Thank you everyone for participating in the AMA! I'm sorry that I'm unable to take any more questions. To learn more about MSF, including how to donate and apply to volunteer, please visit


Médecins Sans Frontières/Doctors Without Borders (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF offers assistance to people based on need, irrespective of race, religion, gender or political affiliation.

Dr Unni Karunakara was elected International President in June 2010. He has been involved with MSF since 1995, when he set up a tuberculosis control programme in Ethiopia. He went on to work as a medical coordinator for MSF programmes in Azerbaijan, Brazil and the Democratic Republic of Congo. Dr Karunakara has also worked in MSF’s public health department in Amsterdam, moving on to become medical director of MSF’s Access Campaign. In 2007, he was part of the medical emergency response team that treated victims of cyclone Sidr in Mathbaria, Bangladesh.

Comments: 554 • Responses: 28  • Date: 

koreanknife264 karma

What a great organization. What qualifications do you look for when you hire people?

I have a 4 year microbiology degree and would love to work with MSF if I could.

UnniKarunakara330 karma

We obviously need medics (docs, nurses, psychologists, lab scientists, ...) but we are able to work because we have logisticians, engineers, journalists, epidemiologists etc. as part of the response teams. I would suggest that you visit our website ( and fill out an application form.

[deleted]1 karma


UnniKarunakara8 karma

Limited opportunities but they do exist. Please get in touch with our office in NYC.

alx3m193 karma

Thank you for this AMA.

What do you think the biggest problem the organisation faces?

UnniKarunakara262 karma

There are broadly two challenges that we face. a) to reach populations in distress. For example, in Syria or in the Sahel. b) to provide these populations with good quality treatments and ensure that they have access to essential quality diagnostics and medicines.

UnniKarunakara183 karma

Thank you for your questions! I'm sorry that I wasn't able to answer all of them. To learn more about MSF, including how to donate and apply to volunteer, visit Have a nice day.

heyjude321169 karma

1) How do you deal with countries that are difficult to operate in due to security risks.


  • Will MSF ever operate in Somalia?

  • Has the kidnapping (and release) of the two Spanish aid workers limited your operations in the horn of Africa?

UnniKarunakara286 karma

MSF has been operational in Somalia for more than 20 years and we continue to provide much needed health services in several parts of the country. Somalia is one of the most difficult humanitarian contexts in the world today. We are focused on meeting the health needs of Somalis in the very narrow humanitarian space we have today.

Salacious-165 karma

Does Doctors Without Borders do anything to improve permanent medical facilities and conditions in countries, or is it all short-term aid for disaster situations?

UnniKarunakara217 karma

In many countries, we work with health authorities to build capacity in order to meet health needs. While construction of facilities is not an objective in itself, we do from time to time, work to upgrade facilities so that the right sort of environment for effective health care delivery exists.

sbw2012134 karma

How do you resist the pressures from governments who want you work in a way that supports a political agenda?

UnniKarunakara219 karma

Dialogue, dialogue, dialogue.

TakTakyon121 karma

Hi Dr. Karunakara, my family currently donates to the MSF organisation every month. What are other ways people can help those who need assistance when they lack the qualifications required for professional work in the field?

UnniKarunakara275 karma

One does not need to get on a plane to Africa to be a humanitarian. Policies made in Washington and Brussels have huge impact on the live of people we work for for. I would urge all supporters to hold your parliamentarians, politicians, and governments, for the policies they make. For example, a couple of trade treaties that are being negotiated by the US as well as by Europe has the potential to limit the availability of affordable, effective, quality medications for people in resource poor settings.

tomcat101178 karma

Hi, Doc and thanks for all the good work. What made you decide to give up a regular practice and get started with MSF?

UnniKarunakara125 karma

Even during my university days, I was interested in practicing medicine that was more social in nature. Medical humanitarian work allows me to work with some of the most vulnerable populations in the world, and provide quality medical care where very little exists.

RaisinToGrapeProcess61 karma

Hi Dr. Karunakara, thanks for doing this AMA.

Much progress has been made in the water and sanitation sector in recent decades, but climate change threatens to reverse some of that progress. When we think of the kind of urgent emergencies and disasters that MSF works with, the gradual effects of climate change don't immediately come to mind. However, these effects may very well be disastrous for many developing countries, especially Pacific island countries where I work. Does MSF have a strategy for building resilience of communities vulnerable to climate change, especially with regards to water and sanitation? Thank you.

UnniKarunakara74 karma

MSF is a humanitarian organisation and as such we aim to alleviate suffering. Our objective therefore is to provide life saving medical care. In places like Haiti few years ago and in S Sudan today, WatSan is an essential component of our health response. We rarely embark upon stand-alone WatSan activities that require long-term developmental approaches for its success.

persian10058 karma

Thanks for the AMA Dr Karunakara! As a final year medical student who is keen to join MSF, I was wondering how does one go about getting involved with MSF?

I was told that you need 2 years post Specialist Training experience and placements are for 6 months. is that true? and is there any variation to this to get involved earlier or for shorter periods of time? Thanks

UnniKarunakara63 karma

Yes, that is true. Requirements vary from country to country and I ask you to get in touch with our offices in the countries you live. We are cognisant of medical association standards in the countries where we work in and try to ensure that our teams are sufficiently qualified and experienced.

caffeine_infused42 karma

Thanks for coming on Reddit!

MSF currently makes every attempt to hold itself accountable to its many private donors. What are MSF's plans to hold itself accountable to its patients?

UnniKarunakara68 karma

Accountability is an important concern for us. How do we hold ourselves accountable to patients? This is a difficult question. Can a patient hold an organisation accountable if the patient does not have the ability to sanction that organisation? Reporting to the government is a poor proxy, as they may not legitimately represent the interests of patients. Ultimately, what I would like to see is transparency. How do we make programmatic choices and the quality of implementations. I have seen patients tweeting in Haiti and Somalia and social media has the great potential to be a game changer.

Betterby30me37 karma

I'd love to hear more about the role of MSF mental health officers, in providing psychosocial aid (or is it more of an administrative role?). I am currently working on gaining deeper clinical skills in community mental health care, and am interested in also learning how MSF operates in the same, given the scarce-resource limitations of humanitarian work. I'm doing an MA in Social Work in Mental Health in India at the moment, with previous training in disaster psychosocial care as well as internship/work experience in post-conflict and gradual-onset disaster settings.

UnniKarunakara59 karma

We do have substantial mental health activities, ranging from psychosocial approaches to psychiatric care for individuals. Personally, I feel that we need to bring the same rigour to MH that we have for our 'physical' health programmes.

Thyg33 karma

I am an r.n.. I would like to know if nurses ever have the opportunity to work worth Doctors Without Borders; if so, how could someone like myself become involved, apply, etc. Thank you for being here. I was so excited to see this was going to be an AMA. Edit: I'm in the U.S.

UnniKarunakara49 karma

Of course! Many of our volunteers are nurses and make invaluable contributions to our humanitarian efforts. please go to for more info.

jrjohnstone22 karma

MSF is known for providing care to those who are in need of medical emergencies, epidemics, or have difficultly accessing services.

From a public health perspective, a sound health system is one that incorporates the formal health system with a strong community health system as each one compliments the other.

From an MSF perspective, what steps, if any, are taken to ensure that when you close a programme, the health and community systems are better than when you first entered into the area.

UnniKarunakara37 karma

As a humanitarian organisation, MSF treats patients and not health systems. Patients are always at the centre of our operational choices. Having said that, it is important to interact with existing systems, whatever their capacity, to reach patients in a meaningful way. Concerns about sustainability does not stop us from acting but it is a concern when we wish to leave. Rather than focusing on the sustainability of a particular programme (we always try to do a responsible handover to authorities or other organisations), we focus on building sustainable models of care, as we have done in the past in nutrition, sleeping sickness, malaria, HIV etc.) that can be replicated or scaled-up therefore benefitting more people.

blubbermouth21 karma

Hello Dr. Karunakara! Can you tell us a little about the bike trip you will soon be taking?

UnniKarunakara60 karma

:) I plan to cycle 5000 ams from the North to the South of India starting October this year. On this trip, I plan to speak to medical students about medical humanitarian action in more than a dozen colleges across the country. I also hope to meet and discuss 'health' and 'humanitarianism' with people I meet along the way. More details later. Follow my progress on twitter and social media.

beanstein21 karma

What are your thoughts on media coverage of disasters and how this affects the way people give donations? For example, a hugely covered crisis like the earthquake in Haiti vs. underreported, perhaps slower and more pervasive but no less dire situations such as a famine? How do you deal with the imbalance of donations that can arise?

UnniKarunakara44 karma

We work constantly to raise awareness about "forgotten" or "ignored" crises. For example, the Central African Republic. We request that donors consider leaving their donations unrestricted. By not restricting your donations for a specific emergency or project, you will enable us to allocate resources more efficiently to people most in need.

gdelarocha20 karma

As a follower of MSF's Access Campaign, I want to thank you for the amazing work you're doing on evaluating the potential impact of free trade agreements (like TRIPS and TPP) on the provision of affordable medicines. What are the biggest challenges you face when it comes to standing up to those who are interested in strengthening ip protections? What is the be the best piece of advice you can give to future ip/human rights lawyers who want to advocate for the continued protection of affordable medicines?

UnniKarunakara33 karma

Ensuring access to affordable diagnostics and treatments must be a priority. If we are to continue meeting global health needs it is absolutely important that we address structural barriers that prevents people from accessing life saving treatment. We have to have a system that puts lives ahead of profits. Lawyers, activists, and campaigners should keep the pressure on so that we a system that works not just for the rich but also for the poor.

anriarer15 karma

Could you discuss the interaction between MSF (and other aid organizations) and military forces in your work? What role do international military forces play in stabilizing disaster areas and war zones that you work in? What role do you think they should play?

UnniKarunakara35 karma

Our interaction with the military depends on their mode of engagement. For example, in Haiti we referred many patients to the US military doctors operating on a ship outside Port-au-Prince. Here they were in a humanitarian mode. In Afghanistan for example, the military is in a belligerent mode and that makes engagement difficult. As you may know, our ability to work in difficult contexts and access remote populations depend on our independence and neutrality. We are concerned that in many conflict areas, that the military often, very deliberately, blurs the line between humanitarian assistance and military assistance. This can be confusing for those who rely on humanitarian assistance for survival and may also put our teams in danger.

barefootballerina15 karma

Hi Dr. Karunakara! What prompted you to apply to MSF for that first programme in Ethiopia, and what was it about that experience that inspired you to continue on with the organization?

UnniKarunakara20 karma

Well, what I saw literally changed my life and made it impossible to practise a different kind of medicine. The needs were immense and there was very little available in the way of quality medical care. While MSF does some things well and others not so well, I was impressed by the commitment of its volunteers and the incredible culture of reflection and debate within the movement. I continue to be impressed 18 years later.

chilaca13 karma

Where does most funding come from at MSF?

UnniKarunakara45 karma

Around 90% of our funding comes from 4.5 million individuals around the world. We get some funding foundations, corporations, and other organisations. MSF does not accept funding from the US government for example.

TheCasemanCometh12 karma

What was the MSF response like in Haiti after the earthquake and the Indian Sub-continent after the Tsunami?

UnniKarunakara13 karma

We rushed to meet the immediate medical needs that arose after those natural disasters. The Tsunami provided fewer opportunities for humanitarian medical action as much of the needs, within a few of weeks, were rehabilitative and reconstructive in nature. In Haiti on the other hand, the earthquake resulted in a great loss of local capacity and was followed by a massive cholera epidemic that we responded to.

chris_m_h7 karma

Unni, thanks for your leadership in MSF during the difficult times, especially last week.

What do you think is the bigger global priority - attempting to curb environmental destruction, or to address human suffering?

Chris Houston.

UnniKarunakara15 karma

We have very deliberately taken on a narrow mandate - to provide health care to people in crisis. Medium- to long-term concerns about the planet should not come at the cost or our ability to meet the immediate health needs and suffering.

scoutycat7 karma

MSF has refreshingly taken what might be viewed as a political stand, calling out governments that are abusive or indifferent to the plight of their citizens. Has this affected your ability to work in some areas? And, many of the areas that MSF deals in have major corruption issues. How do you deal with people who expect graft, bribes, or other special treatment? And finally, I think you guys are fantastic!! Thanks for all you do!

UnniKarunakara14 karma

Our speaking out has occasionally resulted in us being kicked out of countries. Ethiopia, Sudan etc. We are not a political actor or a human rights organisation. But while meeting health needs in the places we work, we talk about factors that impact health of populations, so that it can be addressed, either at the local level or global.

jordypants6 karma

Have you met Guy Delisle? His wife?

UnniKarunakara7 karma

No. would love to, though.

o-o-o-o6 karma

Which specialities do you see MSF valuing most highly in the coming decades? In which direction do you think this type of high-level medical aid will progress?

How does MSF maximize the value of each physician that volunteers?

Thank you for the work you do! I've dreamed of working with MSF for as long as I can remember.

UnniKarunakara9 karma

As the epidemiological shift becomes more and more apparent in the countries we work, we are looking to developing models of care for non-communicable diseases. It goes without saying that infectious and vaccine preventable illnesses and other neglected disease will take most of our time for years to come.

colorcollector3 karma

What's your favorite color?

UnniKarunakara22 karma


ImGoing2Hell4This-21 karma

Wild guess here.

You are a socialist you supports gay marriage and the murder of children through abortion?

Edit: Nailed it.

UnniKarunakara11 karma

I believe that all human beings deserve a life of respect and dignity.