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Doctors Without Borders chief Joanne Liu is determined to hold the world elite accountable

Dr. Joanne Liu on the campus of McGill University in Montreal, the school where she first studied medicine.

Angus McRitchie

Joanne Liu does not have much time to sit around watching Netflix, but on vacation recently, she caught a series that has captured her imagination: Homeland, the acclaimed political thriller about the fevered plots of U.S. spies and their terrorist enemies. The show stresses the intelligence community's fallible humanity, but also its brutal comfort with collateral damage. Watching it, Dr. Liu says, "You start thinking, 'How could Kunduz be a mistake?'"

She is referring to an incident that remains the most upsetting – "by far" – of her tenure as Canada's second international president of Médecins sans frontières (MSF), the famed charity also known as Doctors Without Borders.

Kunduz is the city in northern Afghanistan where, last Oct. 3, an American air strike killed 42 patients and staff in an MSF hospital. The sick and wounded burned in their beds as a helicopter gunship spent 29 minutes strafing the facility, continuing even after MSF had called the military in horror.

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Afterward, commanders said it was all a big mistake – despite their sophisticated technology and intelligence gathering, they'd mistakenly believed the hospital to be a Taliban compound.

In the months since, MSF facilities in Yemen and Syria have also been bombed, incurring heavy casualties each time. Then, at the end of April, the Pentagon reported that, rather than face criminal charges, those responsible for the carnage at Kunduz would merely be reprimanded.

In a video produced by Médecins Sans Frontières, a staff member tours the ruins of the hospital in Afghanistan destroyed by U.S. air strikes.


Soon after the Kunduz attack, U.S. President Barack Obama called her to apologize. But his remorse did not strike Dr. Liu as entirely heartfelt. "I think he's on message," she says. "He's probably on call number 55 of the day."

Now Dr. Liu has decided to drop the gloves and make putting an end to such attacks an immediate priority.

MSF suddenly pulled out of a special summit that took place this week in Istanbul to call for a better international response to humanitarian crises, calling it "a fig leaf of good intentions."

The Geneva-based Dr. Liu did, however, go to New York this month to call on the UN Security Council for a renewed commitment to the safety of medical facilities in war zones. "It's worth the fight," she says. "I have nothing to lose."

Then again, the Quebecker who, at 51, wants to become the first person ever to serve two consecutive terms at the helm of the Nobel Prize-winning agency, is not one to shy from a fight.

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With the posture of a GI and the bulging knapsack of a college freshman, Dr. Liu cuts a rather daunting figure when she enters a room.

It is not, necessarily, a misleading impression. During an interview in Montreal earlier this year, she uses the word "bullshit" liberally and emphasizes her points by pounding on the table.

"I'm completely allergic to being politically correct," she says, and then spends nearly two hours proving it.

It is a fitting performance for the leader of an organization that prides itself on bad manners. Even as it has grown into a well-oiled machine, with its staff of over 30,000 and more than $1-billion in annual revenue, MSF has preserved the rebellious spirit of the French doctors who founded it, strutting across the world stage with a curled lip, denouncing brutal regimes and Western complacency alike.

Dr. Liu is skilled at this kind of tough talk, and seems to relish it. During the Ebola crisis, she scolded the World Health Organization (WHO) for its tepid response by saying, "We wanted Batman, and you didn't even send us Robin."

But, thanks to the leadership it displayed during the epidemic, MSF is now enjoying its longest moment in the spotlight since winning the Nobel Peace Prize in 1999 – when led by another Canadian, James Orbinski – and Dr. Liu has begun to acknowledge the need for a little diplomatic finesse. The organization, she says, needs to go beyond "just bashing everybody."

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It's why the Quebec City-born physician reluctantly decided to attend this year's World Economic Forum, the annual confab in Davos, Switzerland, for the global helipad class – "not my crowd," she concedes.

The challenge now facing Dr. Liu – in the last year of a three-year term – is how to keep her elbows out even as she rubs shoulders with the world's power brokers. A self-described "stunted adolescent" with a deficit of charm, she also has a surfeit of self-awareness that may make her just the person to pull it off. "I think we can be the rebels at the table," she says.

Shared roots in Biafra

Understanding Dr. Liu, and understanding MSF, means going back to 1970, when she was a six-year-old living in the Quebec City suburb of Charlesbourg. Images of civil war and famine were emerging from the Nigerian region of Biafra – pictures that showed children with tent-pole legs and distended bellies, hallmarks of extreme malnutrition.

Piped into every living room with a TV in all their stark, alien horror, those starving children piqued the world's conscience. Dr. Liu and her parents were not immune. "When I was young and I wouldn't eat, my parents would say, 'Eat, or else you're going to become a little Biafran,'" she says.

As the unfolding disaster in Nigeria was awakening her awareness of the wider world, it was bringing another powerful force into being, closer to its source. In 1971, a small group of doctors and journalists, many of whom had worked for the Red Cross in Biafra, formed MSF.

Then, as now, the Red Cross maintained a policy of discretion in war zones to ensure access to patients on both sides. The rebellious French doctors rejected this logic, insisting instead on the power of témoignage, or bearing witness.

Although Dr. Liu shared a seminal moment with MSF, her path to its leadership was circuitous. As a teenager, she was earnest and bookish, but still in search of herself. She navigated those uncertain adolescent years by reading stories of epiphany and spiritual growth, books like Zen and the Art of Motorcycle Maintenance and Siddhartha.

In her fluent but slightly off-kilter Québécois English, she calls this period "the journey to search for your soul."

Many people who know her say that she was also formed by the alienation of being a visible minority in the deeply pure laine suburban Quebec City of the 1970s. "She struggled, being the only Asian student in a high school and all that," says Conrad Sauvé, head of the Canadian Red Cross and a fellow Quebecker. "That's part of her personality, and part of her fighting spirit."

To find an outlet for that fighting spirit, Dr. Liu would have to look abroad. Like many idealistic Canadian teenagers, she signed up for Katimavik, the national youth-service program, but found it unsatisfying, and her fellow volunteers immature. She was 20 by the time she received a flash of revelation like those depicted in her favourite books.

It happened on a trip to Mali with another humanitarian organization, now called Crossroads International. Africa was obscure to her then, a jumble of images and misunderstood phrases from childhood. Raised middle-class by parents who ran a Chinese restaurant, she saw desperate poverty and real hunger for the first time in Mali.

"That was the really lifetime-changing experience," she says. "It really deeply touched me. And I remember, when I came back, I said: 'This is it – I'm going to go into medicine.'"

Her professional choices from that point on were remarkably disciplined. In medical school at McGill University, she specialized in pediatrics, realizing children in developing countries would always need care.

Her fellow students and trainee pediatricians, many of whom she remains close with, remember her as tomboyish, outdoorsy, supremely energetic and – then as now – irreverent toward the powers that be. "She was already quite a personality back then," says Valérie Lamarre, now a physician at Montreal's Sainte-Justine hospital, where the two trained. Bowing to convention has never been her strong suit, Dr. Lamarre adds. "We were a bit of a group that was … disres-pectful of authority."

Of course, to work for MSF, Dr. Liu was going to need more than a chip on her shoulder. After graduating from McGill, to prepare herself for the gore she knew would be waiting for her on the front lines of the world's conflict zones, she interned at Bellevue Hospital in New York.

"I wanted to do stab wounds and gunshot wounds," she recalls matter-of-factly.

In the early nineties, New York had plenty of both. She remembers being told that ambulances wouldn't collect shooting victims in the Bronx until the bullets had stopped flying. At first, she was terrified.

"When I arrived there, they said, 'You're on call tonight.' And I was, 'What, what? I'm on call?'" she says, impersonating her own slack-jawed astonishment.

"I was completely dépassée [overwhelmed]. I went, 'Oh. My God. I'm in charge.' "

Being in charge would soon become second nature. After her trial by fire in New York, she threw herself into humanitarian medicine, first treating patients in relatively impoverished Canadian communities from the Maritimes to the Far North. Then, while working in the pediatric department at Sainte-Justine, she used her time off to travel the world for MSF, racking up 20 postings in 16 countries, from the Democratic Republic of the Congo to Haiti.

All the while, she maintained a notably austere personal life. When, at one point, she left Montreal for an administrative posting with MSF in France, she asked to leave her things with Denis Soulières, another colleague at Sainte-Justine. Everything she cared to keep fit into two boxes, Dr. Soulières recalls in a recent tribute video put together by the Collège des médecins du Québec.

"She accepted the sacrifices … " says Dr. Lamarre, her med-school colleague. "She accepts not having the nice house and not having kids."

During her MSF postings, Dr. Liu learned things they don't teach even at Bellevue, like sleeping with your boots on in case you need to flee in the night. But even more, she absorbed a culture. "People say I'm tough, and too blunt," she says. "I'm a product of my organization. MSF is a blunt, tough, no-nonsense organization."

Being blunt is not only a by-product of the brutal conditions in which MSF volunteers work – it's central to the organization's ethos. Since its founding schism with the Red Cross, MSF has operated with a peculiar and sometimes contradictory double mandate: to save lives, and to talk about doing so.

Over the years, that has led to a series of brave stands on issues from the Vietnamese boat people to the Rwandan genocide, calling for the international community to act while pulling more than the organization's weight on the ground.

But it has also meant turning that withering gaze inward; if few organizations are as celebrated as MSF, few are as self-excoriating. The history of the "movement" – as it prefers to conceive of itself – is full of schisms and excommunications.

Volunteers and staff are "often passionately in love and in hate with the organization," says Peter Redfield, an anthropologist at the University of North Carolina who has written a book, Life in Crisis, about MSF. "Contentment is terrifying to them."

That culture of debate can be consuming for an international president. Dr. Orbinski, who held the position from 1998 to 2001 and is now chair in global health governance at the Balsillie School of International Affairs in Waterloo, Ont., says that being distracted from its medical mission by internal squabbles is a "danger" for MSF. "Within MSF, being rebellious, being oppositional – those are tools. They are not the North Star."

Her own rebellious ranks help to account for Dr. Liu's extreme press-aversion. She agreed to an interview with The Globe only after months of negotiation. She has drawn criticism from MSF colleagues for newspaper profiles in the past, on the grounds that they constituted showboating. Her parting demand in Montreal, as she pushed through a Métro turnstile, was: "You're not allowed to portray me as a hero!"

Students and faculty at McGill's International Masters for Health Leadership saw this chippy side of Dr. Liu when she enrolled in the elite management program on the eve of her bid for the MSF presidency.

Henry Mintzberg, a co-founder of the program, recalls her uneasy initial participation in "morning reflections," during which students sit in circles and share their thoughts. "Joanne had the look of someone who was thinking, 'What am I doing here?' " Prof. Mintzberg says.

Eventually, he adds, she became an eager student, to the point of challenging faculty about the curriculum and pointing out flaws in the program.

That restless, improving streak in her nature propelled her up the MSF ranks. By the summer of 2013, she had been involved with the organization for 17 years, including five years from 2004 to 2009 as head of its Canadian branch. Being in the field had taught her a lot, she says, but she wanted to make a bigger difference – the kind you make when you're in charge.

Ebola: 'Don't exaggerate'

Within months of her election as president in October, 2013 – on her second attempt – reports of patients with Ebola-like symptoms began trickling out of Guinea, a small West African country that borders on Mali, where Dr. Liu had devoted herself to medicine almost 30 years before.

First identified in 1976, the Ebola virus has a roughly 50-per-cent fatality rate, spreading quickly during outbreaks and causing severe vomiting, diarrhea and internal bleeding. MSF soon recognized the potential for an epidemic. At first, so did the WHO and the U.S. Centers for Disease Control and Prevention. But by May, 2014, the number of cases being reported declined, and the others began pulling out their staff.

MSF stayed, fearing the worst was yet to come. Non-essential staff from headquarters in Geneva were shipped out to West Africa, to the front lines, where they set up clinics, often in remote areas; it was all hands on deck, Dr. Liu recalls.

A spokesperson for the WHO responded by tweeting, "Don't exaggerate."

"We were very upset about that," she says. But as summer wore on, MSF was vindicated: Ebola exploded, claiming nearly 1,000 lives by the beginning of August. The WHO declared the outbreak a global state of emergency soon after.

Dr. Liu made sure to bear witness to the disease's toll. In August, two days shy of a planned vacation with her husband – an engineer and motorcycle aficionado – she flew with a team of doctors to Ebola's epicentre in Liberia. "It was hell on earth," she says. "Dead bodies all over the cities."

At the Sainte-Justine pediatric ward, about six patients die in a year. In Liberia, Dr. Liu saw that many while visiting a single clinic. "One in [every] two were dying," she says. "That was upsetting. That was awfully upsetting."

With MSF already taxed to its limits and staff warning her not to overpromise, Dr. Liu went to Monrovia, the capital, to meet Liberian president Ellen Johnson Sirleaf. "I remember President Johnson Sirleaf talking to me and being completely overwhelmed by the situation," she says. "I'm seeing how much despair she has in her eyes …

"I remember looking at her and saying, 'Madame President, this is one thing I'm going to promise you: I'm gonna use my voice to tell the world what is happening in Liberia.'"

In late August, four days before the UN General Assembly was to meet in New York, Dr. Liu received an e-mail inviting her to speak. "People were ready to listen," she says.

Before drafting her remarks, she called the MSF heads of mission in Liberia, Sierra Leone and Guinea. "The best lines of my speech are coming from my heads of mission," she insists.

But the performance became Dr. Liu's apotheosis – a masterpiece of calibrated emotion, rendered all the more powerful by her sober, almost-affectless voice.

"I put all my heart to it," she says now.

The message was a call to collective sacrifice, with echoes of her rhetorical idol, Winston Churchill: "To put out this fire, we must run into the burning building," she told the chamber.

In November, Dr. Liu returned to Liberia, and was received at the presidential palace. As she walked through the grounds, a gardener stopped her. "You're the one who did the speech – thank you," she remembers him saying.

Dr. Liu is justly proud of her role in turning Ebola's tide. But she's also frank about what really made the world pay attention. "Fear," she says, laughing ruefully, by way of explanation. "I wish it would have been something else.

"People paid attention when it was knocking at our doors, and they said" – here she adopts a ditzy American drawl – "'Oh, my God, I might get it.'"

Although beating Ebola may be Dr. Liu's greatest professional triumph, an accomplishment a lesser person might retire on, or at least feel good about, it seems to have darkened her world view. She claims to reject cynicism as "too easy," but there's no denying that her political analysis is shot through with, at the very least, a kind of world-weary realism.

"Today, we're like the poster child of Ebola. But the reality is, for six months we just screamed in the desert, and nobody was willing to listen to us," she says.

'Not a little bush hospital'

Dr. Liu was on her way back to Geneva from South Sudan last fall when she heard about Kunduz. While catching a connecting flight in Turkey, she turned on data roaming to check her phone. "Then I saw the e-mail and just said, 'Oh, my God.'"

The hospital had opened in 2011 after two years of negotiation, and was state-of-the-art for a facility in the field.

"This was not a little bush hospital," Dr. Liu says. "I used to call it the jewel – le bijou. It was such an amazing place to be … People were walking three weeks to come and see us."

A month after the attack, she went to Afghanistan to attend a memorial service for staff killed in the bombing. She heard stories of courage and devastation, of doctors setting up makeshift operating tables amid the wreckage, as the bombing went on. "It was so hard listening to those stories," she says. "You just wanted to cry."

Her friends will not be surprised that Dr. Liu is taking the issue so much to heart; she isn't one to shake things off, they say. People who know her remark on her capacity for bottling up the anguish that comes from immersion in the world's most damaged places.

"She doesn't go around sharing her suffering. She probably should," says Rafael Bengoa, a former health minister for Spain's Basque region and Dr. Liu's mentor in the McGill management course. "I know she's tough, but I would encourage her one day to do that."

For now, Dr. Liu persists in the kind of bluff hard-headedness that has come to characterize her outlook on world politics. "It doesn't take out anything from our sense of outrage and our sense of loss for our colleagues," she says of the hospital attacks, but "it would be quite naive to think this is not something that we would be exposed to. … It's like playing hockey and being surprised when someone checks you when you're skating with the puck."

Instead, Dr. Liu seems to cope by hounding world leaders. On May 3, a week after an MSF-supported hospital in Aleppo was destroyed by a Syrian air strike, she was in New York to present the Security Council with a stark message: "Stop these attacks."

The same day, the council unanimously adopted a resolution to strengthen protection for medical care in war zones. Still, as she knows, the response is just a beginning. It's the big war-waging states like Russia and the U.S. that must lead on re-establishing the inviolability of medical facilities in the field of battle.

She has been delivering that message incessantly since Kunduz, to anyone in power who will listen, and hopes that might include Prime Minister Justin Trudeau – a fellow Montrealer and former chair of Katimavik – with whom she has been seeking a meeting. Even a second-tier power such as Canada denouncing hospital attacks would have an impact, she believes. "It's completely selfish, and nationalist to a certain extent," she says, "but of course I would like to see Canada do that."

Davos and diplomacy

Dr. Liu spends much of her time jetting around the world to various war zones – Yemen one day, Syria the next – but her office, and her home, is in Geneva. With every world crisis a fire for MSF to put out, the Swiss city has become something of an oasis for her.

In Geneva, she can go for runs around Lac Léman, hikes in the Alps, ski trips to the Portes du Soleil. "I like the fact that it's quiet, I like the fact that I can chill out and not hear sirens all the time," she says. "You need a balance in life. You just cannot be all the time on an adrenalin peak. You need to recharge."

Maybe it's the Swiss air, but Dr. Liu also seems to have been imbued with some of the local zest for diplomacy. As the terror of Ebola recedes from memory, she is determined to harness the legacy of the disease to push for generic drugs to be developed with a view to making them available in poor parts of the world.

But she recognizes that convincing pharmaceutical giants to forgo profits will require a different set of skills from the ones she brought to bear on Ebola.

"I keep telling people you can't just sit in your corner and complain about things," she says. "I'm not ready to sell my soul. But I'm ready to talk."

This stance has, predictably, engendered grumbling in the MSF ranks. It's partly why she was so reluctant to attend January's World Economic Forum in Davos, where she sat on a panel, alongside pharmaceutical executive Andrew Witty, about the future of antibiotics. "She would have been very nervous about what MSF would have said, but she was willing to face down her own organization," says Jeremy Farrar, director of the Wellcome Trust, a global health charity, and another co-panelist at Davos. "Not now so much, but historically Davos would be the sort of antithesis of what MSF stands for."

Her sojourn to the resort town started badly when she was unaccountably left off a panel about Ebola. "She was really pissed off about that," recalls Jorge Valero, a Spanish journalist who interviewed her at the conference. (But later she says: "This is how influence works. I think we got bumped out by other big names. I think it's unfortunate, to a certain extent.")

Even so, she managed to display remarkable tact at Davos, and left some people feeling that she was leading MSF in a new direction. Seth Berkley, chief executive officer of Gavi, a nonprofit alliance of public and private vaccine providers, sat on a panel with her and was struck by her efforts to bury the hatchet.

Long-time antagonists, Gavi and MSF have conflicting stances on the role of Big Pharma in the Third World, but "she made a point of saying that, 'People think we hate Gavi, but really we support Gavi,'" Mr. Berkley recalls.

"Often MSF criticizes Gavi," he adds. "And what annoys me about that is that we're just as interested in the same things as they are. … I think Joanne understands that, and is trying to be more reasonable about it."

The softer touch at Davos has paid dividends, says Peter Piot, the pioneering Belgian researcher who helped to discover Ebola (named after a river in the Democratic Republic of the Congo). He had dinner with Dr. Liu during the forum, and says her new approach "has increased MSF's influence for sure."

Of course, Dr. Liu hasn't put down the bayonet altogether. She still walks out of meetings – "sometimes, when I get bored" – and the art of browbeating will continue to figure in her repertoire, she says.

Diplomacy will never come naturally to her, a fact she recognizes with droll resignation. "I'm not thinking I'm that charming," she says. "Apparently I'm not. I've been told."

In fact, she says, someone recently informed her that – and here it's tempting to ask whether she needs a new set of friends – "I don't see any other individual that is capable of sustained outrage as much as you, Joanne.'"

"I said, 'I don't know how to take it.' But I guess I'm gonna take it as a compliment."

Eric Andrew-Gee is a Globe and Mail national correspondent based in Toronto.

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About the Author

Eric Andrew-Gee has covered national news for the Globe and Mail since 2015. He previously worked at the Toronto Star, where he was a reporter, and Maisonneuve Magazine, where he was an editor. Eric won the 2015 Goff Penny Award for Canada’s top newspaper journalist under 25. His work has also been nominated for two National Magazine Awards. More

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