Témoignage of the photograph: 50 years of MSF : The Lancet / Fouad Kronfol

50 years ago, in the wake of famine in Biafra, Nigeria, a group of French doctors and journalists founded Médecins Sans Frontières (MSF) on the belief that all people should have access to high-quality health care irrespective of gender, ethnicity and race, religion, creed, or politics. The movement was founded on the principles of independence, témoignage (bearing witness), impartiality and neutrality, and medical ethics. Now MSF Australia mark aspects of their work since then in the 50 years of Humanity photo exhibitions that have been showing in different locations across Australia and in New Zealand.

I went to the see the exhibition when it was in Melbourne at the large warehouse auditorium of Big Plans Melbourne, a self-described “leading visualisation experience” but often used for viewing local real estate plans at large scale. Ironically, this turned out to be a fitting venue for a close encounter with the photographic témoignage of MSF. The expansive setting offered a generous physical and mental distance between each visual photographic story pillar to absorb, often in wonder or horror, the contexts of each photograph.

The words “MSF 50 years” were projected onto the floor, surrounded by the compelling work of photographers past and present, chronicling powerful moments in the daily life of the patients and communities who are the core of MSF's efforts. The first photograph that captured my attention is Sebastiao Salgado's Rwandan refugees—three young children wrapped in a blanket, their facial expressions ranging from caution, surprise, and exhaustion as they peep out to a world that has forgotten them. The 1994 Rwandan genocide resulted in around 800 000 Rwandan deaths, mostly Tutsi minority killed by Hutu militia—the scale and brutality of these events shocked the world. Nearly 1 million Rwandan refugees fled the conflict to Goma and Bukavu in the Democratic Republic of the Congo. But the conditions they found there were difficult, and thousands of refugees died related to a scarcity of clean water and food and outbreaks of cholera and dysentery. The children in this poignant photo were being cared for in an orphanage set up by MSF in response to the Rwandan genocide.

Decades later, medical teams are being sent to global disaster and conflict zones worldwide by MSF. In the early years of MSF many of the internationally mobile staff for the humanitarian medical non-governmental organisation (NGO) came from high-income countries, but in more recent years they are more likely to come from Africa or Asia than Europe. Internationally recruited staff have always been in the minority, with the bulk of MSF's teams consisting of locally hired staff.

Kate Geraghty, Life in Kibati refugee camp, the Democratic Republic of the Congo, Jan 30, 2009
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Copyright © 2022 Kate Geraghty

The exhibition itself is witness to lives saved, lived, and lost. The events, places, and people captured in these photographs highlight individual stories in humanitarian crises and the dedicated work of the MSF medical staff and teams on the ground. MSF has always had a good relationship with journalists and the media and the many photojournalists who have chronicled the work of MSF are testament to this over time.

Amid some dark photographic narrative testimonies, shine images of spontaneous joy. Kate Geraghty, a renowned Australian war correspondent, spoke to The Lancet about her photograph, Life in a Kibati refugee camp, the Democratic Republic of the Congo, that is exhibited. The photo depicts two older women who are neighbours, embracing happily having been reunited after not knowing for some time if the other was alive or harmed. Fingers clasped, heads close, one with her hands around her companion's shoulders, their expressions show their unconstrained delight. Geraghty, who spent several field trips photographing MSF missions in Ukraine, Sudan, and Ethiopia, commented: “it is such a privilege to witness that you can never get tired of photographing images like these”.

Andrew Quilty, US airstrikes destroy MSF hospital, Afghanistan, Oct 10, 2015
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Copyright © 2022 Andrew Quilty

Jennifer Tierney, the Executive Director of MSF Australia and New Zealand, told The Lancet, “photography can really embed témoignage in our work, particularly for regions and contexts which do not get the attention easily of international press”. Tierney identifies malnutrition and the ongoing challenges for asylum seekers and refugees as top priorities for humanitarian medical assistance in 2022 and beyond. “It has been a while since we saw malnutrition globally at this scale”, Tierney says. In another of Geraghty's photographs, Malnutrition screening taken in 2009 in the Democratic Republic of the Congo, a child looks up at the health care-worker measuring their mid upper arm circumference, a standard measure for screening malnutrition in children. Since 1981, MSF has often been one of few international NGOs providing medical care in the Democratic Republic of the Congo, where there are millions of displaced people.

The photographers capture all stages of the lived lifecycle while bearing witness to the consequences of the major humanitarian crises of the past decades. Juan Carlos Tomasi's Portrait of Issa, Niger 2018 tells in one simple image the story of Issa, a young boy kidnapped by an armed group during a village attack after witnessing the killing of another boy. He squarely faces the camera, fingers and thumbs in a circle gesture around each eye—a commanding young presence and witness. In Diffa, southeast Niger, about a quarter of a million people are forcibly displaced, two-thirds of them children. MSF is running a large-scale mental health and psychosocial support programme there.

Among the diverse photographs on display, some of the most stark are those devoid of all people, showing the devastation of war and the absence of life as its irrevocable result. Andrew Quilty's work, US airstrikes destroy MSF hospital is perhaps one of the most harrowing of the collection. The photograph depicts a completely empty bombed hospital ward, broken bed frames, and cracked windows in the wake of US airstrikes in 2015 that injured 37 people and killed 42. Although the Geneva Conventions grant protection of medical units in conflict, they were not enough to protect patients and medical staff in the context of a rapidly moving front line. Health-care attacks in conflict continue to be a cause of concern today in many conflict zones worldwide.

50 years of Humanity also documents the experiences of individual patients. Majid Aljunaid photographed a patient at an MSF COVID-19 treatment centre in Yemen on Aug 7, 2020. The patient, Bahir, was admitted in a serious condition to the Al-Sahul isolation centre for COVID-19 patients supported by MSF. Bahir's words accompany the image: “With the care I received here, life came back to me... I thank all medical staff, who helped me. After God, they are the reason why I survived.”
Both Tierney and Geraghty tell me of the immense respect they have for the work of the photographer and the humanitarian medical missions. By witnessing together across the decades, this combination of compelling photojournalism and medical assistance has resulted in a historical legacy and exhibition that bears witness and solidarity to people accessing health care in the most precarious of contexts.

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Copyright © 2022 Sebastião Salgado, Rwandan refugees, the Democratic Republic of the Congo, July 7, 1994/ Sebastião Salgado