Benefiting Some More than Others

In March 2022, intercommunal fighting forced Médecins Sans Frontières (MSF) to suspend its activities after nearly fourteen years of operating in Agok, a small town located in the disputed Abyei Special Administrative Area (ASAA) on the border between Sudan and South Sudan. After the shock of having to close a 185-bed hospital unexpectedly came questions about the unintentional consequences of MSF’s presence. With the benefit of hindsight, the organisation deemed it important to examine the potentially destabilising influence it might have had on the local environment. This article builds on an internal capitalisation exercise conducted with the aim of documenting MSF’s experience and critically reflecting on the potential of aid being a factor in disrupting local balances, or worse, a factor in fuelling violence. By exploring the premises that MSF was an anchor factor for the population and that the economic fallouts made Agok a place worth fighting for, the author investigates the long-term, unintended impact of MSF’s presence on the local political economy of conflict, as well as the organisation’s possible share of responsibility for aggravating intercommunal grievances. Based on the observation that aid inevitably benefits some more than others, the author also asks to what extent MSF was aware of the adverse consequences of its presence and whether more awareness would have led to different operational choices and mitigating measures. This questioning does not detract in any way from the project’s achievements in terms of providing high-quality secondary healthcare in a context where there was none, in one of the poorest countries in the world.