I'm Adam Cooper. Welcome to Season 6 of The Mediator Studio. In today's episode, I sit down with Dr. Joanne Liu, former president of Medicine San Francier, to hear her unique journey through the world of humanitarian work on the front lines. When it comes to humanitarian crises, if you ever feel like there's more to a story than what's being told, you might enjoy the podcast What's Unset. Join the new Humanitarians, Ali Latifi and Obiyanya Dike, as they explore the open secrets and uncomfortable truths at the heart of the world's conflicts and disasters, like why Afghan civil society is calling for engagement with the Taliban and why humanitarians are still left to struggle with mental health. You can listen to What's Unset, a podcast by the new humanitarian wherever you get your podcasts. When they finally got to my team, they said, "This is the right us. Our prison wants to speak to your president." And they said, "No, she's not available." And they said, "No, no, but you didn't understand us." He said, "Barak Obama wants to talk to Dr. Joanne Liu. Yeah, we heard you well, but she is still not available." Welcome to The Mediator Studio, a podcast about peacemakers, bringing you stories from behind the scenes. I'm your host, Adam Cooper. I'm at the Oslo Forum, which started out as a small gathering in 2003, and is now entering its third decade, bringing together some of the world's leading figures in peacemaking. Participants from around the world are here to discuss the major conflicts of our day, from Gaza to Yemen, Sudan to Afghanistan, and the war in Ukraine. My guest today is a distinguished Canadian pediatrician, best known for her extensive work with medicine on frontier MSF, also known as Doctors Without Borders. She's currently chair of the board for the Center for Humanitarian Dialogue, HD, and is a professor at McGill University's School of Population and Global Health. Joanne Liu, welcome to The Mediator Studio. Good morning. Good to have you here. I'd like to begin by giving our listeners a sense of your early life, where your motivations and values came from. You were born in Quebec City, Canada, in the mid '60s, the child of Chinese immigrants who left poverty in China became to own and run a restaurant. You were working at the TIL to help your father. Tell me about those times and what they taught you. Well, those times were particular because we had a restaurant in French province, where there was very little other, what I call, visible minorities. So we were one of the rare Chinese restaurants, and it was a 24/7 type of restaurant. Everybody in my family ended up working in the restaurant and very early on. And so I think what those times taught me was what I call the treaty, the discipline, the dignity in the duty. This is where we had to deal with and act as children. And at the age of just 13, the young Joanne Liu reads a book by a French doctor, Jean-Pierre Willem, working for Medicine of Frontier. Tell me how that fired your imagination. I think it was in the period of my life where I was looking for meaning. It is sort of existential crisis of teenager time. And I thought that book was great. This man, this surgeon was going overseas, working in the most improbable, most difficult places, and he was bringing care, and he was making a difference in people's life. And I thought the way, anyway, I read it at that time, was, "This is cool." And so I said, "Maybe this is something that I could do." And back then, we were not talking about what is white civilizations and all that, but it was the appeal of having the competences, bringing it somewhere where it's almost done as extensive, making a difference in people's life. And it does inspire you, because then, age 18, you go off to Mali for your first volunteering experience. Tell me about that. Yes, I went with Canadian Crossroads to Mali and work in the rural area for three months. And I think it was one of my best days in Africa, because you are hosted by your family. You go and you walk to the water well each morning, you pick up your water, and that's the way it is. And so you go in the field. But it was of all my stay in Africa and I've made several afterwards. It was the only time that I had the pure and privileged time of just hanging out with people. It's funny, because they always called me the little one. And because I was the smallest one, I was the one who had to do everything. And it's interesting, because I had no, in the hierarchy there, I was the lowest. But you were happy to be there, right? I was happy. Well, the first of many missions to follow later on in life, but before that, you study medicine in Montreal and New York, specializing in pediatric emergency medicine. Why pediatric emergencies? Well, when I did med school, I just realized that the pediatric patient were the funniest patient to have, because they don't play game. Children, when they're sick, they stop eating and they stop playing. When they get better, they stop eating and they start playing. And so this is the great thing. And I just said, "Okay, so I'm going to do pediatrics." But in addition to that, I'm going to do ER, because I'm going to go and work in conflict zones. And so then you start to use your vacations to undertake missions for MSF. You know, what did your peers and family think about that work? Everybody was hoping that it will pass. Like a phase, right? Yeah. Just get it out of your system. Exactly. It's going to get over it. And as time passed by, it was even less getting over it, but more present in my life. And I ended up taking more responsibility in the organization. But for me, from the reading from Jean-Pierre Vinem, he was a bit the dream of a teenager. So in 1996, you joined MSF fully. And it would be an organization you'd work for for the best part of three decades, becoming its international president in 2013. During that time, you tried to negotiate humanitarian access in places like Gaza, safe spaces for medical staff, help to free colleagues, help hostage, but your first mission, working in Mauritania with refugees from Mali, doesn't go well. Indeed, it ends with you resigning in protest. What happened? I often say that when you've been dreaming for something for so long, your chances are being disappointed or fairly high. And so basically, I had imagined myself that when you go in a place where there's refugee people, everybody will be aligned to give the best to those people who are even much more vulnerable, I would say, situation. And so I was very appalled by the fact that the UN High Commissioner, refugee personnel wanted to move the camp closer to the border of Mali. And I just said, "Why?" I said, "Well, it just gives the sense that something has happened." I said, "But nothing has happened except that there are only five kilometers closer to the border." But then I realized it was an absolutely cosmetic maneuver. The guy was at the end of his mandate, and he needed something tangible that had happened doing his one-year assignment. And so I protested against it. And I just said, "If you do that, then I said you have to make sure you have the plastic sheeting that people can rebuild their housing, and then that us will prepare as well to accompany them." And of course, none of that was done, and then people end up standing under, I remember so well, under the rain for two weeks, waiting for plastic sheeting. We have increased number of pneumonia, increased number of malaria, people died. And I made a report about that. And I remember because I can get sometimes so obsessed about things. I just said, "I'm going to register everything, and I'm going to the evidence that was really detrimental on the health of the refugees." And it was. So we were able to bring this back afterwards and then put them in front of their responsibilities. Let's talk about one of the defining experiences for MSF, which was the Ebola outbreak. In 2013, there's a serious outbreak of Ebola in West Africa, that by the end of 2016 would kill over 11,000 people, decimating the healthcare infrastructure in Liberia, Guinea and Sierra Leone. Hundreds of health workers died in this unprecedented outbreak. MSF was one of the few international organizations advocating the deployment of massive emergency resources to counter the regional epidemic. It would bring MSF to the forefront of international tension to find the organization for years to come. Where were you when the sheer scale and significance of what was going on dawned on you? I had been following since the beginning, and my team really raised it to me at the spring of 2014. This is different. And the difference was that we discovered there was chain of transmission of patients that were geographically distanced, more than 250 kilometers. In the past, you used to have one chain of transmission in one remote village, and most of the time we just died out there. But the fact they were so remotely distanced meant that we had basically on their own cluster brewing. So we brought this to the attention of people. And then what we used to say, because back then we were not used to that kind of size, and we just said, "You know what? We think it's different." That's the only thing we could say back then, we think it's different. And I remember on social media, we kept saying it's different and all that. And at one point, WHO said, "No, no, no, but we're crying wolf. It's still under control. There's only 100 cases. Not factoring in that they all basically dispatch on such a geographic." Yeah, they told you not to exaggerate. Yeah, we were a bit taken aback by that. But the reality is you raised those things and actually you wish you are not right. Because we knew what it meant if we were right. And so we ended up being right. Because yes, it was going on on a very, very, I would say spread geographic landscape and the chain of transmission where many of them were not connected. And what was your approach to negotiating that skepticism against that skepticism from the likes of the WHO and others? Back then, Gaza was under fire. Syria was not going well. And the world is having a tough time to deal two big crises at a time. So basically, what shifts things is in July 2014, two humanity and aid workers from Samaritan Puris got infected in Liberia and were repatriated in the States. And all of a sudden, we move from complete indifference to massive hysteria. Then we have to deal with that. Because now we had the attention that we wanted, but non-coordinate and hysteria attention is a challenge as well. And you try to use the profile of the moment and to get attention at the UN and the Security Council and General Assembly. Tell me how you went about that work negotiating resolutions and so on. We were babies back then because we didn't have a clue of what we were getting ourselves into. And so what is interesting is the fact that nothing happens for no reason. So you have to remember that we were struggling at the UN to get a resolution on Syria. In 2013, there was a use of chemical weapons. Barack Obama said that is a red line. And then saying that, nothing happened after the red line. And so there were a real, I would say, realization that a leader may bark loud but might not bite. And this is what happened. So all of a sudden, U.S., I think they wanted a bit of a success. And they wanted as well to portrait that they were still one of a leading nation in the world. So came Ebola, which is a great thing because it's a common enemy. We can all line up against a common enemy. And so the thing that we didn't do in COVID-19 but back then we did. And so what happened is in September, the U.S. had the presidency at the UN Security Council. And so when you have the presidency, everybody knows that at the UNC, you decide on the agenda. And so they put Ebola on the agenda. And so they invited the MESF on September 2nd, 2014 to come in brief, the member states. And then after that, they invited us, which was one of my colleagues, Jonathan, to come from Liberia to brief by video conference, the UN Security Council. I just wanted just to mention that the resolution that passed at the UN Security Council was a second resolution on the medical topic at the UNSC. The first one was on HIV AIDS in 2000. And so basically labeling a medical threat as something that could disturb the security of the world. And that statement was done by Barack Obama equating terrorism's to Ebola. So this is not a small feat. And so the resolution was passed unanimously and it was backed by 128 nations, one of the most supported resolution in the UNSC in history. So it was important because after failing of passing resolution on Syria for the last year, for some reason, it allowed the U.S. to creep up to his status of we are world leader. I'd like to turn to Afghanistan, a country you've been involved with since the 1990s. As part of your role in MESF's country operation, you find yourself in the Panchia Valley in northern Afghanistan in the early 2000s. Your team is talking with Ahmad Shah Masoud, the Mujahideen leader, who had resisted the Soviet invasion, then fought against the Taliban, which took over Kabul in 1996. What was MESF attempting to achieve in its talks with Masoud? Well, I think it was access, you know, access in the Panchia Valley. We were there throughout the occupation and then our team were coming into the Panchia Valley. And basically the way it happened is you will walk into the Panchia Valley in fall, then it will basically bomb the entrance of the valley and then it will come out at springtime. They will not fight over winter, so you will just have your team there. My obsession being a physician was, "Oh my God, I don't want to get a petticitis because I would be stuck with it in the valley." But beyond that, it was good work. And then 9/11 happens in 2001, everything changes. Two days before the attack on the Twin Towers in New York, Masoud was wounded, subsequently killed by al-Qaeda suicide bombers. How did all that affect your operations in Afghanistan? It affected massively. Well, like money, we didn't see it coming, but we knew it was a game changer. I was in charge of operation in Afghanistan back then. And I remember coming back from lunch at the headquarters in Paris and MESF, we never used to turn on our TV in the office in Paris. And also then the two TV were there. The last time we did that was the, for the peace of both eyes. And so I'm walking in, people say, "Come, come on the third floor." And then I keep seeing those Twin Towers falling over and over again because they were just putting them in the cycle on TV. And I remember just said, "Oh my God, the world will never be the same again." And everybody looked at me, rolled up their eyes and just said, "Oh, you're the North American thinking that the world exists and revolving around you." But the reality, it really changed a lot of things. But immediately speaking, our task for us, we had a crisis sale. We had to get our American citizenship out of the country, which was a very difficult task because nobody wanted to leave. Physician never wants to abandon their patient, so it was the negotiation. I want to fast forward to 2015. By this time, you're the international president of MESF. In October of that year, the US military, which was supporting the Afghan government against the Taliban, bombed an MESF hospital in Kunduz in the north of Afghanistan. 42 people were killed, including 14 of your colleagues. Where were you when you heard that terrible news? I remember vividly. I was coming out from South Sudan. I landed in Turkey and I was at the airport, and then I just saw email Kunduz on their attack. And I just had visited the trauma center a few months ago. It was such an amazing place because it was a trauma center, high level of care, where we were doing internal fixator, where we were doing skin graft, and we had high especially if in orthopedics, but as well in ICU, intensive care unit, emergency, anesthesia. And everybody knew that if you have a broken bone, you would go to Kunduz trauma center. And so what was it like that plane journey to Geneva with this on your mind? You know that it's unfolding. I assume you knew some of the staff, your colleagues who are working in that hospital. It's just this thing that you like the little hamster in the wheel. You start to imagine all sorts of things and you can spin, spin, spin, spin. But the thing is real. And even then, by the time I go to the office, we're still wandering because we had to do the call of ourselves was missing. During their strike, the team called everybody. They called NATO, they called the special forces, they called Washington, they called the Afghan government. One of the person told us at one point, we don't know what's happening, but we're praying for you. Thank you very much. Because they all knew they had been informed of the location of the hospital was well known. There's an MSF site. So it must have been extremely confusing to you and your staff how it could have get caught up and there was five airstrikes on the building. I mean, what were your sort of emotions at that time, knowing that they should have known that that was your hospital? We were in disbelief. I think they were like a mix of feelings. We were angry, but we were warning because we found out the direct of the hospital as a slave. You have to imagine a hospital under attack, but really targeted on the central building and being doctors of emergency as soon as the airstrikes stop, which lasted between some people say up to one hour, is the fact that you just pick up things and you start to work and try to save the survivor. And so everybody went into this mode of, okay, who's alive? What can we do? And it was one of our staff. We just improvised operating table in the office and we tried to work on his amputated leg and stop the bleeding. What we needed to do was try to save as many of our staff as we can, try to save as many of our patients as we can and transfer them to the next hospital. And anybody were saying, well, we'll cry later whenever there will be time. And I'm sure you did and those must have been devastating for you. And later on, you demanded an independent international investigation. You didn't get it. Why not? So very early on, the ask was, we need an independent evaluation. And the reason why we asked that is even us were saying, did we make a mistake and we're not aware? And then we don't think we can be judge and jury. So it was as much as for us that as much for the other people. And so our legal department just said, and by the way, there's this thing that exists, which is called the International Humanitarian Fact Finding Commission. And it's been created in 1991, ratified by 76 states. And basically, it allows to have an independent investigation. And the only thing that we need, it needs to be activated by your country. And then the country who are involved will allow the investigator to access the proof. And the feedback would be confidential. So we thought that was not a bad deal. And then it will have somehow act as a role model. We thought for the state, it was maybe a way to prop themselves up a little bit, but it didn't really fly. Well, the US was very skeptical and President Obama himself called you to apologize. And I understand you took the call, but refused to accept his apology. Tell me about that phone call. Well, actually, the White House was really craving to get ahold of us. And so the airstrike happened on October 3, early, early hours of the morning, which is from the Friday to Saturday. And then early on on the Sunday, we started to have call from Samantha Power, where's the ambassador to the UN back then. And then after that, the White House. And remember myself saying, "Don't pick up your phone. Don't pick up your phone." And I said, "Okay, why?" He said, "The White House wants to talk to you." And then so when they finally got to my team, they just said, "This is the White House. Our prison wants to speak to your president." And they said, "No, she's not available." And they said, "No, no, but you didn't understand us." He said, "Barak Obama wants to talk to Dr. Joen Liu. Yeah, we heard you well, but she is still not available." The idea was we didn't want to talk to them before our press conference, because at the press conference, this is where we asked for the International Humanity and Fact Finding Commission. And we thought that if we were to speak to them before, they would basically don't play everything. So we just said, "We'll speak to them afterwards." And you did speak to them afterwards. Indeed. And he expressed his sympathies, but you were very careful in the wording that you used back to him. We don't want to be rude, but we don't want to start to fail into, like, a profusive thank you. So it was sort of, "Yes, thank you. I acknowledge your sympathy, and I will convey them to the team." But our big message, what we wanted to pass, there were like a few message. The one was about the ask for the independent investigation. That's one thing. The second one was the fact that we are treating everybody, including the combatant war wounded. Does he have a problem with that? And so there was two of the key things for us, because we were thinking we're going to go back. I'd like to touch on Yemen. You went there in 2015, not long after the civil war had broken out. You've said that being a woman was an advantage in talking to the Houthis, the main non-state armed group in the country. Give me some examples of that. What were you negotiating? What difference did your gender make? Yemen was a brutal conflict, and there were a lot of war wounded, and the team of MSF remained throughout the peak of the military operation. And this is always something that people do remember, is if you stick with them in the harder and toughest moment. And so when I met the head of the ruti back then, after I had actually worked as a physician in one of the hospital, one of the things he said was, "You stayed with us. It was a big deal." He said, "You're a double injury." He said, "You're a physician and you're a woman." You referenced earlier that you yourself had practiced as a physician in Yemen. I think you're referring to when you decided to fill in for staff who were absent, and it's happening at the peak of the conflict. Tell me about how that came about. I'm a practicing physician. I never stopped practicing throughout all those years of working with MSF. And in MSF it's not something many people do that. It's just going back at the fill level. And then we often say touching patient. That's the way we like to say it. But living the daily life and the daily circumstances, it's a huge reality check. And I think it makes you much more real about when you go to negotiate with the people, either locally there or after a headquarters when you come back home. I'd like to start drawing together some broader lessons and taking your point about the credibility and legitimacy that comes from doing that hands-on work yourself. It sounds like it's extremely important to you to stay close to the issues that you're working on. When you step back and you look at the international community more widely, do you think that those working on conflict are sometimes too divorced from realities on the ground? I think you can easily get distance and not understanding what is at stake in the fill. When you go to the fill, it's really like you are in like an HDTV, 360 degrees, you see everything, you smell everything and you feel everything. From a distance you're just going to get that kind of concularity. I think it makes you more real, more human and at times more vulnerable. But I think that's what we miss sometimes, some humanity in dealing in those so-in-human crisis. We sometimes get very, very difficult in trying to get the best deal in mediation and I think that sometimes we should settle for what I call the imperfect solution, a non-complacent imperfect solution, but that allows us to still move a bit forward. Because warning the perfect solution might be like the grail that just doesn't exist except in our fantasy. The cost of that getting that what we call the rule of the little step at a time might be in some particular circumstances the only way forward. Let's talk about a conflict that's ongoing which has enormous humanitarian consequences. As we recall this episode, the war on Gaza is front of mind for many in both the humanitarian and mediation community. You went there three times as president of MSF. The two big issues were negotiating the security of civilians and humanitarian access. Both of those involved close working relationships with the Israeli army but also Palestinian groups like Hamas. What lessons did you learn 20 plus years ago that might be relevant today? Sometimes you know when you witness what is happening in Gaza, we have the feeling that we haven't learned much and it's a big, big collective failure. I think that we haven't learned that if you don't break the cycle of violence then you will not break the cycle of retaliation and we obviously didn't manage that. And the fact that we have two group of people who are asking for the same basic things of a home and a place that is safe to grow as a community and then somehow we're notable to align interests and plan to make this happen one beside each other. I'm oversimplifying but at the end of the day, it's human being who wants a place to live in peace, to a certain extent. So it's not happening. We had so many attempts of peace and so many models of some people say there was a few big missed opportunities in the past but we are what we are today and the place we are today is the annihilation of the humanitarian space in war zones. You said in the past, sometimes when I see very difficult things in the field, I need to see beauty, to believe in humankind. When has that happened to you in the past when you saw difficult things and needed something else in your life to remind yourself of basic humanity in the world? When it was the most striking is when I came back from the detention center in Libya where I thought, well actually, I could not believe the way we were treating human being and how we have dehumanized them over and over and over again for the sole crime of people wanting a better life. I just couldn't believe that they were stuck in those detention center in Libya, in a dark room, one on top of each other, that having more than a square foot large to set and I just said, my god and this is my public finance who is supporting that. We sort of plan my visit there and I just said, if I go there, I said we need to speak up because if we don't speak up, then we become the auxiliary so something needs to happen. We know that massive erosion or insult to the basic human rights is happening on a daily basis and if we don't put that forward and center on the media in front of leaders, I think we will fail. To give yourself the energy and mental space to be able to advocate on behalf of issues like that, is there something that you turn to as a relief or an alternative so that you could have that somehow arrest from the tragedy of that situation that would give you then the power to advocate on behalf of those people? Yeah, so this is where I guess beauty comes in. I remember when I came back from Libya, I called a friend and said, you need to bring me to see some beauty. I said, that's the only way I'm going to be able to believe again in human being. And where did you go? Switzerland is such a beautiful country. So I went hiking and then after that I went to an exhibit of Cezanne and then after that, the same day and then after that in the evening, I went to listen to opera. Three of the things I love the most. Well on that happy note, we must close. Jo-Ann Liu, thank you so much for being my guest in the Media2Studio. Thank you very much. And there we end this edition of the Media2Studio. To get more episodes as they come out, please subscribe wherever you get your podcasts. We always love to hear from you. So if Jo-Ann Liu's career in war zones provoked any thoughts or questions, please get in touch via the listener survey and the show notes on our website. Or do drop me a message on Twitter @AdamTalkspeace. The Media2Studio is an Oslo forum podcast brought to you by the Center for Humanitarian Dialogue and the Norwegian Ministry of Foreign Affairs. Our managing editor is Christina Buchhold and the producer is Chris Gammus. Research for this episode was by Oscar Eshembrenner. Big thanks also to Giles Pitts and Lee Buedong for her support. Hope you'll be with me for the next edition. Until then, from Lozbe gods in Norway, this is Adam Cooper saying goodbye and thanks for listening. [MUSIC PLAYING]
