Let me start off with a good old American colloquialism: It ain’t over till the fat lady sings.  Well, in terms of my career with MSF, the fat lady is warming up her voice.  After 15 years, today is my last day.  Question I am asking myself:  So, Mr. Ex-Director, what words of wisdom after all that time?  What is the big message?  What is the meaning of our MSF/humanitarian life?  Answer I keep coming to: Beats me.

Every time I feel on the verge of grasping it, waves of emails and interruptions tumble me back to the starting line.  More pertinently, waves of challenges from, well, reality.  I cannot understand why MSF was forced to withdraw from Somalia. Why a multi-billion-dollar aid industry struggles to provide a meaningful response to crisis in South Sudan. Or why easily preventable diseases tear through children in so many parts of the world.  Humanitarian action is complex.  No duh.

But there is a message. I have seen the light.  Specifically, I saw the light a few months ago, cycling to work on yet another cold, damp day in London.  I saw a pair of legs.

The owner of these legs was weaving in and out of the traffic (in this town where last year more cyclists have died than British military personnel in Afghanistan), those boxy black letters his well-inked press release about the power and peril to his left, right and rear.  It was a message for MSF, for all of us.

Let us begin with HUMANITY, since that is the simple imperative where humanitarian action itself should begin.  At once compassion for those who suffer and a declaration of our fundamental sameness.  We are one family, the family of human beings, all so very different at first glance and yet blessed with an identical, universal dignity.  The humanitarian imperative commands a bond with those who do not look or sound like us, believe in what we believe, or watch the same edition of Big Brother that we watch.  The imperative propels us towards those who suffer not out of duty to kin, friends or clan, not out of affinity to those who share our religion or nationality, but because the suffering of one affects the whole and touches us as individuals.  Because in responding to the stranger, we build our own place in the family of humanity.

On top of that, humanity has propelled me to crisis – to this career – because humanity itself is at the root of crisis.  To be sick or injured and have no access to care is bad enough.  All the worse when it is caused by or paired with violence, abuse, exclusion, oppression.  Or greed, power, hatred. Or staggering, structural poverty.  There is something compelling, challenging and sinister about that combination – of responding to crisis because something bad happened to people (e.g., rains didn’t fall) and because something wrong was perpetrated against them (e.g., displaced onto marginal lands).  Compelling because that is where MSF finds those most in need.  Challenging because being humanitarian requires more than therapeutic action.  Sinister because it transforms medical action into an act of protest against the human origins of the harm.  MSF’s very engagement levies an accusation against those who reject humanity.

And that means some people won’t like us.  And that means some won’t let us do our work.  So, MSF (not to mention the rest of the humanitarian system):  What are you going to do?  As the proficiency, ambition and impact of our medical action becomes ever greater, what will become of our commitment and courage as an organization of protest?  As governments around the world become ever more cynical and capable in their manipulation/control of humanitarian aid, as they insist that we shut our neo-colonial mouths, what course will we steer?  What choices will we make?  Establishment aid agency or rebel humanitarian?  Fractious silos of ego and power or collective voice of dissent?  Muted opinion?  Round after round of risk-averse calculation? Or “Fuck Taxis,” because that is the voice of a piece of humanity bearing witness to powerful pieces of its antithesis.  Fuck inhumanity.

Well, MSFers?  I’m leaving.  So what are you going to do? The trend may be clear, but on this key question of humanitarian identity, the fat lady has yet to sing.

[I will leave MSF but Humanicontrarian will live on for a few weeks, then take a break, and then come back fresher than ever.  I hope.]