Fresh Air

Last week, on June 25, the Israel Defence Forces (IDF) killed a Palestinian Islamic Jihad (PIJ) commander named Fadi Jihad Muhammad Al-Wadiya in an airstrike. In addition to his role in PIJ, where he was responsible for developing and advancing the terror group’s missile array and other work involving chemistry and electronics, Al-Wadiya also worked as a physiotherapist embedded with Médecins Sans Frontières (MSF), also known as Doctors Without Borders, the international medical aid organisation. MSF denounced al-Wadiya’s killing, saying, “We are outraged and strongly condemn the killing of our colleague, Fadi Al-Wadiya, in an attack this morning in Gaza City.” The NGO did not retract its denial that Al-Wadiya was a terrorist actor even after the IDF released several photos showing Al-Wadiya in his PIJ uniform.

This incident can be fairly described as one of MSF staff terrorism, and follows another kind of controversy, regarding MSF politicisation, the month of before.

In May, MSF President Dr Christos Christou visited Australia on a fundraising and public relations tour. Appearing at the National Press Club, his speech was a long denunciation of Israel – with the core message being that “MSF is frankly horrified by Israel’s assault on Gaza” and baseless claims that Israel is attacking medical facilities for no valid reason. He demanded, “Australia must take immediate concrete actions to hold Israel to account. Australia must apply appropriate sanctions on Israel.” He denied this was political, or contrary to MSF’s tradition of neutrality, saying, “That is not a political act. That is a medical act that follows the rationale of us trying to protect the people that we serve.”

These two incidents demonstrate how MSF is badly compromised. They are part of a larger pattern of extreme bias that has been evident with respect to the organisation for many years. MSF is a case study in a well-meaning aid organisation that has lost its way.

Who are MSF?

Some humanitarian aid organisations conduct political campaigns that undermine the helpful work they are meant to do. Yet, their management is subject to very little scrutiny or accountability because of the “halo effect” that surrounds their humanitarian work.

MSF is a case in point.

It is an international humanitarian organisation with a 2023 annual income of €2.365 billion (more than A$ 3.8 billion) whose purpose is to deliver medical aid to those in dire need.

But as the Fadi Al-Wadiya incident above illustrates, MSF has a history of allowing terrorists to operate with impunity in its facilities, of tolerating and defending terrorist groups and of making highly political public statements, especially with regard to the Israeli-Palestinian conflict – far from the ideal of neutral provision of aid.

MSF tolerance of terrorists

The case of Fadi Al-Wadiya is illustrative of MSF’s negligence with respect to working with terrorists. He joined MSF in 2018. He was at that time a rocket manufacturing expert, working in the PIJ rocket manufacturing unit for more than 15 years. The same year that he joined MSF, he sought to leave Gaza for Iran to undergo training with two other terror operatives. He was well-known to Israeli military intelligence. MSF either made no checks into his background – or simply didn’t care. And even after his background was exposed publicly, the organisation reflexively denied it.

Another example of MSF’s multiple collaborations with individual Palestinian terrorists and groups is Mahmoud Abu Nujaila, who was an MSF doctor and an official within the Popular Front for the Liberation of Palestine (PFLP) –  a terrorist group that is banned in many countries. He was the head of the PFLP Union of Health Work Committees, which ran the Al-Awda Hospital, with which MSF works extensively, and constantly praised PFLP terrorists and terrorist acts on his social media. Another medical officer MSF employed from that same Al-Awda hospital is Ahmad Al-Sahar, who publicly praised two Hamas terrorists on social media in April 2023.

MSF has also  provided funding to the Abdel Shafi Community Health Association (ACHA), founded and directed by senior members of the PFLP. On multiple occasions, ACHA facilities were used by the PFLP to hold events.

On August 20, 2018, Hani Majdalawi, a nurse working for MSF, “was shot dead…after shooting and throwing a grenade at soldiers.”

In 2007, an MSF employee from Gaza was arrested in Israel for allegedly plotting to assassinate Prime Minister Ehud Olmert. The NGO responded, “We are very sad for Bashir, but we want to make it very clear that we make a distinction between his professional work and what he does on his personal time. I don’t think our organization can be held liable for every aspect of its staff’s lives.”

Participating in hospital subversion

MSF humanitarian aid in conflict zones is often delivered through local partners.

In Hamas-ruled Gaza, where all hospitals are under the Hamas-ruled local Health Ministry, medical personnel are suborned into collaboration with Hamas. As pointed out by Anne Herzberg, legal research director at NGO Monitor, this is not a new phenomenon. In 2009, Gaza’s Indonesian, Al-Rantisi  and Al-Shifa  Hospitals were all widely reported as hosting Hamas military operations.  The head of USAID reported  in 2014 that Hamas used Al-Shifa as a military command base. A Dutch journalist recounted  seeing Hamas fighters using Al-Shifa in 2014 and that everyone knew about it. Reports say Al-Shifa had Hamas VIP areas, weapons and ammunition warehouses, intelligence and communications centres and gun firing and rocket launching positions, all encountered by the IDF in  2023.

Jewish women taken hostage on October 7 and later released in the late November hostages- for-ceasefire-and-prisoners deal recount how they were hidden within and under hospitals in Gaza. Globally distributed CCTV footage  showed armed men taking male hostages through Gaza hospitals whilst individuals dressed in medical scrubs watched on. Mohammed Abu Selmia, director of Al-Shifa Hospital, was arrested for his other role as a senior Hamas commander in November 2023.

in June 2024, volunteer Kurdish orthopaedic surgeon, Dr Baxtiyar Baram, who went to Gaza to provide medical aid, gave eyewitness confirmation that Al-Awda and Kamal Adwan Hospitals, where he performed surgery, were Hamas military strongholds. He explained that the reality is that Gazan doctors must accept that Hamas leaders use hospitals as military bases, saying “Many doctors in Gaza hospitals are senior Hamas operatives.” It would be impossible to embed in hospitals otherwise. He drank coffee with a founder of Hamas in one of them.

Although he had to work with Hamas, Dr Baram had the courage to speak out afterwards against this practice of embedding terror operations in hospitals. So why has MSF refused to do the same?

MSF ethical failures and possible criminal conduct

Many MSF staff in Gaza are locals and, for them, working alongside and for Hamas is their necessary modus operandi. Likewise, overseas volunteer MSF doctors are co-opted and do not speak out because they wish to continue their work in Gaza’s hospitals.

When confronted with the choice of providing medical assistance, or refusing to aid Hamas’ crimes, MSF doctors in Gaza hospitals choose medical assistance. As a matter of serving needy patients, this is arguably the right choice, putting individual patients first.

However, MSF’s further subsequent silence about this reality is not even arguably defensible. Silence is not in the best interests of patients’ lives endangered by use of hospitals as military bases because the hospitals thereby lose their status as protected facilities under the laws of war.

Also grave is that MSF doctors’ covering up of Hamas’ crimes is itself commission of a complicit crime known as concealment. Herzberg explains that a person is culpable for both acts and omissions, such as failures to report a crime.

The silence of MSF doctors and staff conceals Hamas’ crimes and enables further terrorist crimes. Not only individual doctors, but also MSF’s leadership are implicated in concealment by omitting to disclose those crimes.

The serious crimes that Hamas commits in Gaza include war crimes, crimes against humanity, terrorism and hostage-taking. These universal crimes are prohibited under almost all foreign laws. For example, they are prohibited under Australian law even if committed overseas. Moreover, concealment of such crimes are themselves likely also criminal offences.

Politicised anti-Israel advocacy

Dr Christou’s anti-Israel outburst noted above was hardly unique, nor are such politicised statements something new following the outbreak of the Israel-Hamas war on October 7. It is a part of a long-established pattern of partisan political statements by MSF officials. Here are some examples, as collected by NGO Monitor:

• MSF rhetoric includes accusing Israel of “collective punishment,” “indiscriminate bombings,” and “wholesale massacres”.
• In October 2023, MSF tweeted, “We are horrified by the recent Israeli bombing of Ahli Arab Hospital in #Gaza City, which was treating patients and hosting displaced Gazans. Hundreds of people have reportedly been killed. This is a massacre. It is absolutely unacceptable…” MSF ignored the videos, images, and intelligence materials demonstrating that an Islamic Jihad rocket had “misfired” (i.e. detonated in Gaza instead of Israel) and hit the hospital parking lot.
• In June 2021, MSF posted an article titled “The Disease of Settler Colonialism and Apartheid.” According to the article, “MSF will continue treating the wounds of this violence, but the cure for Palestinian suffering will only come with the end of settler colonialism and apartheid…We are treating the consequences of settler colonialism and apartheid, for which we have no medical cure.”
• In May 2018, during the violence on the Gaza border, MSF condemned Israel’s use of force, describing it as “unacceptable and inhuman”. MSF further claimed that “this bloodbath is the continuation of the Israeli army’s policy during the last seven weeks: shooting with live ammunition at demonstrators, on the assumption that anyone approaching the separation fence is a legitimate target.” MSF ignored the violent nature of the protests, which included Molotov cocktails, arson, and attempts to breach the border fence with Israel.
• In August 2016, MSF celebrated its 20 year anniversary of working in Hebron with a “play which displays the ongiong [sic] struggle in Hebron’s H2 area…[and a] photo exhibition showcasing the psychological effects of occupation and violence on Palestinians.”
• In December 2015, MSF-France launched an exhibition titled “In Between Wars”, meant to display “the haunting and recurrent side of the violence of daily life under occupation.” The exhibition pays tribute to Palestinian “martyrs” and refers to images of “Palestinian young throw[ing] stones and Molotov cocktails at heavily armed Israeli soldiers” as scenes “iconic of the Palestinian resistance against occupation.” The exhibition was described by the head of MSF-USA as “depicting the humanitarian hardships Palestinians face,” but, in reality, the exhibition served as a showcase for virulent anti-Israel propaganda.
  • Roger Cukierman, head of the Council of Jewish Institutions in France, condemned the display as “an apology for terrorism…that could inflame antisemitic violence.”
• In September 2015, MSF-Spain published a short video glorifying 14-year old Palestinian Ahed Tamimi, who has engaged in numerous provocations against the IDF. In the video, Tamimi is pictured under posters of family members whom she refers to as “martyrs”. One of them, Muataz Washaha, was a member of the PFLP terrorist organisation who reportedly planned and carried out terror attacks against Israelis across the West Bank.
  • The video claims disingenuously that “every Friday the village [of Nabi Saleh] demonstrates peacefully” against Israeli policy, thus omitting the numerous planned, directed and premeditated violent incidents instigated by the villagers, including by Tamimi herself.
• In a July 7, 2015 opinion piece, MSF-USA Executive Director Jason Cone attacked Israeli security policy while omitting Hamas terror attacks against Israeli civilians, alleging: “Israeli fears of rocket fire from Gaza… and the ongoing threat of tunnel-enabled attacks… cannot justify the devastating medical and psychological consequences for Palestinians of the barriers, checkpoints, bombing campaigns, blockades, and incursions.”
  • Cone contributed to the demonization of Israel by presenting Palestinian rocket attacks against Israeli civilians as being “acts of resistance on one side and terrorism on the other.”
• In a July 2015 promotional video, Mathilde Berthelot, an MSF program manager, charged that Israel uses Palestinian violence “as an alibi for a policy which is repressive and expansionist.” The video refers to Israeli military operations in Gaza as “wholesale massacres” and claims that Palestinians are subjected to daily “humiliation and oppression.”
• MSF’s internet campaign, “Occupied Minds”, features emotive stories of Palestinian suffering and Palestinians blaming Israel for their situations. The narratives often have little or nothing to do with medical issues. Descriptions of Israeli measures are devoid of context and erase Palestinian terror and Israeli self-defence.
• In July 2014, Jonathan Whittall, head of humanitarian analysis at MSF, accused Israel of trapping an entire population in “what is essentially an open-air prison.”  He continues to say that “Some of the prisoners have organised into armed groups and resist their indefinite detention by firing rockets over the prison wall.”
• In July 2010, MSF worked “closely with an Israeli team of burn specialists” to treat victims of a fuel tanker crash in the Democratic Republic of Congo. According to a Haaretz report, one of the Israeli doctors described negative interactions with the MSF volunteers, who “did not want to be around him or the other team members.”
• MSF accused Israel of “devastating disregard” for civilians during the 2009 Gaza war, alleging that Israel conducted “indiscriminate bombings” during the fighting.

MSF is in breach of administrative law by reason of its political lobbying. Organisations engaged in lobbying cannot be registered as charities. If it does not stop this politicisation, MSF risks undermining its charity status pursuant to the usual national laws in most jurisdictions where it fundraises.

Remedies going forward

The good health of the MSF Gaza operation and its organisational leadership are compromised in multiple ways: by breaches of ethics, by breaches of organisational ethos and by breaches of administrative and criminal laws.

The first corrective step for MSF to take is to examine and self-diagnose its institutional illness. It can then formulate organisational policies that will remedy its current politicisation and protect it from politicisation in future. This is a longer-term institutional health plan.

If MSF fails to take care of its illness itself, then steps might be taken by governments. These include governmental administrative and funding reviews.

MSF charitable status should be reviewed by the Australian and other governments in light of its public record of political advocacy. Ongoing failure to prevent these unethical and political activities must see MSF lose its charitable status altogether.

Governmental funding, whether direct or through partnerships with third parties, should be audited and suspended until MSF has put its house in order, via measures that prevent unethical, criminal and political activities.

Ultimately, there is the threat of criminal sanctions. Although admissible evidence from a foreign war zone is likely to be difficult to prove in courts, nevertheless governmental articulation of a bright line between humanitarianism and criminality under universal laws must be publicised.

In Aesop’s fable, a lame frog claims to be a wonder-working doctor but is taunted by a clever fox: ‘Physician, heal thyself!’. So must it be for Médecins Sans Frontières, which wore a halo but went rogue.

Greg Rose is a professor of law at the University of Wollongong, a senior fellow of The Hague Initiative for International Cooperation and a visiting fellow at AIJAC.