 00:23:11,280 So it's, it's small groups, but also half of humanity on one 383 00:23:11,280 --> 00:23:15,240 level, right. So there are, there's a spectrum 384 00:23:15,240 --> 00:23:18,320 here, but I, I think it's important to, to really 385 00:23:18,320 --> 00:23:22,960 highlight the marginalized groups, all the most vulnerable, 386 00:23:22,960 --> 00:23:28,120 as I said, because, yeah, you know, our tradition in MSF is to 387 00:23:28,120 --> 00:23:32,760 really look for, look for those people that are, that are left 388 00:23:32,760 --> 00:23:36,800 behind or fall through the gaps or discriminated against. 389 00:23:37,520 --> 00:23:40,200 And there are suddenly going to be more in those groups than 390 00:23:40,200 --> 00:23:43,400 ever before. Yeah, I think sometimes it's 391 00:23:43,400 --> 00:23:45,040 humanity. You make this mistake where 392 00:23:45,040 --> 00:23:47,320 we're like, oh, that's a niche group, but we don't understand 393 00:23:47,320 --> 00:23:49,000 that it's a marginalized niche group. 394 00:23:49,000 --> 00:23:51,960 But the repercussions go affect everyone like you said. 395 00:23:51,960 --> 00:23:52,640 Half the. World. 396 00:23:53,320 --> 00:23:56,840 So Javed, you recently started your new role as the MSF 397 00:23:56,840 --> 00:24:00,440 International President. And my question to you is what 398 00:24:00,440 --> 00:24:04,440 is your vision for MSF in the upcoming years and everything 399 00:24:04,440 --> 00:24:07,400 we've talked about today? Are you optimistic about the 400 00:24:07,400 --> 00:24:09,600 future? Oh gosh, these are big 401 00:24:09,600 --> 00:24:11,880 questions. Shall I answer truthfully? 402 00:24:12,800 --> 00:24:14,280 We'll. Take. 403 00:24:14,280 --> 00:24:17,480 Truthfully, we'll take. I'm not sure it's it's a happy 404 00:24:17,480 --> 00:24:19,960 ending if I answer too truthfully. 405 00:24:20,280 --> 00:24:25,000 No, no, let me be serious. I think, you know, it's almost 406 00:24:25,000 --> 00:24:26,960 like the question about what keeps me up at night. 407 00:24:29,360 --> 00:24:32,560 It, it can feel bleak, it can feel bleak. 408 00:24:33,120 --> 00:24:35,440 You know, what's happened this last year? 409 00:24:36,360 --> 00:24:39,360 Let's also be truthful. Is, has been an acceleration 410 00:24:39,920 --> 00:24:43,560 right of, of a trend that we were seeing for years already. 411 00:24:43,920 --> 00:24:52,960 And that trend is, is, is what we're coming to categorise as a 412 00:24:52,960 --> 00:24:57,760 meta crisis, right? So you've got this Poly crisis 413 00:24:58,160 --> 00:25:03,720 of the climate emergency, antimicrobial resistance and, 414 00:25:03,760 --> 00:25:06,960 and just conflict everywhere it feels, right? 415 00:25:06,960 --> 00:25:10,560 Large swathes of the world becoming uninhabitable, all of 416 00:25:10,560 --> 00:25:14,320 these things compounding and, and basically the end of modern 417 00:25:14,320 --> 00:25:16,880 healthcare because there's only about two antibiotics left in 418 00:25:16,880 --> 00:25:20,440 the world, right? So there's all of this already 419 00:25:20,440 --> 00:25:26,840 happening and now, and one symptom of that is the global 420 00:25:26,840 --> 00:25:29,840 cuts, not just from the US, but from all the other countries 421 00:25:31,320 --> 00:25:34,320 there. There's this sort of anti 422 00:25:34,320 --> 00:25:40,640 science, anti solidarity, anti humanity and, and, and and and 423 00:25:40,640 --> 00:25:42,720 then so, you know, they're stepping back for 424 00:25:42,720 --> 00:25:45,480 multilateralism. This. 425 00:25:47,120 --> 00:25:52,240 Yeah, this, this, this almost denial of the other person's 426 00:25:52,240 --> 00:25:57,240 dignity just seems to be bubbling ever stronger. 427 00:25:58,040 --> 00:26:00,560 And and that's the meta crisis, right? 428 00:26:00,560 --> 00:26:05,760 And these two things together for me feel when I've slept 429 00:26:05,760 --> 00:26:10,320 well, like an immense challenge that we will navigate, right? 430 00:26:10,440 --> 00:26:12,640 Because we know what we're good at. 431 00:26:13,560 --> 00:26:18,040 We're good at focusing almost conscious sort of short 432 00:26:18,040 --> 00:26:22,760 sightedness on the needs of that vulnerable community, and we 433 00:26:22,760 --> 00:26:27,040 will get it done whatever we feel that they need and they ask 434 00:26:27,040 --> 00:26:29,160 us for. That's within our capacity. 435 00:26:29,640 --> 00:26:32,440 Right point. So on. 436 00:26:32,480 --> 00:26:36,880 When I've slept well, it's fine. We can tackle anything, we'll 437 00:26:36,880 --> 00:26:38,560 get it done. We always have. 438 00:26:39,440 --> 00:26:44,120 When I haven't slept well, I'm a bit like, Oh my God, what the 439 00:26:44,120 --> 00:26:46,200 hell? This feels like the end of the 440 00:26:46,200 --> 00:26:50,480 world. Because at A at precisely the 441 00:26:50,480 --> 00:26:55,520 moment that we need every country to get together and do 442 00:26:55,520 --> 00:27:01,920 the right thing for the planet, forget out all the rest, we're 443 00:27:01,920 --> 00:27:04,920 doing exactly the opposite. We're just breaking up and it 444 00:27:04,920 --> 00:27:09,160 and it feels like a profound period of change, actually. 445 00:27:10,920 --> 00:27:16,120 But on a positive note, we will always do what we've always 446 00:27:16,120 --> 00:27:17,520 done. And that's important. 447 00:27:17,720 --> 00:27:19,640 And that's important in my role, right? 448 00:27:19,640 --> 00:27:24,680 We need we, you know, that steely laser eyed focus. 449 00:27:25,120 --> 00:27:26,960 We're not going to abandon our principles. 450 00:27:28,040 --> 00:27:33,040 Actually, humanity, the core principle of humanity is not 451 00:27:33,040 --> 00:27:36,720 going to change for us. And we need to be very clever 452 00:27:37,040 --> 00:27:44,040 and very clear on understanding which countries, which 453 00:27:44,040 --> 00:27:50,080 communities, which powers still uphold that principle and, and 454 00:27:50,080 --> 00:27:52,640 making sure that we have our sort of, we know where our 455 00:27:52,640 --> 00:27:56,440 allies are. You know, humanity is 1 medical 456 00:27:56,440 --> 00:27:57,960 ethics. We're not going to stop being 457 00:27:57,960 --> 00:28:00,960 medical, right? So we're humanitarian, we're 458 00:28:00,960 --> 00:28:02,720 medical. We're not going to abandon 459 00:28:02,720 --> 00:28:05,640 humanity. We still see the dignity in 460 00:28:05,640 --> 00:28:08,200 every human being and their worth. 461 00:28:08,360 --> 00:28:12,120 That's intrinsic and born and medical ethics. 462 00:28:12,400 --> 00:28:15,440 We're not going to stop being independent, right? 463 00:28:15,960 --> 00:28:19,120 And then we have impartiality, of course, which means that a 464 00:28:19,120 --> 00:28:20,760 patient is a patient is a patient. 465 00:28:20,760 --> 00:28:24,640 We don't discriminate. So these things are core and, 466 00:28:24,640 --> 00:28:27,040 and they're not going to change. And it's really important. 467 00:28:27,040 --> 00:28:30,200 And my role and the role of all the leaders within MSF will be 468 00:28:30,200 --> 00:28:36,240 to make sure that we, we, we reaffirm constantly our 469 00:28:36,240 --> 00:28:40,320 principles, we stand by them. We're not going to waver, no 470 00:28:40,320 --> 00:28:43,720 matter how hard it gets. I love that. 471 00:28:43,720 --> 00:28:46,880 I think as we've been talking, there's so much change happening 472 00:28:46,880 --> 00:28:50,040 in humanity and I think it's so important that MSF, we stick to 473 00:28:50,040 --> 00:28:51,920 our tenants. And as you explained in your 474 00:28:51,920 --> 00:28:53,960 vision, I see that a patient is a. 475 00:28:53,960 --> 00:28:56,360 Patient is a patient. Like, that's not going to 476 00:28:56,360 --> 00:28:58,800 change. I think that's really on the 477 00:28:58,800 --> 00:29:02,560 days when you get good sleep and the world seems positive. 478 00:29:02,560 --> 00:29:05,360 Those are the things that we do need to remember to make. 479 00:29:05,640 --> 00:29:06,840 Yeah. Thank you so much. 480 00:29:07,400 --> 00:29:10,560 So thank you, Javed, for taking us through some fairly 481 00:29:10,560 --> 00:29:13,120 complicated topics that we've talked about today. 482 00:29:13,120 --> 00:29:16,800 And we really appreciate your time and your insight. 483 00:29:16,800 --> 00:29:19,640 Especially with these topics, they affect so many people's 484 00:29:19,640 --> 00:29:21,480 lives. So thank you very much. 485 00:29:21,520 --> 00:29:23,000 Thanks for having me Chugo. Thank you. 486 00:29:23,560 --> 00:29:25,600 Thanks to our audience for tuning in. 487 00:29:25,680 --> 00:29:28,320 You can check out our website For more information about 488 00:29:28,320 --> 00:29:31,320 funding cuts, our work, and the ways you can help. 489 00:29:31,600 --> 00:29:35,080 That is at doctorswithoutborders.org and 490 00:29:35,080 --> 00:29:38,560 wherever you are listening to this podcast, please subscribe 491 00:29:38,560 --> 00:29:41,120 and leave us a review. It will help us reach more 492 00:29:41,120 --> 00:29:45,320 people interested in our work. This is Humanitarian Lens, a 493 00:29:45,320 --> 00:29:48,360 podcast of Doctors Without Borders USA. 494 00:29:48,720 --> 00:29:52,200 I am your guest host Chiga Hunania, and until next time.