International General Assembly (IGA)

On 9 December 2009, the MSF international council (IC) voted a series of resolutions framing the governance reform process. The proposal on associative governance reform was to be developed in the direction of an elected international board (IB). This should include looking at the possibility of setting up an international general assembly (IGA) and/or an international membership while exposing the pros/cons for clearly elaborated recommendations/choices.

document

Minutes from MSF International Council Meeting, 9 December 2009 (in English)

Extract :

After discussing in three subgroups on governance issues, the IC voted the following resolutions. 4/5ths majority votes in favour were needed to pass all resolutions related to governance issues.

• Associative governance proposal, including structure and function toward the executive, be prioritized and further developed by WG for presentation at March Conference and then for March IC to decide on & send to general assemblies & for decision at June IC.

19 in favour, 1 abstention (MSF Italy) - PASSED

• This associative model should be developed in the direction of an elected International board (IB), including looking at the possibility of an IGA and/or international membership, with pros/cons for recommendations/choices clearly elaborated.

Unanimous

INTERVIEW

Brussels was often ahead of everyone else in terms of association issues. They were already holding an assembly for representatives of all the OCB associations/ sections – the OCB gathering. This was the precursor of a model of an international association with the right to vote. Obviously, it still seemed to us that it would be very expensive to hold an international general assembly. And then what would it vote on? The risk was that decisions would be watered down. So, this international association would have to be represented by a much smaller body – the new international board – that would make decisions. That required creating a representative system. And that’s when we said that all of the associations had to feel that they were represented on the new international board and, thus, be able to elect its members, other than those who served de facto.

Dr Christophe Fournier, MSF International Council President from 2007 to 2010 (in French)

On 14 March 2010, the IC refined the governance reform proposal.

They built on the idea of an international general assembly (IGA) that would be recognised by all the entities and associative members as the highest authority in the movement. This IGA would delegate some specific powers to an international board (IB) for supervision of social mission and resource sharing in compliance with the MSF movement strategic multi-year vision.

This IB would come into effect in June 2011 and the transition toward the IGA should be achieved in 2012 at the latest.

The general assemblies of the various associations of the movement submitted their recommendations for improvement of the proposal and granted their presidents with a mandate to promote these recommendations during the June 2010 international council meeting.

document

MSF Governance Reform, IC Proposal to general assemblies, 14 March 2010 ( in English)

Extract :

The IC is asking the general assemblies to endorse the general direction of its proposal, to make any recommendations they see necessary to help improve it and then to delegate to each of their respective presidents the mandate to promote these recommendations during the final discussion at the June 2010 IC in Amsterdam where the new associative governance for the movement will be decided. Recommendations of the GAs could range from, but should not be limited to, the role and composition of the IGA and IB, to the elements that a multiyear movement-wide strategic vision should contain, to the calendar for implementation of these changes.

It was agreed at the IC in December 2009 that the GAs will not be asked to endorse the executive side of our governance, but in order to ensure that changes at the associative level will connect with the headquarters and field executive, the main line management platforms (ExDir, ExCom, DirMed and RIOD/DirOp) are being revised and will be presented in the coming months.

From 25 to 27 June 2010, the IC discussed and clarified these recommendations and voted on the main lines of the revised proposal.

There were again tense discussions about the operational centres’ representation on the IB and about the types and criteria of entities to be represented on the IGA.

Eventually, the IC agreed on the next steps to be taken: the revision of the MSF International statutes for compliance with the reform outcomes and the set up and definition of membership criteria for an association of individual members and the modalities of its representation on the IGA. This association would be named ‘movement wide association’ (MWA).

document

MSF Governance Reform: June 2010 International Council Decisions, Final, 1 July 2010 (in English)

Extract:

Introduction

The international council (IC) held a meeting on 25-27 June in order to make decisions based on the outcomes of the general assembly voting/debates on the governance proposal launched at the March conference in Barcelona. The aim was to discuss the recommendations made by the 19 general assemblies, all of whom voted in favour of the direction of the proposal, to further develop proposals submitted by the governance working-group, and to make decisions on the next steps.

This document provides an overview of all of the IC decisions made so far on the governance process. The document has been laid out using a similar logic to that used in the statutes of ‘MSF International’ (the association that currently houses the IC and ICB).

Preamble (from March Proposal)

In accordance with an agreed timeline and implementation plan, the current international council will be transformed into an international general assembly (IGA).

IGA membership will comprise a range of entities including elected representatives of a) current national section associations and b) other associative entities approved by the IC (until it is transformed into an IGA) including an Association of Individual Members.

The IGA is the highest authority of the movement and is recognised as such by all entities and associative members.

This new associative set up would continue to safeguard and guide MSF’s social mission based on the Charter, Chantilly, and La Mancha, while strengthening the following aspects: MSF’s medical humanitarian action and leadership

• Common ownership of MSF’s social mission

• Accountability on an international level

• Inclusiveness and meaningful associative membership

• Global/Transnational outlook with local connectedness.

IGA composition should reflect the following: inclusiveness, denationalisation, diversity, stability (a minimum term) and harmonised membership criteria. Representatives of the following types of entities could be included in an IGA:

• Existing entities

• New associative entities – with regional groupings being encouraged

• Association of Individual Members – criteria to be determined

• FADs can present motions to the IGA via non-voting representatives.

One person will have one vote at the IGA – no proportionality of voting

This general direction has been reaffirmed and the specifics are expanded upon in the following sections.

The right to representation on the IGA/Membership of ‘MSF International’.

Note: ‘MSF International’ is the Swiss-registered association that currently houses the IC/ICB and will be reorganised to accommodate the IGA and IB. The ‘IGA’ will become the ‘general assembly’ of MSF International and the ‘IB’, the board. An entity that becomes a member of ‘MSF International’ will have a right to representation on the IGA. The IGA in turn will elect the IB.

1. The right to representation on the IGA/Membership of MSF International

Criteria for an associative entity to be represented in the International general assembly (of ‘MSF International’)

The March proposal stated that:

‘There will be common criteria for entity representation (existing and new) at the IGA (of MSF International), decided by the IC (and once established, the IGA) with admission/expulsion decided by the IC (and once established, the IGA) by four-fifths majority. The IGA can only change its composition by four-fifths majority.’

The criteria agreed at the June 2010 IC meeting are as follows:

Required criteria for entities as members of the IGA

• Be comprised of a critical mass of at least 50 members.

• Be comprised of at least one-third of members with international field operational experience.

• Be comprised of a board of majority elected members, the majority should be medical and there should be no voting members from the executive.

• Required minimum of one-third members with medical/paramedical background and striving for majority with medical/paramedical background.

• Strives to meet the minimum suggested criteria for individual membership, rights and duties in an associative entity.

Other points of consideration of entities as members of the IGA

• Bringing a new perspective that will complement and enrich the guidance of the social mission.

• Adheres to guidelines for its activities including defined oversight, legal set-up, management and funding system, and has a connectedness to operations. Growth must be manageable and projected costs clearly articulated.

• No conflicting activities or confusion of representation as regards other MSF associative and executive entities, especially MSF operations.

• Freedom of speech, freedom of association and the ability to operate without interference from any external individual or body.

• Transnational/regional approach. Encouraging initiatives that go beyond national boundaries in terms of their representation, membership and board compositions.

Additional points on new associative entities in the IGA

• The IGA may consider giving non-voting membership to entities while they develop to meet criteria.1

• New associative entities are encouraged to pair up with an existing associative entity and the IC Associative Standing Committee to support their development. […]

2. The international general assembly (IGA)

2.1 Overall Purpose

The IGA is the general assembly of ‘MSF International’. The IGA is the highest authority of the MSF movement and as such is the guardian and decision-maker regarding MSF Charter and identity.

2.2 Rights

Representation on the IGA

The IGA is composed as follows:

• The international president.

• The treasurer.

• All associative entities approved by IGA can elect 2 members to IGA (minimum medical). Each member entity is to determine the mode and eligibility for their IGA representatives (either by/from board or general assembly).

Note: There is to be no ‘Association of Individual Members’ representation on IGA until such membership and mechanism for representation is decided upon by the IC in December 2010.

Voting on the IGA

• All member entities have equal representation and voting rights.

• One vote per representative.

• The president has a single vote.

• The Treasurer has a vote if an elected IB member and no vote if co-opted.

2.3 Duties / Roles and Responsibilities

• Elects or appoints members of an International board (IB), including the president of the IGA and IB.

• Delegates to the IB the responsibility and authority to monitor entities’ compliance with the Charter and international agreements.

• Endorses a multiyear Vision of the MSF Movement.

• Holds IB to account through an annual presentation and endorsement of a moral report of the IB and combined financial accounts.

• Approves IB recommendations to establish/disestablish associative entities and any MSF representation in a country/region except field missions. (4/5ths majority decision)

• Makes recommendations to International board.

• Develops and animates the associative life of the movement.

• Establishes Standing Committees of the IGA as required. Any Standing Committee is accountable to the IGA.

• Can delegate any other powers not retained by the IGA to the IB only (and not to the executive platforms).

• Approves IB recommendations to establish/disestablish an operational directorate. (4/5ths majority decision).

2.4 Functioning

Meetings

• 1 per year formal.

• Standing committees, online debates, etc between meetings.

• Proposing larger ‘La Mancha type’ gatherings for broader reflection when needed.

President of the IGA

• President of the IGA is elected by the IGA.

• President also chairs the IB.

• President cannot hold any other executive/associative post in MSF.

• Term: three years, maximum two terms.

3. The International board

3.1 Overall Purpose

The IGA delegates to the International board (IB) specific powers for overseeing the Movement’s social mission and resources in line with the multi-year Vision of the MSF Movement.

3.2 Composition of the IB:

• Any member of any associative entity of the IGA/MSF International can run for a position on the IB.

• The board will be made of 12 persons, including the treasurer. The IB will additionally co-opt a treasurer if an elected member is unable to fill this role. Co-opted members have no voting rights.

• Seats will be maintained for the OC representatives (president or other board member), but all other positions will be elected. All IB members must give up all other executive positions in MSF.

• Such candidates must demonstrate that they have sufficient time for the post and must meet one of the following criteria

o Have experience of senior MSF management at field level

o Have experience of senior MSF management at headquarter level

o Have significant experience of sitting on an MSF board.

• A job profile for an IB member should describe basic desired competencies.

• The IB must maintain a 2/3rds majority of persons with a medical background.

• The president can be paid for full-time work, but all other IB members should be compensated for IB work only up to one-half time, with the aim of maintaining the voluntary associative spirit of the IB.

• With the exception of the president, the treasurer and vice president, no person can simultaneously be a voting member on the IB and IGA.

3.3 Duties / Roles and Responsibilities

• Approves the multi-year Vision of the MSF Movement and presents this to the IGA for endorsement.

• Approves multi-year (5-year) resource-sharing frameworks and oversees overall movement financial situation ensuring proper generation and allocation of resources in line with multi-year Vision of the MSF Movement.

• Prepares and presents an annual moral report of the IB and international budget and combined financial accounts to the IGA for endorsement.

• Approves international agreements linked to implementation of the multi-year Vision of the MSF Movement and additional exceptional international agreements and decisions.

• Holds Operational Directorate boards accountable in accordance with these international agreements.

• Holds Entity boards accountable in accordance with all international agreements and takes action or proposes action to the IGA in cases of non-compliance.

• Endorses Operational Directorate (multi-year) Plans of Action (including resources needed to implement) as presented collectively by the ExCom in their compliance to multi-year Vision of the MSF Movement and potential points of disagreement brought forward by the ExCom. Within this frame, the IB may refuse parts of a plan which are in contradiction with the movement’s strategy or stimulate action in areas which have not been taken up by any OD.

• Recommends establishment /disestablishment of associative entities and any MSF representation in a country/region except field missions and sends the recommendation to the IGA for approval. (4/5ths majority decision).

• Recommends establishment/disestablishment of an operational directorate and sends the recommendation to the IGA for approval. (4/5ths majority decision)

• Notwithstanding local, fiduciary accountability of entities which cannot be delegated, all boards (Entity and OD boards) will be held accountable to the IB with respect to:

o Implementation of the social mission in line with internationally agreed strategic ambitions, and the principles of MSF as contained in the Charter, Chantilly and La Mancha;

o Contracts, agreements or decisions made at the international level (such as IB/IGA resolutions, movement resource sharing agreements, bilateral agreements with IB/IGA, MOUs). Such contracts, agreements, or decisions should indicate clear timeframe for validity as well as implications of noncompliance.

• Ensures timely resolution of conflicts within the movement.

• Elects vice president and appoints treasurer (for endorsement by IGA). Appoints the Secretary General.

• Approves/withdraws appointment of additional members of ‘ExCom’.

In the following months, the ICB took over from the associative working group for these issues.

In December 2010, the IC decided that the movement-wide association (MWA) would be incorporated into the statutes as a constituency of individual members and would have two seats on the IGA. The individual criteria and institutional member composition and size criteria in the statutes would apply to the MWA.

document

Minutes from the MSF International Council Meeting, 10-12 December 2010 (in English)

Extract:

Associative Governance Reform implementation

The final version of the statutes will be submitted for the IC’s approval in June 2011, meanwhile there will be regular updates on the IC workspace.

The IC approves the above guidance and planning of the associative governance reform implementation as follows and delegates supervision of further development to the ICB.

December 2010-June 2011

GRP Implementation (supervised by ICB)

• Finalise statutes and internal rules in line with IC decisions (Draft on workspace by Jan/Feb 2011).

• Guidance note for Institutional Member Representation (minimum term/organised rotation).

• Prepare processes for IB elections.

• Further feedback to GAs on developments in governance process.

• Develop core processes/accountability framework for IB functioning.

• Sections/institutional members to identify IGA representatives.

• Individual membership: AIM/MWA – Develop final proposal/plan.

• Vision/ambitions – Further develop/FAD input.

• Executive governance – Develop a final proposal for IC submission in June.

IC Meeting June 2011

• Approve final statutes and internal rules.

• Decision on final proposals for the ‘association of individual members/movement-wide association’.

• Vision/ambitions draft document for further input.

• Executive governance approval.

IGA December 2011

• First IB elections.

• Consider further approval/implementation of proposals for association of individual members.

• Final decision vision/ambitions

Decision (four-fifths majority), passed with:

16 votes in favour

3 votes against (MSF France, MSF Belgium, MSF Italy)

1 abstention (MSF Sweden)

Membership criteria

The IC decides that, before the December IGA, each section will have to provide the ASC [Associative Standing Committee] with:

• Detailed information on whether or not they comply with the membership criteria.

• The reasons/arguments for them not complying/disagreeing with these criteria.

The ASC will compile this information and report back at the December 2011 IGA, who will then decide on the next steps and/or approve exceptions.

Decision made without vote. […]

Movement-wide association (MWA)

The IC directs that the individual criteria and institutional member composition and size criteria in the statutes apply to the MWA.

Decision (four-fifths majority), passed with:

19 votes in favour

1 abstention (MSF Italy)

The IC directs that MWA be incorporated into the statutes as a constituency of individual members (based on individual membership/affiliation in MSF International).

Decision (four-fifths majority), passed with:

16 votes in favour

3 against (MSF France, MSF Belgium, MSF Italy)

1 abstention (MSF Australia)

The IC directs that representation of the MWA (having met the above-mentioned criteria) have two seats to the IGA. The IC recommends that the IGA consider representation of the MWA.

14 in favour – 2 against – 4 abstentions. (Not a formal pass, but accepted as a positive indication to allow development of draft statutes and a detailed proposal. Subject to formal IC approval in June 2011.)

In February 2011, the ICB had a tense discussion on the revision of statutes, based on comments expressed by the MSF legal advisor and shared by several ICB members.

Some of them were still concerned with inclusion criteria for new associations being too flexible and a drift toward centralisation of the movement that could hamper the autonomy of operational centres.

document

Minutes from the MSF International Council Board Meeting, 17 February 2011 (in English)

MSF International Statutes

Introduction by Unni [Karunakara, MSF International President] and update on developments since the December 2010 IC meeting.

Unni tasked the lawyers with drafting a new version of the statutes based on previous IC and ICB decisions and based on existing statutes. Unni, Kris [Torgeson, MSF international secretary general], Adrio [Bachetta, Consultant on MSF International Governance Reform] and Françoise Saulnier [MSF Legal Department] provided instructions. Unni felt that the lawyers have done a good job.

Françoise had some concerns and wanted to address her concerns to the lawyers directly. As most of these were more political than legal in nature, Unni thought that the ICB should discuss these before forwarding them to the lawyers. Unni asks the ICB members to express their opinion on Françoise’ note and the drafted response as well as state any other concerns they may have regarding the statutes.

Reinhard [Doerfer, MSF Austria president] expressed his concerns regarding Françoise document by mail. For him, the new version of the statutes is good.

For Matt [Spitzer, MSF USA president], the document is clear, its purpose is clear and well within the scope of what we expect and in line with the decisions made by the movement.

Pim [de Graaf, MSF Holland president] agrees to the document and congratulate these who drafted them. Nevertheless, the fact that senior MSF people question some political decisions is to be taken seriously as we need to avoid a scenario of Gas [General assemblies] not approving the statutes because of second thought regarding the political general orientations. It is unfortunate that these questions are raised now but they remain legitimate and we need to address them.

Meinie [ Nicolai, MSF Belgium president] believes the document is good overall, although she understands Françoise’s worries regarding a possible threat to the core of MSF and how we manage operations.

She has several comments, questions and issues of concern:

• The new version of the statutes and related documents continue to state that the IGA can decide to increase the number of MWA representatives at the IGA. She insists that this be removed from all the documents; although this statement is right, mentioning it provides too much of a political message.

• How is accountability of individual members ensured? (The lawyers seems to share this concern).

• How to make sure that OCs will still have a strong enough voice?

• How to find the right balance between the need for more inclusiveness and for a variety of members at the IGA and the risk of the IGA becoming too big and impossible to manage (we don’t want MSF to become some sort of IFRC).

• We should maybe look into the veto right (minority veto of OCs or other sections’ veto) as proposed by Reinhard.

• We should also look into operationality and make it more of an IB responsibility.

Unni explains that in the new version of the [Governance Reform Process] update, any mention of a possible increase of the number of MWA representative at the IGA has been removed as per discussions at the Paris ICB. The confusion arises from the fact that IC did not reach the 4/5 majority in Athens on the issue of 2-seat representation for the MWA (4/5 is required for any change of the statutes).

Marie-Pierre shares Meinie’s concerns and considers these are crucial issues. She notes that overall, Françoise is defending the operationality of MSF and the need to keep this as an essential objective. She recalls that Françoise had sent a note explaining her concerns before the IC and regrets that this one page document was not shared at the time (Unni noted that because it was sent two days ahead of the meeting and hence not tabled for discussions).

Marie-Pierre believes it is important to open MSF more to the other societies, culture etc. and to integrate new voices to feed the reflexion and debate within a larger body. But this has to be done in a cautious way. Being more inclusive is good but we have to be responsible as well and we should not give power to these who should not have it. We need to be clear on which entities we are bringing in and what we expect from them, and we need a process that provides full guarantee and security, as OCs already agreed to be in minority at IB level.

Already in Barcelona, Marie-Pierre raised concerns on how to organise inclusiveness and the need for solid guarantees with regards to the composition of IGA, with strong and clear criteria to accept or not a candidature. The IGA can overrule the IB and can make any decisions, so we need to be very careful. Opening the door to more and more associations can drive us very quickly in a direction we have neither chosen nor expected.

Marie-Pierre believes that at this stage, the statutes do not provide enough guaranties with regards to the political agreements we made. In addition, as the statutes refers to the internal rule for many key issues, it will be impossible to make any decision on the statutes without:

• a draft version of the internal rules and

• clear criteria for admission of new members at the IGA. […]

Abiy recalls that for the past ten years, we’ve had very rough statutes, unfinished draft internal rules but we managed to work; so he does not see how new statutes of much better quality would prevent us from functioning smoothly. Nevertheless, Abiy understands the concerns regarding the balance of power between the IGA and the IB and he agrees on the need for clear recommendations on how the MWA should be integrated into the IGA. We need to devote enough time to identify the problems and find the right way forward.

Unni believe that the concerns of a power grab by new entities in the IGA to be overblown. The current 19 sections have two representatives each at the IGA. In order for these sections to be at a 1/5 minority at the IGA, we need to have an IGA of 190 members.

Marie-Pierre objects that lots of associations are knocking at the door. As there is no guideline on how and why to accept them, the easiest answer is yes (e.g. IC decision re the East Africa Initiative). So we can quickly end up with many more people at the IGA than expected.

Unni agrees that the composition of the IGA and a potential power unbalance resulting from a rapid change in its composition are legitimate concerns. But the statutes already contain all the elements to control this e.g.:

Article 16.2.h of the statutes stipulates that the IB shall:

make recommendations to the International general assembly concerning the establishment or dissolution of new associations registered under the Name of MSF, which are comprised of individual members and may eventually be considered for admission as Institutional Members

Article 11.3.l stipulates that the IGA shall:

approve recommendations by the International board to establish and disestablish associations registered under the Name of MSF, which are comprised of individual members and may eventually be considered for admission as Institutional Members

These articles provide guarantees that the size of the IGA will also remain under the IB control. In addition, the note to be sent to the new entities (that the ICB approved) clearly stipulates that meeting all the criteria does not guarantee a seat at the IGA, as it will be a case by case decision based also on the added value of the entity.

Unni fully accepts that we failed to discuss the application of EAA at the IC adequately and what added value they bought to the movement. This was more a failure of the process and less a problem of the wording of the statutes. However, he welcomes proposals on specific language to be included in the statutes on this matter.

For Matt, we need to find the right balance between fear and naivety; taking some amount of risk whilst making sure we don’t risk the very nature of the organisation. He agrees that there must be some criteria and a clear formulation of what is expected from the new members.

It seems that in the process of defining these criteria, we’ve become less ambitious since we decided that these were to apply to existing sections (as some small sections feared they could not comply with them).

Meinie agrees on the need to define better and strengthen these criteria. These should also apply to existing sections and we should be ready to make difficult decisions. She agrees with a careful control of the IGA composition, as this body will have in hands the Charter, the Statutes and MSF identity.

Unni suggests that he visits both OCB and OCP to discuss IGA size and composition:

> Language of the statutes,

> Language of the internal rule,

> Language to be used in instructions given to new entities to apply.

Marie-Pierre and Meinie agree. Matt agrees to also contribute.

In June 2011, the IC endorsed the revised statutes of the MSF International association.

In December 2011, the first IGA took place in Paris while MSF was celebrating its 45th anniversary.

MSF Brazil, MSF East Africa, MSF Latin America and MSF South Africa associations were presented and endorsed as MSF institutional members.

A panel debate with representatives from MSF, Human Rights Watch and ICRC tried to answer the question: is MSF an independent humanitarian actor?

Eventually, the IGA elected the six members who were to sit on the IB alongside the international president and the five operational centre presidents.

document

Minutes from the MSF First International general assembly, 16-18 December 2011, Paris (in English)

Extract:

PRESENTATION OF NEW ASSOCIATIONS AND VOTE

Matt Spitzer presents the evaluations and recommendations of the Associative Standing Committee (ASC): […]

A representative from each of MSF Brazil, East Africa, Latin America and South Africa are welcomed to present their association, introduce a short video and answer questions. […]

Floor – why is there MSF Brazil and MSF Latin America?

Representative for Brazil – MSF Brazil is borne from having operations and an office in Brazil for a long time. For a lot of reasons it was necessary for Brazil to have an association and this year for the first time it created board and statutes. MSF Brazil has 120 departures and raises EUR 5m each year. This is not antagonistic to the Latin American process, it is not a problem to MSF Brazil that MSF Latin America exists and they can work together.

Floor – it was said clearly that new entities should be regional associations, can you give more detail on how you envisage the future of regional associations and how they will evolve. For example, will the regional associations become several national associations or will the national associations merge to become regional associations? Will South Africa be based in more than one country? What happens if there is fundraising in different countries?

Unni – during the governance reform process there was a clear willingness and ambition to bring new voices to the table but at the same time having 20-30 new associations was not considered suitable as we need to be able to function and make decisions. A clear preference was stated for regional associations. Do not focus too much on the name but on the aspiration; it is important we are thinking in more than national terms and all these entities are approaching this with the right spirit and a collective voice. In future it is easier to split than to come together so it is good to start together. There is a clear understanding of the principle of non-exclusivity and the need to be organic so if changes are required for meaningful membership these will be dealt with at that point.

Floor – regarding resources for the whole association, we have a deficit projection of over EUR 60m for this year and huge operational ambitions, how will new associations bring new voices rather than divert resources from our beneficiaries?

Representative for South Africa – it speaks to our identity, in our social mission we are trying to get populations to provide care which is becoming increasingly difficult for many reasons, one of which is how open we are to other perspectives. It is the associations’ responsibility to engage with the world outside MSF and consider if resources might be better spent in another way.

Representative for East Africa – if you consider the added value the new associations will bring, including vision and ambition as well as the huge value our operations and beneficiaries will receive from this engagement, including the access it will grant us to our beneficiaries, the amount that will be spent on new associations is not a big issue.

Representative for Brazil – Brazil is here as an entity able to fund its own activities and give money to the Movement because at one point someone invested in us. Sometimes you have to make investments to get things back.

Floor – What will being a full member of the IGA bring to your association and how will it make it even stronger?

Representative for Latin America – this is a great opportunity to be formally recognised which is tremendously important just as it is for the people we assist to feel recognised. Representative for East Africa – most of our members feel like they are employees of MSF but not part of MSF and they want to feel ownership, for MSF to be theirs and this attitude can be changed by being part of the IGA.

Representative for Brazil – at the moment we do not feel as if we are inside MSF. Membership will bring responsibility and increase the power of our debates and allow us to add to Movement-wide debates.

Representative for South Africa – we know about the need for sectional inter-dependence, we need to speak about how bottom-up decisions and having this responsibility at the top filters down and improves our operational responses. The challenge will be to ensure the IGA is relevant, considers the relevance of our actions and ensures operations take into account our new voices when informing and critically examining operations.

Floor – some of the presentations, particularly East Africa, showed a crossing of the governance and executive roles. Have the associations considered those risks and the steps they might take? Counselling operational sections on matters of access and security might be very helpful but brings with it risk to personnel so OCs have a responsibility back. Normally associations give vision and the executive directs operations; in East Africa’s presentation your association appears to do both. If this is the case, thought must be given to how to manage those risks and whether your association can do both roles.

Representative for East Africa – operations usually consult national staff when making decisions as they know the context and how to solve problems. We are not looking to be operations, nor to be involved in decision making, speaking out etc, but we can offer advice. We plan to have a huge network, including key actors, to offer to Operations.

Matt Spitzer – this key issue of separation and respect for the boundaries between the executive and associative is ongoing and relevant to existing members too. During this process that question was asked along with how these entities could be involved with operations because they are so removed, despite the two questions clearly conflicting.

Floor – How do you make sure you are bringing a truly independent fresh new voice to the IGA if you have been funded by a section or OC?

Representative for Latin America – we receive funds from OCBa and have support from the International Office. We are trying to be financially independent and have been given good ideas on how to find more than one funding source and are thinking of other ways to search for funds.

Representative for South Africa – we are young and not financially independent yet but we imagine our future to be. Because our members meet across OCs it helps that there is not such a specific link. At the same time we are deeply connected to operational projects and we want to develop channels but that architecture does not exist yet so it is something we can talk about developing if we are part of the IGA.

Floor – how do we make sure people in the new association will contribute to and focus on the mission and prevent it becoming a union dealing with HR issues etc?

Representative for South Africa – when you take away the employee-employer relationship, the proximity to issues unites and binds members. This is not a trade union and has not been for the past four years.

Representative for East Africa – there are some countries where MSF is not present but members from there are part of our association and they still discuss the MSF vision. There is no issue of salary in those countries.

Floor – The self imposed freeze on growth has gone on too long; I am so happy we have the chance to welcome these four entities. I hear an absolute minimum; you are not pushing yourself as much as you can. There is a fear in Europe that as you are young, with so much energy and resources to offer the Movement you will change MSF forever. Are you worried you will be considered second class as you are so associative based and you are not harvesting resources (finances, people) or becoming operational centres yet?

Representative for East Africa – within the Movement do you consider there to be a first and second class? This question is not about people coming from our region, we believe one of the things MSF will continue to do is support our population. This is more valuable than comparing ourselves to Amsterdam, Paris etc.

Representative for Brazil – it is much more a challenge for us to show you who we are, as we are different and you do not know us yet.

Representative for Latin America – after you hear some of our contributions you will ask yourselves the relevance of present actors! […]

The IGA is asked to vote on the following resolution:

The IGA approves the associations of Brazil, East Africa, Latin America and South Africa as Institutional Members of MSF International.

A representative suggests voting on each entity separately rather than in a combined vote in order to underline the legitimacy of the decision for each association.

• The IGA votes on whether to vote for each association separately: […]

The IGA unanimously supports voting for each association separately.

A representative suggests conducting the vote in a confidential manner as she argues that it is a more democratic way as each representative will feel freer about their vote. A member from the Floor responds that to achieve transparency and democracy in MSF, the associations should know how their representatives vote, so this vote should be conducted in the open. The chair requests a show of hand from the IGA on whether to vote on the associations confidentially or openly and the chair concludes a large majority agrees to vote on these resolutions in the open.

• The IGA votes as follows:

Resolution: The IGA approves MSF Brazil as an Institutional Member of MSF International.

[…]

The IGA unanimously approves MSF Brazil as an Institutional Member of MSF International.

• The IGA votes as follows:

Resolution: The IGA approves MSF East Africa as an Institutional Member of MSF International. […]

The IGA unanimously approves MSF East Africa as an Institutional Member of MSF International.

• The IGA votes as follows:

Resolution: The IGA approves MSF Latin America as an Institutional Member of MSF International. […]

The IGA unanimously approves MSF Latin America as an Institutional Member of MSF International.

• The IGA votes as follows:

Resolution: The IGA approves MSF South Africa as an Institutional Member of MSF International. […]

The IGA unanimously approves MSF South Africa as an Institutional Member of MSF International. […]

Announcement of the IB election results […]

The IGA elects the following individuals to the International board:

3.5 years Morten Rostrup

3.5 years Darin Portnoy

2.5 years Colin McIlreavy

2.5 years Michalis Fotiadis

1.5 years Jean-Marie Kindermans

1.5 years Clair Mills […]

IGA motions and resolution list

2011:

• The IGA approves MSF Brazil as an Institutional Member of MSF International. Accepted

• The IGA approves MSF East Africa as an Institutional Member of MSF International. Accepted

• The IGA approves MSF Latin America as an Institutional Member of MSF International. Accepted

• The IGA approves MSF South Africa as an Institutional Member of MSF International. Accepted

2012:

Motions:

• Associative life in the field Accepted

• Requesting a review of associative independence for IGA representatives Adjourned

• Medical male circumcision as part of the HIV package Adjourned

• Amending the MSF Charter Accepted

• Reviewing the operational approach in Somalia Accepted

• Analysing the feasibility of an Operational Directorate outside Europe Accepted

• Coherence in representation Accepted

• Demand for common data collection and protocols Accepted

• Gender awareness Adjourned

• Environmental impact Adjourned

• Reviewing our western identity Rejected

• Reviewing operational choices on HR Rejected

2013:

Vision vote:

• MSF’s medical ambitions Accepted

• Compromises to our modus operandi Accepted

• Financial independence Rejected

• MSF and the aid system Accepted

• Roadmap for a framework for growth Accepted

• Roadmap for the development of the MSF Association Accepted

Motions:

• Enhanced and expanded advocacy Accepted

• Cohesion and diversity of MSF Accepted

• Kidnapping incident management Accepted

• An organisation of volunteers Adjourned

• Operational communications and fundraising Adjourned

• MSF USA motion on the health of resources to carry out our social mission Accepted

• MSF as a responsible employer needs harmonisation! Accepted

• IRP2 Rejected

• Remove the ‘Desert Year’ from the expatriate remuneration policy! Rejected

• Framework on associative life in the field Accepted

2014:

The IGA endorses SARA’s application for institutional membership Accepted

Motions:

• Motion on staff equity and empowerment Accepted

• Motion on improved set on steering ratios Accepted

• Motion on humanitarian space Accepted

• Motion on use of institutional funds in armed conflicts Rejected

• Motion on migration Rejected

2015:

• The IGA endorses MSF Southern Africa as a section Accepted

• The IGA endorses MSF Brazil as a section Accepted

Motions:

• Motion on medical presidents Accepted

• Motion on Institutional Membership criteria Accepted

• MSF France counter-motion on Individual Membership criteria Rejected

• Motion on Individual Membership criteria Accepted

• MSF UK amendment motion on motion on Contractual Guarantees Accepted

• Motion on Contractual Guarantees Accepted

• Abstentions in the IB Accepted

• Requirement for IGA reps to be sitting/current association presidents. Accepted

• Formalisation of the branch-to-section guidance note. Accepted

• Sponsorship of IB candidates and coverage of their expenses Accepted

• Motion on intersectional cooperation on security Accepted

• Motion on migration Accepted

• Motion on HR as a priority Accepted

• Motion on institutional and private funds Accepted

2016:

Motion:

• Motion on individual voting rights – local contracts Adjourned

• Remove ‘Belgium’/‘France’/‘Holland’/‘Spain’/‘Switzerland’ from legal and external branding in the social mission Accepted

• Humanitarian ethics: MSF’s commitment to ethics reflection, discussion and concrete measures to improve our humanitarian action and to reduce moral distress Accepted

• MSF and terminally-ill patients Adjourned

• International day of associative activism Adjourned

• Promote disability inclusion in MSF Accepted

• Towards a new MSF: Towards a revision of IRP-II Accepted

• Psychiatry in our projects Accepted

2017:

Motion:

• Medical and humanitarian consequences of environmental degradation on health Accepted

• Prevention and management of sexual violence and harassment Accepted

• Motion on local contract votes Accepted

• Motion: Call to action across the movement to enact the MSF resolution on safe abortion Accepted

2018:

Motions:

• MSF must not succumb to global HIV fatigue Accepted

• Palliative care – Beyond Saving Lives Accepted

• Promote and develop an organisational culture enabling and ensuring gender equality across the movement Accepted

• Growth, evolution and complementarity. The future of MSF. Accepted

• Towards a policy on smoking Accepted

• Humanity, respect and non-tolerance of abuse Accepted

• Towards an intersectional charter for patients’ rights and responsibilities Accepted

• Motion: A new OC model is needed Adjourned

Endorsement of new entities:

• Lebanon branch office Accepted

• Reinsurance captive Accepted

• Shared IT services centre Accepted

1. The international president and treasurer are ex officio individual members of ‘MSF International’.