Interview with Stephane Doyon, Operations Manager at Medecins sans Frontières in Paris. He completed his first humanitarian mission in Sierra Leone in 1996 as a logistician with Action Contre La Faim (ACF). After four additional field missions in Africa as logistician and then head of mission, he joined the ACF Parisian Headquarters in 2000 as the chief of operational logistics and then becoming the Desk for Asia Programs.
In 2003, Stephane joined MSF as a head of mission in Sierra Leone and then Colombia. In 2006, he coordinated the advocacy Campaign against malnutrition of MSF with OCP and the Access Campaign, working in MSF’s Paris headquarters. Since September 2023, he is also a member of Steering Executive Board of MSF Access.
1/In your view, what are the most effective ways to improve the performance and efficiency of nutrition delivery in humanitarian contexts?
When I first worked in the field, the main constraints were technical and operational, as before the advent of ready-to-use therapeutic foods (RUTFs), all children suffering from acute malnutrition had to be hospitalised. This meant that, during major crises, hospital capacity was quickly overwhelmed, and it was impossible to meet the needs of everyone.
The innovation of therapeutic foods, combined with changes in protocols, has completely transformed the situation. It has made it possible to treat children at home and to move towards much more decentralised models. Today, in certain contexts such as Nigeria, it is possible to care for a very large number of children. The technical limitations have therefore largely been overcome. The main obstacles now lie elsewhere: they relate to resource mobilisation and funding.
Nutrition has long been regarded as a strictly humanitarian issue, funded mainly during times of crisis. This creates significant instability: funding depends on the level of media coverage or on whether a situation is classified as a “crisis”. Areas with comparable needs may thus receive significant support or, conversely, be neglected depending on prioritisation criteria, which distinguish between crisis zones and conflict zones. We therefore see a form of structural “triage”, which depends as much on financial capacity as on the political recognition of crises.
Specific areas known as “fragile” are also defined as zones where de facto authority may differ from government authority. However, in most contexts, health issues are often managed through government channels, and it becomes difficult to deliver this aid when a given area is governed by another actor. In north-eastern Syria, Darfur or certain areas of the DRC governed by armed groups, it is difficult to deliver humanitarian aid to these sensitive areas due to political and security constraints, and sometimes because of a waning commitment from the international community.
Today, in fragile contexts, the main challenge is no longer technical, but rather one of resource mobilisation and predictability.
2/How can stronger humanitarian diplomacy and better protection of aid workers improve access to life-saving nutrition interventions?
Access to healthcare depends above all on respecting and protecting healthcare facilities and medical staff. When healthcare facilities are not protected by the warring parties, their ability to continue operating becomes uncertain. Staff are exposed to risk, which limits the continuity of services or may discourage people from seeking care. Under these circumstances, access to nutritional care is directly compromised.
With Ukraine as a most recent example, we are seeing a worrying erosion of these principles; international humanitarian law is no longer being respected, including by states who have historically been strong advocates for these principles. Ensuring the protection of healthcare infrastructure and workers is therefore essential to guarantee the continuity of services and enable people to access them without hindrance.
3/What concrete measures should the EU prioritise to ensure safe, inclusive, and people-centered nutrition assistance?
On a global scale, it is now unacceptable that, in the 21st century, children continue to die of malnutrition when such effective solutions exist. The main challenge now is to mobilise sufficient financial and political resources. Innovative mechanisms, such as sustainable funding or dedicated taxes, could help to secure budgets more effectively. The needs are estimated at around $2 billion, which remains modest given the resources that can be mobilised by international donors.
Beyond funding, it is essential to make responses more inclusive and integrated. For a long time, a strict distinction was made between prevention and treatment. Today, it is necessary to do both simultaneously. Simplified protocols already allow for better coverage of both severe and moderate forms of malnutrition, but this approach remains insufficiently implemented.
In some contexts, there is even a reverse trend, with increasing segmentation of care, driven more by funding constraints than by medical justifications. Inclusion must also extend to mothers and pregnant and breastfeeding women. Their nutritional status is often similar to that of children, and their care is crucial for child health. Integrating these groups into programmes is essential.
Finally, prevention efforts must be strengthened, particularly through social protection systems in times of crisis. The aim is to take early action to prevent nutritional decline rather than intervening only once malnutrition has set in.
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