I am Unni Karunakara, International President of Médecins Sans Frontières/Doctors Without Borders (MSF). Ask me anything!

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.

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 (www.msf.org) and fill out an application form.

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

Thank you for this AMA.

What do you think the biggest problem the organisation faces?

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.

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 www.msf.org Have a nice day.

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

Also:

• 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?

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.

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?

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.

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

Dialogue, dialogue, dialogue.

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?

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.

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

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.

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.

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.

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

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.

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?

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.

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.

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.

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.

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

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.

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.

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

:) 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.

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?

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.

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?

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.

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?

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.

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?

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.

Where does most funding come from at MSF?

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.

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

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.

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.

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.

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!

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.

Have you met Guy Delisle? His wife?

No. would love to, though.

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.

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.

What's your favorite color?

Blue

Wild guess here.

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

Edit: Nailed it.

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