Former International President of Médecins Sans Frontières (MSF) and current Chair of HD’s Board, Joanne Liu provides her humanitarian insights to better inform the practice of mediation. Inspired by an MSF doctor's book she read as a teenager, she has worked as a humanitarian paediatrician in conflict zones for 30 years. Joanne Liu recounts her negotiations for humanitarian access in Yemen, her advocacy at the UN for an emergency response to Ebola, and how she stood up to the US administration after the bombing of an MSF hospital in Afghanistan. She also shares what helps her to keep faith in humanity in the face of devastating crises.

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Adam Cooper 00:00 I'm Adam Copper. Welcome to Season 6 of The Mediator’s Studio. In today’s episode, I sit down with Dr Joanne Liu, former President of Médecins Sans Frontières, to hear her unique journey through the world of humanitarian work on the frontlines. When it comes to humanitarian crises... if you ever feel like there's more to a story than what's being told, you might enjoy the podcast “What’s Unsaid”. Join The New Humanitarian’s Ali Latifi and Obi Anyadike as they explore the open secrets and uncomfortable truths at the heart of the world’s conflicts and disasters. Like why Afghan civil society is calling for engagement with the Taliban. And why humanitarians are still left to struggle with mental health. You can listen to “What’s Unsaid”, a podcast by The New Humanitarian, wherever you get your podcasts. Joanne Liu 00:46 When they finally got to my team, he just said, “This is the White House. Our president wants to speak to your president”. And they said, “No, she's not available”. And they said, “No, no, but you didn't understand us”. He said, “Barack Obama wants to talk to Doctor Joanne Liu”. “Yeah, yeah, we heard you well, but she is still not available”. Adam Cooper 01:08 Welcome to the Mediator’s Studio, a podcast about peacemakers, bringing you stories from behind the scenes. I'm your host, Adam Cooper. I'm at the Oslo Forum, which started out as a small gathering in 2003 and is now entering its third decade, bringing together some of the world's leading figures in peacemaking. Participants from around the world are here to discuss the major conflicts of our day, from Gaza to Yemen, Sudan to Afghanistan, and the war in Ukraine. My guest today is a distinguished Canadian paediatrician, best known for her extensive work with Médecins Sans Frontières, MSF, also known as Doctors Without Borders. She's currently Chair of the Board for the Centre for Humanitarian Dialogue (HD) and is a professor at McGill University's School of Population and Global Health. Joanne Liu, welcome to the Mediator's Studio. Joanne Liu 01:59 Good morning. Adam Cooper 02:00 Good to have you here. I'd like to begin by giving our listeners a sense of your early life, where your motivations and values came from. You were born in Quebec City, Canada, in the mid-sixties, the child of Chinese immigrants who left poverty in China became to own and run a restaurant. You were working at the till to help your father. Tell me about those times and what they taught you. Joanne Liu 02:29 Well, those times were particular because we had a restaurant in a French province where there was very little other, what I call, visible minorities. So, we were one of the rare Chinese restaurant, and it was a 24/7 type of restaurant. Everybody in my family ended up working in a restaurant, and very early on. And so, I think what those times taught me was what I call the 3Ds: the discipline, the dignity and the duty. This is what we had to deal with and act as children. Adam Cooper 03:03 And at the age of just 13, the young Joanne Liu reads a book by a French doctor, Jean-Pierre Willem, working for Médecins sans Frontières. Tell me how that fired your imagination. Joanne Liu 03:13 I think it was in the period of my life where I was looking for meaning, this sort of existential crisis of teenager time. And I thought that book was great. This man, this surgeon, was going overseas, working in the most improbable, most difficult places, and he was bringing care, and he was making a difference in people's life. And I thought the way, any way I read it at that time was, this is cool. And so, I said, maybe this is something that I could do. And back then, we were not talking about what is white saviourism and all that, but it was this appeal of having a competence, bring it somewhere where it's almost not as extensive, making a difference in people's lives. Adam Cooper 03:57 And it does inspire you, because then, age 18, you go off to Mali for your first volunteering experience. Tell me about that. Joanne Liu 04:06 Yes, I went with Canadian Crossroads to Mali and work in the rural area for three months. And I think it was one of my best stays in Africa, because you are hosted by a family. You go and you walk to the water well each morning, you pick up your water, and that's the way it is. So, you go in the field. But it was, of all my stay in Africa, and I've made several afterwards, it was the only time that I had the pure and privileged time of just hanging out with people. It's funny because they always called me the little one. And because I was the smallest one, I was the one who had to do everything. And it's interesting because I had no, in the hierarchy there, I was the lowest. Adam Cooper 04:50 But you were happy to be there, right? Joanne Liu 04:52 I was happy. Adam Cooper 04:53 Well, the first of many missions to follow later on in life. But before that, you studied medicine in Montreal and New York, specializing in paediatric emergency medicine. Why paediatric emergencies? Joanne Liu 05:05 Well, when I did med school, I just realised that the paediatric patients were the funniest patients to have, because they don't play game. Children, when they're sick, they stop eating and they stop playing. When they get better, they stop eating and they start playing. And so, this is the great thing. And I just said, okay, so I'm going to do paediatrics, but in addition to that, I'm going to do ER, because I want to go and work in conflict zones. Adam Cooper 05:32 And so, then you start to use your vacations to undertake missions for MSF. What did your peers and family think about that work? Joanne Liu 05:41 Everybody was hoping that it will pass. Adam Cooper 05:44 Like a phase, right? Just get it out of your system. Joanne Liu 05:48 Exactly. Gonna get over it. And as time passed by, it was even less getting over it, but more present in my life. And then I ended up taking more responsibility in the organisation. But for me, from the reading from Jean-Pierre Willem, it was a bit the dream of a, of a teenager. Adam Cooper 06:04 So, in 1996, you joined MSF fully, and it would be an organization you'd work for the best part of three decades, becoming its International President in 2013. During that time, you tried to negotiate humanitarian access in places like Gaza, safe spaces for medical staff, help to free colleagues held hostage. But your first mission, working in Mauritania with refugees from Mali, doesn't go well. Indeed, it ends with you resigning in protest. What happened? Joanne Liu 06:35 I often say that when you've been dreaming for something for so long, your chances of being disappointed are fairly high. And so basically, I had imagined myself that when you go in a place where there's refugee people, everybody will be aligned to give the best to those people who are in a much more vulnerable, I would say, situation. And so, I was very appalled by the fact that the UN High Commissioner for Refugee personnel wanted to move the camp closer to the border of Mali. And I just said, why? He said, well, it just gives the sense that something has happened. I said, but nothing has happened, except that they are only 5 km closer to the border. But then I realised it was an absolutely cosmetic manoeuvre. The guy was at the end of his mandate, and he needed something tangible that had happened during his one-year assignment. And so, I protested against it. And I just said, if you do that, then I said, you have to make sure you have the plastic sheeting that people can rebuild their housing, and then that us are prepared as well to accompany them. And of course, none of that was done. And then people end up standing under, I remember so well, under the rain for two weeks, waiting for plastic sheeting. We have increased number of pneumonia, increased number of malaria. People died. And I made a report about that. And I remember because I can get sometimes so obsessed about things. I just said, I'm going to register everything and I'm going to give evidence that it was really detrimental on the health of the refugees. And it was. So, we were able to bring this back afterwards and put them in front of their responsibilities. Adam Cooper 08:16 Let's talk about one of the defining experiences for MSF, which was the Ebola outbreak. In 2013, there's a serious outbreak of Ebola in West Africa that by the end of 2016 would kill over 11,000 people, decimating the healthcare infrastructure in Liberia, Guinea, and Sierra Leone. Hundreds of health workers died in this unprecedented outbreak. MSF was one of the few international organisations advocating the deployment of massive emergency resources to counter the regional epidemic. It would bring MSF to the forefront of international tension, define the organisation for years to come. Where were you when the sheer scale and significance of what was going on dawned on you? Joanne Liu 09:00 I had been following since the beginning and my team really raised it to me at the spring of 2014, this is different. And the difference was that we discovered there were chains of transmission of patients that were geographically distanced more than 250 km. In the past, you used to have one chain of transmission in one remote village, and most of the time would just die out there. But the fact they were so remotely distanced meant that we had basically on their own cluster brewing. So, we brought this to the attention of people and what we used to say, because back then we were not used to that kind of size. And we just said, “You know what? We think it's different”. That's the only thing we could say back then, we think it's different. And I remember on social media we kept saying it's different and all that. And at one point WHO said, no, no, no, but we're crying wolf, it's still under control. There is only 100 cases not factoring in that they all basically dispatched on such a geographic. Adam Cooper 10:00 Yeah, they told you not to exaggerate. Joanne Liu 10:03 Yeah, we were a bit taken aback by that. But the reality is you raise those things and actually you wish you are not right. Because we knew what it meant if we were right. And so, we end up being right because, yes, it was going on on a very, very, I would say, spread geographic landscape and the chain of transmission where many of them were not connected. Adam Cooper 10:24 And what was your approach to negotiating that scepticism against that scepticism from the likes of the WHO and others? Joanne Liu 10:30 Back then, Gaza was under fire, Syria was not going well, and the world is having a tough time to deal two big crises at a time. So basically, what shift things is in July 2014, two humanitarian aid workers from Samaritan's Purse got infected in Liberia and were repatriated in the States. And all of a sudden, we moved from complete indifference to massive hysteria. Then we have to deal with that because now we had the attention that we wanted. But a non-coordinated, hysteric attention is a challenge as well. Adam Cooper 11:08 And you tried to use the profile of the moment and to get attention at the UN and the Security Council and General Assembly. Tell me how you went about that work, negotiating resolutions and so on. Joanne Liu 11:21 We were babies back then because we didn't have a clue of what we were getting ourselves into. And so, what is interesting is the fact that nothing happens for no reason. So, you have to remember that we were struggling at the UN to get a resolution on Syria in 2013. There was a use of chemical weapons. Barack Obama said, “That is a red line” and then saying that nothing happened after the red line. And so, there were a real, I would say, realisation that a leader may bark loud but might not bite. And this is what happened. So, all of a sudden, US, I think they wanted a bit of a success, and they wanted as well, to portray that they were still one of the leading nations in the world. So came Ebola, which is a great thing because it's a common enemy. We can all line up against a common enemy. And so, things that we don't do in Covid-19 but back then we did. And so, what happened is, in September, the US had the presidency at the UN Security Council. And so, when you have the presidency, everybody knows that at the UNSC, you decide on the agenda. And so, they put Ebola on the agenda. And so, they invited MSF on September 2, 2014, to come and brief the member states. And then after that, they invited us, which was one of my colleagues, Jonathan, to come from Liberia to brief by video conference the UN Security Council. I just wanted just to mention that the resolution that passed at the UN Security Council was a second resolution on a medical topic at the UNSC. The first one was on HIV AIDS in 2000. And so basically labelling a medical threat as something that could disturb the security of the world. And that statement was done by Barack Obama, equating terrorisms to Ebola. So, this is not a small feat. And so, the resolution was passed unanimously, and it was backed by 128 nations, one of the most supported resolutions in the UNSC in history. So, it was important because after failing of passing resolution on Syria for the last year, for some reason, it allowed the US to creep up to its status of “we are world leader”. Adam Cooper 13:52 I'd like to turn to Afghanistan, a country you've been involved with since the 1990s. As part of your role in MSF's country operation, you find yourself in the Panjshir Valley in northern Afghanistan in the early 2000’s. Your team is talking with Ahmad Shah Massoud, the mujahideen leader who had resisted the Soviet invasion, then fought against the Taliban, which took over Kabul in 1996. What was MSF attempting to achieve in its talks with Massoud? Joanne Liu 14:20 Well, I think it was access. You know, the access in the Panjshir Valley. We were there throughout the occupation, and then our team were coming into the Panjshir Valley, and basically the way it happened is you would walk into the Panjshir Valley in fall, then it will basically bomb the entrance of the valley, and then you will come out at springtime. They would not fight over winter, so you would just have your team there. My obsession being a physician was, oh, my God, I don't want to get appendicitis because I would be stuck with it in the valley. But beyond that, it was good work. Adam Cooper 14:59 And then 9/11 happens in 2001. Everything changes. Two days before the attack on the twin towers in New York, Massoud was wounded, subsequently killed by Al-Qaeda suicide bombers. How did all that affect your operations in Afghanistan? Joanne Liu 15:15 It affected massively. Well, like many, we didn't see it coming, but we knew it was a game changer. I was in charge of operations in Afghanistan back then, and I remember coming back from lunch at the headquarters in Paris. And MSF, we never used to turn on our TV in the office in Paris, and all of a sudden, the two TV were there. The last time we did that was for the Peace Nobel Prize. And so, I'm walking, and people say, come, come on the third floor. And then I keep seeing those Twin Towers falling over and over again because they were just putting them in cycle on TV. And I remember just saying “Oh, my God, the world would never be the same again”. Everybody looked at me, roll up their eyes and just say, oh, you, the North American thinking that the world is revolving around you. But the reality, it really changed a lot of things. But immediately speaking, our task for us, we had a crisis cell. We had to get our American citizens shipped out of the country, which was a very difficult task because nobody wanted to leave. Physician never wants to abandon their patient. So, it was negotiation. Adam Cooper 16:24 I want to fast forward to 2015. By this time, you're the International President of MSF. In October of that year, the US military, which was supporting the Afghan government against the Taliban, bombed an MSF hospital in Kunduz in the north of Afghanistan. 42 people were killed, including 14 of your colleagues. Where were you when you heard that terrible news? Joanne Liu 16:50 I remember vividly, I was coming out from South Sudan. I landed in Turkey, and I was at the airport, and then I just saw e-mail “Kunduz under attack”. And I just had visited the trauma centre a few months ago. It was such an amazing place. Because it was a trauma centre, high level of care, where we were doing internal fixator, where we were doing skin graft. And we had high specialty in orthopaedics, but as well in ICU, intensive care unit, emergency anaesthetist. And everybody knew that if you have a broken bone, you would go to Kunduz trauma centre. Adam Cooper 17:30 And so, what was it like, that plane journey to Geneva with this on your mind, you know that it's unfolding. I assume you knew some of the staff, your colleagues who were working in that hospital. Joanne Liu 17:43 It's just this thing that you, you’re like the little hamster in the wheel. You start to imagine all sorts of things and you can spin, spin, spin, spin, but nothing is real. And even then, by the time I go to the office, we're still wandering because we had to do the call of ourselves. Who's missing? During the air strike the team called everybody. They call NATO, they call the special forces, they call Washington, they call the Afghan government. One of the persons told us at one point, “We don't know what is happening, but we're praying for you”. Thank you very much. Adam Cooper 18:13 Because they all knew they had been informed of the location of the hospitals. It was well known there's an MSF site. So, it must have been extremely confusing to you and your staff how it got caught up and there was five airstrikes on the building. I mean, what were your sort of emotions at that time knowing that they should have known that that was your hospital? Joanne Liu 18:36 We were in disbelief. I think they were like a mix of feeling. We were angry, but we were mourning because we found out that the director of the hospital has lost life. You have to imagine a hospital under attack, but really targeted on the central building. And being doctors of emergency, as soon as the airstrike stopped, which lasted between some people say up to 1 hour, is the fact that you just pick up things and you start to work and try to save the survivors. And so, everybody went into this mode of, okay, who's alive? What can we do? And it was one of our staff, we just improvised operating table in the office, and we tried to work on his amputated leg and stop the bleeding. What we needed to do was try to save as many of our staff as we can, try to save as many of our patients as we can and transfer them to the next hospital. And everybody was saying, well, we'll cry later, whenever there will be time. Adam Cooper 19:36 And I'm sure you did. This must have been devastating for you. And later on, you demanded an independent international investigation. You didn't get it. Why not? Joanne Liu 19:46 So very early on, the ask was, we need an independent evaluation. And the reason why we asked that is even us were saying: did we made a mistake and we're not aware. And then we don't think we can be judge and jury. So, it was as much as for us than as much for the other people. And so, our legal department just said, and by the way, there's this thing that exists which is called the International Humanitarian Fact-Finding Commission. And it's been created in 1991, ratified by 76 states. And basically, it allows to have an independent investigation. And the only thing that we need, it needs to be activated by a country. And then the countries who are involved will allow the investigator to access the proof and the feedback would be confidential. So, we thought that was not a bad deal. And then it would have somehow act as a role model. We thought for the state it was maybe a way to prop themselves up a little bit, but it didn't really fly. Adam Cooper 20:46 Well, the US was very sceptical, and President Obama himself called you to apologise. And I understand you took the call but refused to accept his apology. Tell me about that phone call. Joanne Liu 20:58 Well, actually, the White House was really craving to get a hold of us. And so, the airstrike happened on October 3, early hours of the morning, which is from the Friday to Saturday, and then early on, on the Sunday, we started to have call from Samantha Power, who was the Ambassador to the UN back then. And then after that, the White House. I remember my staff, “Don't pick up your phone. Don't pick up your phone”. And I said, “Okay, why?” He said, “The White House wants to talk to you”. And then, so when they finally got to my team, he just said, “This is the White House. Our president wants to speak to your president”. And they said, “No, she's not available”. And they said, “No, no, but you didn't understand us”. He said, “Barack Obama wants to talk to doctor Joanne Liu”. “Yeah, yeah, we heard you well, but she is still not available”. The idea was we didn't want to talk to them before our press conference, because at the press conference, this is where we asked for the International Humanitarian Fact-Finding Commission. And we thought that if we were to speak to them before, they would basically downplay everything. So, we just said, well, speak to them afterwards. Adam Cooper 22:00 And you did speak to them afterwards. Joanne Liu 22:01 Indeed. Adam Cooper 22:02 And he expressed his sympathies, but you were very careful in the wording that you used back to him. Joanne Liu 22:09 We don't want to be rude, but we don't want to start to fall into, like, profusive thank you. So, it was sort of, "Yes, thank you I acknowledge your sympathy, and I will convey them to the team". But our big message, what we wanted to pass, there were, like, few messages. The one was about the ask for the independent investigation that's one thing. The second one was the fact that we are treating everybody, including the combatant war wounded. Does he have a problem with that? And so that was two of the key things for us, because we were thinking, we're going to go back. Adam Cooper 22:48 I'd like to touch on Yemen. You went there in 2015, not long after the civil war broken out. You've said that being a woman was an advantage in talking to the Houthis, the main non state armed group in the country. Give me some examples of that. What were you negotiating? What difference did your gender make? Joanne Liu 23:06 Yemen was a brutal conflict, and there were a lot of war wounded. And the team of MSF remained throughout the peak of the military operation. And this is always something that people do remember, is if you stick with them in the hardest and toughest moment. And so, when I met the head of the Houthi back then, after I had actually worked as a physician in one of the hospitals, one of the things he said was, “You stayed with us was a big deal”. And he said, “You're a double angel. You're a physician, and you're a woman”. Adam Cooper 23:41 You referenced earlier that you yourself had practiced as a physician in Yemen. I think you're referring to when you decided to fill in for staff who were absent. And it's happening at the peak of the conflict. Tell me about how that came about. Joanne Liu 23:55 I'm a practicing physician. I never stopped practicing. Throughout all those years of working with MSF. And in MSF, it's not something many people do that it's just going back at field level. And then we often say, touching patient. That's the way we like to say it. But living the daily life and the daily circumstances, it's a huge reality check. And I think it makes you much more real about when you go to negotiate with the people, either locally, there, or after at the headquarters when you come back home. Adam Cooper 24:31 I'd like to start drawing together some broader lessons and taking your point about the credibility and legitimacy that comes from doing that hands-on work yourself. It sounds like it's extremely important to you to stay close to the issues that you're working on. When you step back and you look at the international community more widely, do you think that those working on conflict are sometimes too divorced from realities on the ground? Joanne Liu 24:57 I think you can easily get distance and not understanding what is at stake in the field. When you go to the field, it's really like you are in like an HD TV, 360 degrees. You see everything, you smell everything, and you feel everything. From a distance, you just kind of get that kind of granularity. I think it makes you more real, more human, and at times more vulnerable. But I think that's what we miss sometimes. Some humanity in dealing in those so inhuman crises. We sometimes get very, very difficult in trying to get the best deal in mediation. And I think that sometimes we should settle for what I call the imperfect solution, a non-complacent, imperfect solution. But that allows us to still move a bit forward, because wanting the perfect solution might be like the grail that just doesn't exist except in our fantasy. And the cost of not getting that, what we call, you know, the rule of the little step at a time, might be, in some particular circumstances, the only way forward. Adam Cooper 26:09 Well, let's talk about a conflict that's ongoing which has enormous humanitarian consequences. As we record this episode, the war on Gaza is front of mind for many in both the humanitarian and mediation community. You went there three times as president of MSF. The two big issues were negotiating the security of civilians and humanitarian access. Both of those involved close working relationships with the Israeli army, but also Palestinian groups like Hamas. What lessons did you learn 20 plus years ago that might be relevant today? Joanne Liu 26:42 Sometimes, you know, when you witness what is happening in Gaza, we have the feeling that we haven't learned much, and it's a big, big collective failure. I think that we haven't learned that if you don't break the cycle of violence, then you will not break the cycle of retaliation. And we obviously didn't manage that. And the fact that we have two groups of people who are asking for the same basic things of a home and a place that is safe to grow as a community, and then somehow, we're not able to align interest and plan to make this happen one beside each other. And I'm oversimplifying, but at the end of the day, it's human being who wants a place to live in peace to some extent. So, it's not happening. We had so many attempts of peace and so many model of. Some people say there was a few big missed opportunities in the past, but we are where we are today, and the place we are today is the annihilation of the humanitarian space in a war zone. Adam Cooper 27:57 You said in the past, sometimes when I see very difficult things in the field, I need to see beauty, to believe in humankind. When has that happened to you in the past, when you saw difficult things and needed something else in your life to remind yourself of basic humanity in the world? Joanne Liu 28:18 One that was the most striking is when I came back from the detention centre in Libya, where I thought, well, actually, I could not believe the way we were treating human beings and how we have dehumanized them over and over and over again for the sole crime of people wanting a better life. I just couldn't believe that they were stuck in those detention centres in Libya in a dark room, one on top of each other, not having more than a square foot large to set. And I just said, my God, and this is my public finance, who is supporting that? We sort of planned my visit there. And I just said, if I go there, I said, we need to speak up, because if we don't speak up, then we become the auxiliary. So, something needs to happen. We know that massive erosion or insult to the basic human rights is happening on a daily basis. And if we don't put that forward and centre on the media in front of leaders, I think we will fail. Adam Cooper 29:25 To give yourself the energy and mental space to be able to advocate on behalf of issues like that, is there something that you turn to as a relief or an alternative so that you could have that somehow arrest from the tragedy of that situation? That would give you then the power to advocate on behalf of those people? Joanne Liu 29:46 Yeah. So, this is where, I guess, beauty comes in. Adam Cooper 29:48 Yes. Joanne Liu 29:49 So, I remember when I came back from Libya, I called a friend and said, you need to bring me to see some beauty. I said, that's the only way I'm going to be able to believe again in human being. Adam Cooper 30:04 And where did you go? Joanne Liu 30:06 Switzerland is such a beautiful country. So, I went hiking, and then after that, I went to an exhibit of Cézanne. And then after that I, the same day, and then after that, in the evening, I went to listen to opera. Three of the things I love the most. Adam Cooper 30:22 Well, on that happy note, we must close Joanne Liu, thank you so much for being my guest in The Mediator’s Studio. Joanne Liu 30:30 Thank you very much. Adam Cooper 30:36 And there we end this edition of The Mediator’s Studio. To get more episodes as they come out, please subscribe wherever you get your podcasts. We always love to hear from you. So, if Joanne Liu's career in war zones provoked any thoughts or questions, please get in touch via the listener survey in the show notes on our website, or do drop me a message on Twitter @Adamtalkspeace. The Mediator's Studio is an Oslo Forum podcast brought to you by the Centre for Humanitarian Dialogue and the Norwegian Ministry of Foreign Affairs. Our managing editor is Christina Buchhold, and the producer is Chris Gunness. Research for this episode was by Oscar Eschenbrenner. Big thanks also to Giles Pitts and Ly Buiduong for her support. Hope you'll be with me for the next edition. Until then, from Losby Gods in Norway, this is Adam Cooper saying goodbye and thanks for listening.