Keeping Faith: A How To Guide

Keeping Faith in Humanitarianism with Sandrine Tiller (Doctors Without Borders)

• Season 1 • Episode 4

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As crisis after crisis demands our attention, how can we hold onto our compassion and find meaningful ways to make a difference? Who do we trust when ‘fake news’ can travel the world through a tweet or WhatsApp chain? And how do we keep faith in humanitarianism, under attack from competing political agendas?

In this episode, we speak to Sandrine Tiller – Strategic Adviser to Médecins Sans Frontières  (MSF) or Doctors Without Borders – about what she’s learnt from decades working  in the humanitarian sector and the small ways we can all be humanitarians in our everyday lives. 

Find out more about Sandrine's work on  Mis-/Dis-information:

Follow Sandrine on X (formerly Twitter).
Follow MSF UK on Facebook, Instagram or Twitter/X. 


Keeping Faith: A How-To Guide is part of Women’s Interfaith Network's 2024 Keeping Faith Programme. Read more about the programme here and be the first to hear about upcoming events and ways to get involved by signing up to our newsletter. Views expressed on this podcast are the speaker’s own and may not reflect the views of Women’s Interfaith Network.

Hosted by Maeve Carlin

Produced by Maeve Carlin and Adam Brichto

Edited by Adam Brichto

Executive Produced by Lady Gilda Levy

Theme music composed by Jamie Payne

Logo and Artwork designed by Jasey Finesilver

Support from Tara Corry

Keeping Faith in Humanitarianism with Sandrine Tiller

Maeve Carlin: Welcome to Keeping Faith, a how to guide, a new podcast from Women's Interfaith Network exploring how women keep faith in ourselves, in each other, in a cause, or in religious faith so you can learn how to keep faith too.  

I'm your host, Maeve Carlin, and today we're speaking to Sandrine Tiller, strategic advisor to Doctors Without Borders, also known by its French name, Médecins Sans Frontières, or MSF, a humanitarian organization providing medical care and assistance to people affected by conflict, disease, and disasters around the world.

Sandrine has decades of experience in the humanitarian sector. Responding to crises around the world from Eritrea to Ukraine and as a liaison between humanitarians and researchers on issues like mis- and disinformation and the politicization of humanitarian aid.

In today's conversation, we discuss what it means to keep faith as we're confronted with crisis after crisis on our phone and TV screens, how to navigate an information ecosystem that feels more overwhelming than ever before, and finding the small ways we can all be humanitarians in our everyday lives.

Keeping Faith: A How To Guide, is part of Women's Interfaith Network's 20th Anniversary Keeping Faith program, a year-long conversation bringing women together to unpack what keeping faith means to them. You'll hear more about the program in future episodes, but for now, let's jump into our conversation with Sandrine Tiller.

Maeve Carlin: Thank you so much for making the time to speak to us Sandrine. Can you share more about your journey with MSF and how you got into the humanitarian space? 

Sandrine Tiller: Yeah, thank you very much for inviting me on this podcast. So my journey with MSF actually starts a long time before I joined MSF. After university, I got involved in some grassroots work in South America and Venezuela and really kind of woke up to working in communities.

And I was doing a lot of work with reading promotion and rural community development. And so I became a development worker and eventually got a bit disillusioned with development work because sometimes it feels a bit never ending and I couldn't get away from it really replicating a lot of the colonial structures, whereas I eventually ended up working on a short contract with the Red Cross movement. And I did evaluation in Kosovo, and the head of the education department there. We had been rebuilding some schools after the war in Kosovo. And he said to me, “you came when we needed you. You did what you said you would do. Thank you.” 

And I really felt like this moment, you know, the light came upon me and I thought, ah, okay, this is how I'd like to work. It's really helping communities when they're in crisis, when they're overwhelmed and really be there in an act of solidarity and support, not to kind of teach people what to do, but to be like an extra hand. And that's really how I see humanitarian work. So I worked with the Red Cross movement for about 10 years and then moved to MSF, Doctors Without Borders or Médecins Sans Frontières in French. And I've been there for about 12 years. 

Maeve Carlin: Wow, thank you so much. I mean, I totally agree with you on that sort of discomfort with those paternalistic elements of development. And I think that's why that more witnessing/advocacy side of MSF's work as well as response in a crisis, I think really resonates with so many of us as a different way of working.

We know that aid is now highly politicised and we've seen this particularly in recent years around our response to migration, whether it's European countries criminalizing volunteers rescuing people in small boats, or the Panamanian government recently ordering MSF teams to stop treating migrants crossing the Darien gap between Panama and Colombia.

How have you seen this politicisation evolve over your career in the sector? And how do organizations like MSF navigate this hostile policy landscape? 

Sandrine Tiller: You're entirely right. Aid is really a political tool. There was a time, perhaps, when we did believe that certain governments could separate their aid policy from their national interest.

And certainly I think the UK government made an attempt to do that with the creation of DFID, the Department for International Development. And the kind of very clear separation between foreign office objectives and aid objectives. And to give it its due, I think UK government was definitely very interested in supporting independent, impartial and neutral humanitarian aid. And, and did so in many cases. 

But I think, you know, the world has really evolved in the past 10 years. You've really seen a much more multipolar world and competing visions around aid, around development, and really seeing how aid has become part of the toolbox in the foreign and diplomacy way of working.

So we've seen in certain countries, aid is really part of an economic program. It's part of a foreign influence program. One of the reasons why I absolutely love working with MSF is that the proportion of money that we take from governments is absolutely tiny. Our global budget is something like 2.2 billion euros. And 96 percent of that is from the public. So it's, it's private money, meaning we are not taking it from government. 

So we don't take money from the EU because of their migration policies. We don't take money from the UK or from the US because of their involvement in various conflicts. So each of the conflict areas where we work, we really look at who are the belligerents, if you want, and who are their funders, and we ensure that we stay independent by not taking any funding from those governments.

So I think this is one of the existential issues for the humanitarian sector right now. We have huge expanding needs. You know, the climate crisis is really actually exacerbating a lot of humanitarian context. Also, we've got some major wars happening now. You can think of Sudan, of course, Gaza, Ukraine with really kind of high intensity, huge displacement, huge destruction, let alone all the droughts and climate events, et cetera.

So you've got a really expanding caseload, but then the funding is really plateauing. and becoming much more instrumentalised. Um, a lot of foreign aid budgets are being used to fund actually domestic refugee or migrant operations. So having that independent funding is really key for the humanitarian sector.

And anyone in the sector is usually quite jealous of MSF. But we work really hard actually to have a kind of ‘people-to-people’ approach. So our donors are, you know, people like you and me. And I was a donor to MSF before I joined actually. We really see them kind of as part of our work. That was a long answer, I think.

Maeve Carlin: No, it was a brilliant answer. I was just thinking that my great aunt for her 100th birthday, instead of flowers, she wanted donations to MSF when she turned 100. So if you're listening, Auntie Margaret. 

Sandrine Tiller: I'll say thank you. 

Maeve Carlin: So this conversation about politicizing migration leads me to something that I only discovered recently and that many people I've spoken to aren't aware of: that MSF is now providing healthcare to asylum seekers detained in former military barracks in Wethersfield, Essex. Can you tell us how political debates around migration are impacting refugees and asylum seekers on the ground here in the UK? 

Sandrine Tiller: Firstly, anyone who is a refugee or an asylum seeker has been through a very difficult mental journey. The decision to leave your home is incredibly anxiety producing. I mean, you can think of it, even if just yourself, you know, if you have to move to Honolulu tomorrow and say goodbye to everyone in your family and go by yourself, you don't know anyone. It's just an absolutely scary thing to do. So psychologically, many of the people that we see in the UK and other places are already coming with that kind of trauma of having left their former identity. We're talking about people who may have been students or professionals or having certain status in their society.

Then they have the trip itself, which is, in our experience, really traumatic. I mean, we're working in places like north-eastern Syria, we're working in Serbia, in Greece, in the islands where some of the migrants end up, also in Italy, in Libya. So we are on all parts of the route. And we can see that the position of Europe, and the UK is part of that in a bigger sense, is really about deterrence, about pushing people into destitution. 

There is an argument that this is about stopping people from coming over, they'll be deterred if they see how badly the facilities are, but that's not at all the case. I mean, most people, if they want to come to the UK or Europe, what they're doing is they're looking for stability, they're looking for protection. And what we have in the UK is a precious society, which you can come from adifferent place and have a chance, you can actually be received in a culture that is open and where you can speak freely, where you won't be persecuted for being gay or for speaking your mind about a political issue where there is the rule of law, where policemen aren't gonna shake you down. So I think this is why people come and if they see, “oh, the barracks are dirty” or it's hellish, they think, “oh, well I will endure because this is my only choice”. 

So we see people who are quite fragile. We see a lot of mental health problems and the indefinite nature of detention is very hard for people to bear because they don't know what's going to happen to them. There isn't a clear procedure. There's so, such a huge backlog and it's on purpose to delay asylum cases to be seen. It's a very traumatic process. And I should say that if you put people together in a closed off space, you don't know who you are anymore. You don't know what your life's purpose is anymore. It really affects your psychology. So it's a very tough. environment. 

And I think, you know, the political debate creates a tension also around people who are trying to help, you know, a neighbour who wants to do something nice for, uh, refugees from Ukraine or from Sudan. They might feel intimidated to reach out a hand because they might feel that it makes their position precarious or that they might be attacked by people who are against this policy. So it's created a lot of tension within the sector as well. 

Maeve Carlin: I think that's a really interesting point about what are the wider ramifications of this hostile political conversation, of course, for the refugees who are most impacted, but what does it do to all of us to demonize the act of wanting to help each other? I think that's a really important point.

This sort of depth of suffering that we're seeing from refugees and migrants leads me into my next question, which is when people switch on the news or look on social media, there are so many crises that need our attention. And I think understandably what happens for many people is that they switch off the news, or they feel paralyzed, or alternatively we engage selectively with one humanitarian crisis but overlook another. Many people have mentioned this recently with regards to Sudan and the Congo. 

I'd love to hear from you how you think we can cut through this kind of compassion fatigue or overwhelm to get through to people and also what those of us listening can do when we experience that overwhelm to move through it to a place where we can take action.

Sandrine Tiller: Yeah, it's a good question. And I think, you know, even as a humanitarian aid worker, you often feel unbelievably helpless, you know, even though it's our job, you feel like, how can we change this situation? My view is, firstly, no one should beat themselves up about feeling compassion fatigue because there's a lot going on. Try also to read the news with care and with attention, and then not end up in the doom-scrolling kind of patterns. 

People living in crisis situations really appreciate having their stories heard. So when there are stories written by people who are in the middle of a crisis, read them, because it's very important, uh, at least in my experience, you know, having worked in, in different conflict zones, people often just really want to tell you their story and they want to, someone to say, yeah, that that's terrible what's happened to you. I'm, I'm really sorry to hear that. So that is an act of compassion, I think, being able to listen to people.

And then the other thing I would say is that there are small ways to help. I belong to a little WhatsApp group. I live in Wandsworth. So the Wandsworth, uh, Welcomes Refugees. So it's a little WhatsApp group. And every now and then they'll say, “Oh, does anyone have, you know, a spare radio, or we've got some new asylum seekers who need bikes or who need phones.” And so we sort of help each other out and, well, provide small scale neighbourly assistance through this group to, uh, refugees and their clothes collections, there's like a quiz night, you can just make a donation. And these are refugees who are, and asylum seekers who are in hotels in my borough.

For me, that's like a small thing that, um, it makes me feel at least that… Yeah, I got emotional there, but, um, yeah, I think it's, it's hard, I think for people in the UK, you know, it's hard for me to know that in my borough, there's people who are, you know, living in some hotel on five pounds a week looking for a way to, to change a situation.

So yeah, so I think these small gestures can be really important as well. And you know, take care of yourself, take care of your loved ones, that's important. 

Maeve Carlin: I, I think that point about encouraging us to start by looking close to home and you actually don't know how far that will take you, you know, looking even in your street WhatsApp group, who needs you there.

And that could take you somewhere that you're really not expecting. These conflicts are here now, all these people, they're in hotels in your borough, as you said. 

Sandrine Tiller: Well, I was in Trafalgar Square on the weekend and I couldn't believe that there was a huge food bank and clothes distribution, you know, full of tourists. That's where we're at now in the UK. All right, now, stop making me cry, because I'm going to cry. 

Maeve Carlin: And I'm going to cry, and we're both going to cry. 

But again, it comes back to that point that it's here, the need is here, the global conflicts, the global crises that you hear about, they're here too. Look close to home, seek it out, do something small.

Sandrine Tiller: Yeah. 

Maeve Carlin: And it might become bigger. 

Sandrine Tiller: Yeah. And at least you're radiating one good thing, you know, you can feel that is a contribution. And I think the worst thing we can, we can do is just end up in a feeling of helplessness and retreat. But yeah, it is overwhelming. It feels overwhelming at the moment, the news.

Maeve Carlin: Speaking of big overwhelming topics, I know throughout the sort of core years of the pandemic, you were doing a lot of work on mis- and disinformation and the info-demic, where we had this massive influx of information against the backdrop of so much uncertainty and confusion, which often damaged public trust in healthcare providers and in public health messaging.

Can you tell us more about that? What have we learned about how communities keep faith in public health information? 

Sandrine Tiller: Yeah, I mean, one of the areas that I was just talking to a colleague about is the volume of information we've got barrelling towards us every day is so huge. She was talking to me about a concept called health literacy. So really about understanding how to access information, how to evaluate information and how to apply information around health. This, I think, is where we need to move towards, not just providing a good message but helping people manage the health information ecosystem and to be able to evaluate, for example, when information is reliable and when not.

We in the UK are very lucky because firstly, we have an amazing NHS information system. You know that you can look on the NHS website and you can just get a very factual, clear, approved piece of information. In many of the communities where we work, there is no NHS website. Maybe people can find the World Health Organization website, which is useful, but often they will be directed to a bunch of different Facebook groups or social media groups or websites with all kinds of information on there.

So, I think, understanding the environment, the information ecosystem that people are living in. And there you can even have, you know, different generations accessing information in different ways. You can have young people getting their info on Telegram or Snapchat, you can have the older generation getting it from TV, others may be still reading the papers, others may be looking at foreign websites with a VPN, or they may be just reading the state media.

So really understanding where people are getting their information from, and then, uh, identifying the reliable information and the unreliable information is really important. This idea of actually building some kind of literacy within the communities is really important. That's an area we're really working on.

Maeve Carlin: Was there a period - after that first wave of major sort of disinformation, misinformation, particularly online - where there was a conscious effort, not only to get information out there, but to go in and kind of rebuild the trust that had been lost? And what does that look like? 

Sandrine Tiller: Trust is our most valuable currency. I mean, trust between people and their healthcare providers is absolutely essential. Very important, firstly, is consistency, reliability, understanding where people are coming from, what are they worried about? What is their health seeking behaviour? What kind of things will trigger them to come to the hospital or not come to the hospital? Are there any obstacles, any barriers? Is it a language thing or is it, you know, they're scared. It turned out in one community, you know, people were scared of the temperature thermometer because it looked like a kind of laser gun, which it does. Understanding what, “Oh, that's, putting people off”. Right? 

So you have to kind of really immerse yourself also in that community. In MSF, we have vast legions of community health promoters who really kind of go house to house or, in refugee camps, they'll go tent to tent and check in on people, especially looking in the corner. Oh, is there someone over there? Oh, they've been sleeping for two days? What's going on there? Or, oh, this disabled person hasn't been able to come to clinic. Well why not? Can we find a way to make sure they come? Or sometimes bringing a doctor or the nurse out to the community to do a kind of in situ health care provision. 

So I think it's that relationship of trust that people know that they can count on you. And in our case, of course, we also have all free services, but they know we're not asking for money. So it's not a money making operation. And that I think also is a quite important part of that trust relationship. 

Maeve Carlin: Speaking of trust, in many communities, both in the UK and around the world, the trusted source is often the local faith leader. And organizations like ours work to bridge the gap between the secular and the religious.

We know there is often a discomfort from secular organizations in engaging with anything that feels too faith-based and vice versa. So what have you learned in your work about how we can bridge those gaps to get the messages out but also make sure we're having culturally and spiritually sensitive conversations about health and healing?

Sandrine Tiller: I think, you know, MSF, we're a secular organization. Our way of seeing the world is very much mediated by the humanitarian principles. So the principle of humanity, the principle of impartiality, which is about not discriminating against people but treating people according to need. The principle of neutrality, which is about not, uh, taking sides in a conflict or, or even in a, on religious sides. So for us, that is a little bit how we frame our environment. 

But of course, we are working within communities that have faith. I think we have more to do on that, but we try to, uh, create spaces for worship in our, in our facilities to support, um, I mean, of course, in hospitals, we have death and dying, so we also try and connect with different groups to help us manage those processes better. During the Ebola crisis, for example, I think a lot of agencies, and I think we did too, made the mistake at the beginning to really see death in a very medical way to, you know, basically separate, uh, dead bodies from the living and make sure nobody touched each other when actually washing the body was quite an important, uh, death ritual for people in West Africa. 

And so we learned about that and we adapted, I think. The other thing is that we really recognize the role of faith leaders and certainly on topics like health information. Having faith leaders echoing or bringing good health messaging is absolutely crucial. It will really help to ensure that people are able to understand what is going on and make sense of it within their spiritual world.

Health and healing - it's a very deep aspect of our humanity, isn't it? Our health, our bodies, our minds, and how we live through life's tough moments. So I feel there's more we could do on this. But yeah, we are trying and working on it. 

Maeve Carlin: Well, it's exciting to hear about that work and that sort of more holistic conversation about what it means to be well, both as an individual and a community. I think it's a really important conversation. 

Thank you so much, Sandrine, for your insights. Can you give us an example, whether it's recently or less recently, of a time when this work has restored your faith? 

Sandrine Tiller: I was lucky enough to get deployed to Ukraine at the beginning of the war. I was working as a kind of government liaison, so working out who we needed to talk to in the Ukrainian government, make sure that we were talking to the right people and getting the permits we needed and, and all of this.

And I met some community groups who had been anti-corruption activists. So they had been working prior to the war, basically on monitoring local council activities to make sure that their contracting procedures were right. And I mean, these young people just decided to completely pivot all of their activities towards humanitarian work. Quite a few of them joined MSF and became our project coordinators and our key middle management and some actually senior management people. So really a kind of reinventing themselves. 

And I felt that was something that was happening in the Ukrainian society more widely. They really wanted to be the protagonist. In the humanitarian response, we, we had to, you know, step back and support them. It's a new environment, humanitarian aid, there's a lot of things that you need to know if you've got no experience of it: you know, things like logistics and how to organize shipments and how to manage food distribution or medical distribution, those kind of things, how to do an assessment. People may not be familiar with all of that, and you wouldn't if you're living in peacetime. 

But we really saw how our Ukrainian colleagues just developed these incredible skills and then of course, were, you know, absolutely spot on in terms of how they manage their relationship with the community and how they engaged with their own society, which was going through a massive trauma.

And they became kind of leaders or exemplars. To themselves. And I just found it a really inspiring time and I came back, yeah, very pleased that actually we were able to shift gears ourselves and, um, allow for a much more, yeah, a kind of Ukrainian response with some of us who are experienced in emergencies to be there as advisors and also to take the responsibility on our shoulders and not to overwhelm them. And I'm still so proud of all of my Ukrainian colleagues who are still working in really, really difficult circumstances there. Yeah. 

Maeve Carlin: And that brings us back to exactly what we were saying at the beginning about working in a way where you can be led by a community, not leading a community and getting away from that uncomfortable colonial dynamic that lingers around some aspects of this work.

Well, we've been talking about incredibly complex and evolving challenges facing humanitarian organizations right now. So how do you keep faith in this work when there are so many obstacles in the way? 

Sandrine Tiller: Well, being a humanitarian is a, is a kind of strange job because like everyone is a humanitarian, really. It is part of being a human to care for humanity. Obviously, there's some exceptions who may not care that much for humanity, but it is in our nature to help others. So, I don't feel in any way, uh, more special than others. And I often see people, carers, people in their community, volunteering, giving of themselves to an amazing degree, and they are often unnoticed or unsung.

So I feel that actually we as human beings have to be humanitarians, really. And I try in my life, with my family, my friends, with myself, my colleagues, I really try and embody the good values of kindness and reciprocity and not being too hard on people, forgiving them if they say foolish things, as we all say foolish things at one time or another, and trying to find ways to connect to each other, find commonalities between each other. I feel that that is the way I want to be and I try to be. We need to be interconnected. We need to be caring of each other because we are facing a very difficult time and we have a lot of big challenges ahead of us.

Maeve Carlin: Thank you again. What a brilliant conversation. Thank you. 

Sandrine Tiller: Oh, great. Oh, it's been a real pleasure, Maeve.

Maeve Carlin: We’re so grateful to Sandrine for making the time to share her experience with us, and reminding us of the small steps we can all take to make a difference close to home. You can find out more about MSF and the vital work they do around the world at the link in our episode notes, wherever you’re listening to this podcast. 

Thank you for listening to this episode of Keeping Faith: A How To Guide. Subscribe now on your podcast app to be the first to hear about our upcoming episodes, and please leave a review or share with a friend to help more people find us. To find out more about the podcast, the 2024 Keeping Faith Programme or to get involved with Women’s Interfaith Network, you can follow the links in our episode notes or go to wominet.org.uk. Until next time, Keep Faith!

 

Keeping Faith: A How-To Guide was created by Women's Interfaith Network. The podcast is co-produced by me, Maeve Carlin, and Adam Brichto. Our executive producer is Lady Gilda Levy. Theme music was composed by Jamie Payne and our logo was designed by Jasey Finesilver. Additional Support from Tara Corry.