Ebola, Bombs, and Migrants: A Conversation with Dr. Joanne Liu

Summary

Podcast Summary

Podcast: A Shot in the Arm
Host: Ben Plumley
Guest: Dr. Joanne Liu
Episode Title: Ebola, Bombs, and Migrants: A Conversation with Dr. Joanne Liu
Date: November 18, 2024

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Main Theme & Purpose

This episode features a powerful conversation between Ben Plumley and Dr. Joanne Liu, former international president of Médecins Sans Frontières (Doctors Without Borders), pediatric emergency physician, and author. Centering around her new French-language book Ebola, Les Bombes et les Migrants, the discussion explores the complex "polycrisis" at the heart of modern global health: pandemics, armed conflict, and migration, and the erosion of solidarity in an era defined by fear and securitization. Together, they reflect on lessons from the field, failures in international coordination, and the essential role of humanity and activism in facing transnational threats.

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Key Discussion Points & Insights

1. Origins & Purpose of Dr. Liu’s Book

• Motivation: Dr. Liu wrote the book to process and analyze her 6 years at MSF (2013-2019), marked by three overwhelming global challenges: the West African Ebola crisis, attacks on hospitals (such as Kunduz, Afghanistan), and surges in migration.
  • “People were asking me, how would you summarize your six years? And I would always say: Ebola, bombs, and migrants.” (02:36, Dr. Liu)
• Core Message: Post-9/11, the ascendancy of fear has led to an obsessive quest for security at the expense of global solidarity, diminishing our shared capacity to respond to crises.

2. Interconnectedness of Polycrises

• Health emergencies, violent conflict, and mass migration are intertwined and mutually amplifying—yet are often treated in isolation by policymakers and funders.
  • “Everything is interconnected and interdependent. …You have to embrace the package together.” (06:01, Dr. Liu)
• COVID-19 reminded the world that distant outbreaks quickly become immediate, paralyzing threats—no country is immune.

3. The Field vs. Policy Silos

• Dr. Liu stresses that field realities always supersede intellectual frameworks. The independence of MSF allows for speaking uncomfortable truths, as compared to the constraints faced by government or multilateral institutions.
  • “At the end of the day, people who are living through the crises are speaking truth at one point.” (07:37, Dr. Liu)

4. Polycrisis and Public Perception

• The book’s success signals heightened public awareness of intersecting, transnational crises—but a destabilizing sense of polarization and resistance to new approaches.
• “Those transnational challenges…are asking us to somehow come together. …But we are facing more polarization and more opposition.” (09:25, Dr. Liu)
• We must form “improbable partnerships” and seek new voices at the table to break the cycle of repeating old mistakes.

5. Personal Narrative

• Dr. Liu’s early aspiration to be a “Doctor Without Borders” was inspired by books and reinforced by Camus’s The Plague, instilling in her a lasting resolve to never accept death or suffering as natural or inevitable.
  • “I remember very clearly in my teenage head to promise myself that I will engage my professional life for life. And this is how I became a physician.” (12:46, Dr. Liu)

6. Pandemic Preparedness: Progress and Pitfalls

Public Awareness and Denial

• Public understanding of public health has increased post-COVID, but trauma has led to “collective amnesia,” a dangerous reluctance to revisit or learn from recent events.
  • “People do not want to go back…people are having what I call a precipitation to collective amnesia.” (15:45, Dr. Liu)

Institutional Failure

• Disappointment with stalled global agreements, especially the Pandemic Treaty (18:15), and with failures to ensure equitable access to vaccines and diagnostics.
  • “…The biggest disappointment that I have, it’s about the pandemic treaty and the fact that we’re not able to get our act together.” (18:15, Dr. Liu)
• Ms. Liu criticizes the ongoing rejection of “open source” approaches for medical countermeasures: “If you’re not planning to work and prepare for everybody, why don’t you let at least those people have the path open and not block to do that?” (19:30, Dr. Liu)

What Threats Loom?

• More pandemics are inevitable due to increased interaction between humans, animals, and the environment.
• Future threats could be viral, bacterial (especially AMR—antimicrobial resistance), or fungal; the systems are not adapting fast enough.
  • “We always fight the last fight when comes a new epidemic and pandemic.” (22:37, Dr. Liu)
• H5N1 (avian flu) is cited as a real, immediate preparedness concern.
  • “I always say that wishful thinking is not a strategy and it’s not an operational plan.” (24:53, Dr. Liu)

7. Climate Crisis as a Health Crisis

• Global warming, pollution, and biodiversity loss compound epidemic risks and food insecurity.
• Prevention remains a “hard sell” because impact is unseen until disaster strikes; solidarity and foresighted thinking are lacking.
  • “My greatest admiration for people who’ve been working all their life in prevention, because you rarely have the spotlight on you.” (29:32, Dr. Liu)

8. Migration: A Survivor’s Narrative

Personal Connection

• Dr. Liu’s family history as Chinese immigrants to Quebec deeply informs her empathy and perspective.
  • “You will never ever be able to prevent parents to dream for future for their children. …There would be no ocean dangerous enough and there would be no wall high enough or no forests perilous enough to prevent them.” (32:29, Dr. Liu)
• Migration is presented as a fundamental human trait, motivated by survival and hope.

Rights-Based Approach in Retreat

• Dr. Liu warns against the dehumanization of migrants and reminds listeners: strict migration controls (“walls”) cannot erase the powerful push factors—drought, war, economic desperation.
• Increasingly, forced displacement (now 120 million globally) is exacerbated by declining development aid.
• She calls for not just maintaining, but expanding commitments to overseas development and humanitarian law, and resisting the normalization of abuses against displaced persons.

9. War, Attacks on Healthcare & the Erosion of International Norms

• The “Bombs” section addresses the deliberate targeting of healthcare in conflicts—this is both a humanitarian and legal failure.
• Dr. Liu recounts the trauma and advocacy after the U.S. destroyed MSF’s Kunduz trauma center in Afghanistan, denounced as a war crime.
  • “Words don’t save always life…but we know that silence may kill.” (45:37, Dr. Liu)
• Despite humanitarian law, recent decades have seen growing impunity in the destruction of civilian infrastructure.
• Meaningful change requires both outrage on the ground and persistent advocacy at the international level—even if international institutions act inconsistently or inadequately.

10. Humanitarian Principles & Operational Contradictions

• Dr. Liu candidly reflects on the internal MSF debate about using the UN Security Council as an advocacy platform, which some see as contradicting principles of independence and neutrality.

11. Final Reflections: Hope, Humanity & Activism

• Dr. Liu’s book ultimately calls for the recognition of our shared humanity and the importance of individual and collective action—drawing inspiration from the HIV/AIDS movement.
  • “If we don’t recognize the humanity in the other person…the person we call ‘other’—I think we are denying our own humanity.” (50:16, Dr. Liu)
• She urges listeners to consider, “What can I do, at my measure?”, emphasizing that change begins at the individual level and multiplies through solidarity.

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Notable Quotes & Memorable Moments

• On the roots of the polycrisis:
  “The security obsession has eroded our mechanisms of solidarity.” (02:44, Dr. Liu)

• On field truth:
  “There’s nothing as real as the truth from the reality and what is happening at ground zero.” (07:30, Dr. Liu)

• On pandemic preparedness:
  “Wishful thinking is not a strategy and it’s not an operational plan.” (24:53, Dr. Liu)

• On the irrepressible force of migration:
  “There would be no ocean dangerous enough and there would be no wall high enough or no forests perilous enough to prevent [parents] dreaming for the future of their children.” (32:29, Dr. Liu)

• On principles and pragmatism:
  “We are speaking the language of the powerful and giving them a free ride of excuses by doing that…” (47:53, Dr. Liu)

• Parting call to action:
  “I profoundly believe that everyone can make a difference. …We need to go back and inspire ourselves from [the HIV/AIDS activist] movement.” (50:16, Dr. Liu)

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Key Timestamps for Essential Segments

• [02:23] – Why Dr. Liu wrote Ebola, Bombs and Migrants; the “era of fear” and evolving crises
• [05:27] – Field realities, interconnectedness, and barriers to joined-up action
• [11:56] – Personal inspiration from literature (Camus, The Plague) and early life path
• [14:42] – Are we ready for the next pandemic? Public memory, trauma, and denial
• [18:15] – Failures of global pandemic policy, vaccines, and intellectual property
• [23:26] – New and old infectious threats: AMR, fungal infections, avian flu (H5N1)
• [27:28] – Climate crisis, denial, food insecurity, and health
• [32:29] – Dr. Liu’s family migration story and the universal drive to move for survival
• [38:02] – Scope and causes of forced displacement, war, and diminishing humanitarian aid
• [41:31] – The weaponization and targeting of health care in modern conflicts
• [45:37] – On silence and advocacy at the UN Security Council
• [50:16] – Final reflections: our “common humanity” and the necessity of grassroots activism

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Tone & Style

• The conversation is passionate, direct, and intensely human—reflecting both urgency and compassion.
• Both host and guest draw on personal experience, literary inspiration, and front-line knowledge.
• Dr. Liu is introspective, yet forceful in her critique of system failures and her insistence on hope through action.

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Conclusion

Dr. Joanne Liu’s insights, rooted in lived frontline experience and deep moral conviction, offer both a sobering assessment of the global polycrisis and a clarion call to personal and collective responsibility. This episode of A Shot in the Arm is essential listening for anyone seeking to understand the tangled challenges of our age—and the solidarity, creativity, and activism required to meet them.

Transcript

[A]

Welcome to A Shot in the Arm podcast. I'm your host, Ben Plumley and this is a podcast about innovation and equity in global health. Well, our guest today, I had a chance to catch up with her earlier this fall, this autumn when we were at the UN General assembly high level meetings and the summit of the future. And she was coming fresh out of a panel on climate pandemics and conflict. And you've heard me talk a lot about that. Well, it's Dr. Joanne Liu. She's a pediatric emergency physician in Montreal, Quebec. Very interestingly, she is also the former international president of Medsas en Frontieres, otherwise known as Doctors Without Borders. She serves on a range of boards, commissions and initiatives, including our host, the Global Listening Project. And she's someone who understands viscerally and the interplay between medical science, politics and the forces that drive us. And she's also released a new book that we're going to talk a bit about. It's in French. Les bola, les bons mes les mi grand. Hopefully it'll be in English soon, but if not, it's a chance for us to get our chops back around our fluency in French. Joanne, welcome to A Shot in the Arm podcast.

[B]

Thank you. Nice, nice to be here.

[A]

And I really appreciate you doing this at, at this time you've just basically come off a, an on call session at the hospital up until about midnight. Right, right. Well, I hope the conversation that we have will be as enthusing to you and our, and our audience, our listeners and viewers as a good strong shot of coffee. So your new book, Lebola les baume est les migrants, we're actually going to cover a lot of the topics today separately and interchangeably. But in my very rough attempt to read it in my genevoir pidgin French, it speaks directly to the poly crises in front of us. And so where are we now? What made you decide you wanted to write this book and what is the message that you're trying to get across to us?

[B]

Thank you very much for the question. And I think that initially when I started to write this book was on maybe a false good idea that it would allow me to digest my six years as international president for San Francis Doctors without borders from 2013 to 2019. And I remember back then when I finished my two mandates, people were asking me how would you summarize your last six years? And I would always say Ebola, bombs and migrants. And so I thought that by doing and writing this book I would allow myself to take a bit of A step back and analyze what happened throughout those six years. But the basic, I would say, premise of this book is I think that since 911 we're living at the what I call the era of fear. And the fear has brought the quest for more security. This security obsession has eroded our mechanisms of solidarity. And in this book I gave three case studies. The Ebola outbreak in West Africa in 2014, 2016, the attacks on hospital with the specific case of the attacks on the trauma center of Kunduz in Afghanistan in 2015, and the migrant crisis.

[A]

You know, it is so funny that you mention 9 11. This was one of the things I was going to come onto later. But as you raise it, much of this deeply resonates and resonates with me. But for me as an AIDS activist, becoming an adult, and I guess we're about the same age, born in the mid-60s, but becoming an adult during the AIDS pandemic. The era of fear started for me when I read a Time magazine article as a young teenager in my school library, realizing that, oh my gosh, this is something that's going to potentially deeply, deeply affect me. But I think you are absolutely right that the mistake we made, or all of us, in assuming that the fall of the Berlin Wall meant what was the truism, the end of history.

Far, far from it. And I guess the other thing that is so interesting about the book and about your thinking more generally is the way you joined the Dalts, because as we said in the introduction, you're a pediatrician, but you led msf, met Saint Sans Frontier for, for, for, in, in two of the. You had two mandates to do that. And I just wonder how you were able, both intellectually and then as a leader to make these connections between violence, between the emergence of pandemics, and then also this sort of mass migration that we are, we're now living in.

[B]

I think it's just because it happens in the field and we're being faced with it. And then we saw that all of a sudden things were coming together and they were amplifying each other to a certain extent. And so we could not take them in an isolated way, but we had to embrace the package together. And so this is what many of us as actor in this ecosystem or struggling with.

And it's a real issue to a certain extent, because especially when we talk about.

Looking for finance for those different project, a lot of people are like only going in one theme and support that, but the reality, everything is interconnected and interdependent. And I think We've seen it very well with the COVID 19, when we realized that you may have a new emerging infectious disease at the other side of the planet. All of a sudden it's reaching out to you and it's basically paralyzing your life, your economy, your livelihood for more than 20 months.

[A]

And yet when you're on the front lines, I can guess that you deal with everything.

All the time. And there's just no, there's no escape from that. I think the problem that we have at the New York and the Geneva level is that we are very, very good at saying, well, actually health, that's a remit of who, coordination around hiv, that's the remit of the joint UN program. And how dare these infectious agents and these health crises.

Try and get in the way of our individual mandates.

But I do think you've had some not insignificant success in smashing down these silos.

What do you put that down to?

[B]

I think that.

I think is the fact that there's nothing as real as.

The truth from the reality and what is happening at ground zero. So you may intellectualize something in Geneva or New York, but at the end of the day, people who are living through the crisis are speaking truth at one point. And I guess that the platform that is msf, Doctors Without Borders, as I would say, the strength, the intellectual and financial independence to speak up the truth. And not everybody has this kind of latitude in this ecosystem of what is the aid sector nowadays.

[A]

And of course, you know, the overseas development sector is seeing such a decline in funding right across the board that we have got to be creative.

The launch of the book, it was published at the beginning of October in French, released in Canada. How is it going? What's the reaction? You've seen to it.

[B]

It's quite interesting because it's much more popular than expected.

So it's very humbling to see that people are curious, people want to understand. They find it fascinating, the link that I'm making, But as well, people are quite aware that we are entering and we have been entered that phase of poly crisis. And they understand that those transnational challenges, some people call them threats, some people call them challenges, some people call it crisis, but nevertheless, those transnational.

I would say challenges are asking us to somehow come together. And it's going to be difficult because we are as well facing, I would say.

A dynamic of more polarization and more opposition. So it's quite, I would say.

Concerning, not concerning, but I think, I think it's quite destabilizing this moment right now and then we're going to need to figure it out some new path, I would say. And I think one of the key thing about figuring out new path is as well, who's going to be around the table to talk about those things. And I always say, and then it's an old thing that everybody say the favorite definition of insanity is to keep doing the same thing and hoping for different results. So when are we going to learn from that and when are we going to go and reach out to different sort of entity and party and voices and improbable, what I call marriage of partnership to find new path of solution.

And I think this book is as well a tribute to that and it.

[A]

Couldn'T come at a more opportune time given everything that is happening in so called western liberal democracies. Right. But that perhaps is for a conversation at another time once we've truly digested what happened in the United States presidential election.

So just before getting onto the components.

Of the book of the Poly Crises, as I was doing my research on you, I came across a wonderful quote you gave to a journalist that growing up in a large family in Canada, your parents ran, I believe, quite a successful Chinese restaurant. But you had a desire, you had a passion from a very, very early age, truly to be a Doctor Without Borders. And I just got to ask, you know, now you've had an extensive, very successful career, hugely impactful. Has it lived up to the young Joanne's expectations?

[B]

That's so interesting as a question. It's true. Since teenage time, I've been wanting to be what we call a Doctors Without Borders. And it's because I read book, and I read a book of a surgeon who went overseas and worked for Doctors Without Borders, msf and I thought it was like really meaningful and as well really cool. So the young Joanne said, whoa, wow, that's amazing. Got to do that. But back then I didn't know that it meant that I would need to become a doctor, which was another, another challenge in itself. But that being said, I read as well another book and it's one of my favorite book that, that I reread during the Ebola outbreak, but during the COVID 19, which is the play from Albert Camus. And one of the things that really struck with me about that book is at one point the protagonist, Dr. Rier is being asked, but what keeps you, what motivates you? Why do you keep going on is that your patients are dying, you have nothing to offer them. And then the person who's asking the question is adding, you don't even believe in God, so why do you keep going at it? Why do you keep caring for people? And the doctor just answered, I never got used to death. I don't know more. And I remember very clearly in my teenage head to promise myself that I will engage my professional life for life. And this is how I became a physician.

[A]

It touches my heart to hear you refer and be inspired.

By Albert Camus, who terrific writer. And I strongly recommend everyone to read both the Plague, the Pestilence, and of course, the Outsider. Gives a really interesting perspective on what drives and what doesn't drive us. And I'd love to come back to literature later in the podcast, if I may, but perhaps we move now onto the first of these crises that form the polycrisis, the pandemics. And.

I guess we've come out of COVID.

How prepared do you think we are for the next one?

And indeed the existing ones? Because not just Covid, you know, we have the. We have the old friends and family amongst us. Hiv, TB and malaria, amongst others.

[B]

Yeah. I think what is interesting is that I think that generally speaking, the general public, I think, is much more aware. You will have asked.

A citizen in the street in 2019, what is the role of public health? And it will have probably a blank face. Not sure.

I think today everybody got a bit of an idea of what public health is doing for them. But so that awareness is there. But what is as well there, I do find in the general public, is this collective trauma. And that collective trauma is a bit of an enemy because people do not want to go back there, People don't want to revisit what happened. And people are a bit in a denial mindset right now about the possible threat of a new pandemic, the current threat of pandemic.

And the fact as well, to go and revisit and making sure that we're going to learn the lesson that we need to learn. It's not surprising when you look at history.

I learned that from someone from Cambridge who just said, was studying famine, which is basically a crisis that goes across all the layers of society. And it takes years for people to revisit those events because it's such a trauma. So I think that we need to be aware how much of a trauma it's been, how much people are pushing back, how much people are having what I call a precipitation to collective amnesia. They want to forget, they want to move on, and they want to pretend that we'll not come back. So are we better prepared. I think few people are more prepared. Many are much more aware, but a lot of people just don't want to think about it.

[A]

I, again, love that you used the word amnesia. I think of it as a willful amnesia. I've been really interested in understanding what happened in the roaring twenties around the world after the 1918 flu. And that really was as bad, if not worse than Covid in many regards. And it wasn't just that people thought, okay, that's done, we want to get on with it. They had really internalized the trauma and made, I think, collectively, a willful decision that we're going to move, going to move on.

There's also something odd, I think, about our language. It's true, I think, for French as well as English, that we are terrific in saying response, but when we talk about pandemic preparedness, our language gets a bit clunky. It's as if we don't really even want to invest time and effort in thinking about what potential scenarios we need to get on top of. Listen to me, I can't even describe it effectively myself. As you've been working with some of the international panels on the lessons learned from COVID.

Are you seeing that people, experts in this instance, are becoming more focused on what needs to be done next, rather than a sort of a reactive, what did we do well? What did we do less? Well.

[B]

I think there's some different parts and bits in the world we're trying to get prepared. But I think that the biggest disappointment that I have, it's about the pandemic treaty and the fact that we're not able to get our act together, to have something that is meaningful and that you can operationalize, to make a difference in terms of inequity, in just to say, for example, access to what we call the medical countermeasure, meaning the vaccines or the treatment or the rapid diagnostic test for a new emerging infectious disease. So this is where I have huge disappointment on the fact that as well, we know that we would need to invest a few billions dollars to save trillions and trillions of dollars down the road if we were to have another kind of event like this. But people say, well, come on, Joanne, it's a one event in a century. Why should I bother about that knowing that there's so many other urgent files to address? And so it's a very, very hard sell.

So this is why I can hear that.

And I sort of have some sort of.

Sympathy for that on the other end. Then what does prevent you to allow some of the low and middle income country then to access the, the know how, the recipes, how to make those different countermeasure. Why then do you block if you're not planning to, to work and prepare and, and, and prepare for everybody. Why don't you let at least those people to have at least the path open and not block to do that? And at this moment I'm speaking, we're.

[A]

Not there yet.

Not even close are we. And in many ways the.

Vaccine populism, nationalism, negativity has been reinforced more than ever. And you look at companies like Afrigen and I had a chance to talk with Petro Terblanche when we were in New York. I mean really fighting the good fight. But damn it, why isn't the world throwing every resource at her and her team to build capacity when it's going to be needed.

As well as sort of getting our heads around what we need to do?

You know, the idea that this, oh, this is once in a hundred years. Well, no, we know from hiv, we know from everything that's going on in the one health or, or planetary health discipline that you know, humans and animals are more closely interacting than ever before. We'll come on to climate in a minute. But there are all sorts of nasty infectious bugs just waiting around the corner. And I just wonder, not to be too.

Dramatic about it, which ones are you concerned about? Are there any that stand out to you as we've really got to get our heads around this?

[B]

About what? A particular.

Virus or.

[A]

A virus, fungal infection, bacterial? What's the next pandemic that you're afraid of? What's the agent that's going to cause that pandemic that you're afraid of?

[B]

I don't think I have that knowledge unfortunately to tell you in a very precise way. What I'm concerned about is the fact that the medium of the disease might not be what we had before. And I think that we'll be ill prepared because we're going to do some cotton paste, let's say for example, that if it was water based or it's just we got that we still haven't got our head around aerosol and droplets to a certain extent and how to manage that. But the thing is, I think that we, like everybody says, we always fight the last fight when comes a new epidemic and pandemic.

So.

I'm convinced that there's going to be more because of the decline in biodiversity and the pressure that a human being is doing on the environment. And so I think that yes, for sure.

A new emerging infectious disease that will be a virus. But I think fungal infection is a real concern. AMR is everywhere. I sit in the hospital on a daily basis. We used to treat upper urinary tract infection. Sorry, urinary tract infection with one day or three days of antibiotic in the past. Now sometimes it's IV for three weeks. So we see that things are changing but, but we haven't adapt our way of doing right now amr, in this.

[A]

Instant being antimicrobial resistance.

[B]

Yes.

[A]

The fact that our antibacterials are just not, not performing as they did because the, the bacteria are getting resistance.

[B]

Yeah, they're getting, they're getting used to.

[A]

Fight and of course that's an issue that's broader than just human health. Of course, the, the extensive use of antibacterials in, in agriculture and in animal husbandry. Yeah.

Okay, what about avian flu? What about H5N1? Because we've begun to see some potential human to human transmission in the United States. But of course the US being the US it's up to the individual states in the first instance to decide how they monitor or not.

Are we perhaps being a little too.

Lazy in, in thinking, well, we're not seeing these massive infections and is that potentially a risk coming from the fact that there is no centralized or overall.

Pandemic preparedness surveillance tool? How scared are you about H5N1?

[B]

I think.

I'm seriously scared for sure. And I think this speaks to the fact that as far as I'm concerned for what is going on right now in the States and possibly in Canada very soon is. I always say that wishful thinking is not a strategy and it's not an operational plan. And then this is what we've been doing about epidemic and pandemic. Generally speaking, people think that things kind of worked out. Oh come on. We are like a developed country, a high income country. We're going to wing it, we're going to do it. Well, it just doesn't work like this. And so it could be H5N1, but it could be something else. But the reality is.

When you look at organization that we call it highly responding in a way, organization.

The reason why they are highly performing is they never take an incident as if it's a random event and that you will overlook. They go thoroughly through it and they make sure that it's fixed. This is what happened with the Challenger many decades ago is we didn't go to the bottom of a little event. And, and to do that it means a bit of an obsessive.

Behavior and mind. And I don't think that we have that kind of energy, that kind of money to finance that kind of energy and that interest either at this stage yet possibly. But for me this is why I'm not able to. I can say it can be H5N1 but it can be anything else. But the reality is we often overlook. We think that goodwill would be there and we think that wishful thinking is preparedness. It's not.

[A]

And I just add to that that we could always wing it and.

HIV and SARS COV2 proved that we can't. You mentioned fungal infections and your concern about that. I'm thinking about friend of the pods, Tony Fauci, who wrote this extraordinary article in the fall about how he was infected with West Nile virus as he was in his garden in Washington D.C. and how that completely knocked him out and made him re evaluate both his individual life, but also what happens next, what he's going to do as an eight year old when he grows up.

It sort of gets us on to the climate conversation.

And how the climate crisis that we are living in is also going to have an impact on pandemics. And I wonder, do you think that we're still in such a level of denial about climate that we are not.

Even willing to start thinking about what new diseases? No, not new diseases. Old diseases we're going to have to face anew West Nile Zika oh, absolutely.

[B]

I think that we.

I'm just being fascinated by the human being and.

Is strength to an to basically box himself or herself.

In denial and just try to carry on as if nothing is happening. I think that needs quite a talent. But this is where we are right now and we're facing what we call a triple environmental issue. The global warming, the level of pollution and the decline of biodiversity. And each of those three elements is feeding each other and amplifying each other and it has an impact on the general health of many, many, many human being.

But we always said anyone who have work in prevention know how much of a hard sell it is Prevention. It's, it's a hard sell because if you don't see the impact then you don't see the urgency to act.

And people and I gave.

My greatest admiration for people who've been working all their life in Prevention because my God, they're a big fighter. You really have to believe in it because you rarely have I would say the spotlight on your saying it just people go to the next crisis. It's like the wildfires we have in Canada right now, it's everywhere. It's really destroying livelihood of thousands of families.

But people don't put the things together.

[A]

No, absolutely. And.

You mentioned earlier famine and the impact of not having access to enough food, adequate food, that's clearly an impact of the climate disruption. And I guess that gets us onto one of the other crises that you mentioned, the migrants, Les Migrems. And.

I've got all sorts of thoughts about that, particularly coming out of this last US election and what a rights based approach has to be around that. But your thoughts on your time at MSF and what it means for the way in which, moving forward we handle, which will be a much greater.

Demand on our economies, our societies.

[B]

Migrants. I always say.

Straight from the beginning that I'm biased on the topic.

So that the listener are aware. I am biased because I'm the product of migration and I am biased because my parents came from China and way back. Just to come back to the beginning of our conversation in the 50s, when you were coming to Canada, you had two choices. You were Chinese, you open a restaurant or landroomat. My parents opened a restaurant and they opened it in Quebec City because my father, with my two uncles said, we think there's going to be more opportunity. And I think they were right because it was a thriving restaurant and this restaurant is still on business right now. So.

I'm the one, and I often say.

I'm the one who's been privileged to live the Canadian dream of going to a country where my parents had opportunities, although they didn't have any education when they arrived, and only the desire to work, the desire to give a future for their children, that was their drive and they were successful. And so.

My bias and my strong belief is you will never ever be able to prevent parents to dream for future for their children. There would be no ocean dangerous enough and there would be no wall high enough or no forests perilous enough to prevent them of dreaming for future for their children. And people will just do it.

And since the beginning of the times, the human being is a migrant animal. It moves where it has resources, it moves where it has future.

That's the way it is. So I think we need to embrace that very small thing that is, I find, universal. Human being is a survivor. He's going to do everything to survive and he would put his life at risk for that. Nobody does that for fun. It's more.

Than it's visceral.

It'S a surviving skills. And this is why I Call migrants survivors. And there's no good or bad migrants. There are only people who are either living for future or living for their life. And it's, it's. And you're not bad or wrong about that. It's just the reality. And I think and what as you said about being right based, it's not because you left your country for different reasons that all of a sudden you are subhuman and you don't have rights to protection or rights to access to care or rights, the very basic rights of dignity. And I do find what I'm very, very concerned about and I completely understand that we country cannot be open bar and there needs to be rules and there needs to be. And that's the reason why we had the global come back about having a predictable, orderly and safe migration flow. That was the reason because we know it will happen so we may as well try to make it in an orderly way.

So yes, that's my thing about migrant is the fact that I think we have a responsibility to talk about people who are looking for future, to talk about them with dignity and not dehumanize them. Because once you've demonized a group of people, you leave a boulevard for abusers. And we've seen it and our history proves that the human being is able to do that.

[A]

That's hugely impactful. It's sort of ah, really touches me deeply, Joanne. I mean listen to me. I'm an American with an American passport, but not with an American accent. I too am a migrant from the United Kingdom. And my late mother used to say, you've shamed us all. You are the first Plumlee to migrate to the United States. Well that's not true actually. There are generations and generations of us going back I'm afraid, even to the, the Mayflower. And yet the experience that us whiteies have of being migrants, well we're not migrants, we're settlers, aren't we? We view this in a very, very different way and it, it disturbs me so, so profoundly.

But I do wonder.

Particularly as it seems that the right based approach.

Across so many things is sort of in retreat at the moment that we have to rethink elements of our strategy around migration. And I think it goes right to the heart of our commitment to overseas development.

It's no surprise that our funding is decreasing. It's no surprise that we're investing in walls and stopping small boats from getting across the English Channel.

When we're not thinking about well what do we do to help people not have to leave their homes. Because sure, we're wired as migrants right from our pre eternal DNA, but we're also primed to create homes, to create safety, to create families, and if we are able collectively in solidarity to ensure that folk in the Democratic Republic of Congo, in Sudan, in Afghanistan, one of the greatest.

Tragedies and failures I think of the Western world, we should be focused as much if not more so than building walls and protections for us, for people coming in. But we should really be investing in making sure that as a solidarity.

A common humanity, we make sure that people can be safe, comfortable and secure where they live.

[B]

Yeah, absolutely. And I couldn't agree more. And I think that.

Right now, enforced displacement, there's 120 million people across the globe. And the reality is the push factors are there. And then we've discussed can be drought, it can be war, it can be economy.

So if we have declining ODA as we have everywhere, more or less so overseas developmental aid budget, of course it will not help. So the push factor will remain. But one of the things on which we may have a say on, because we might not have much.

To lever.

To a certain extent about a drought or something like this, but I think on war and the way we wage war, I think somehow we may have a say. And if we allow wars to happen without limits, where all of a sudden what we've seen over the last few years, if not decades, the laissez aller of observation and respect of.

International humanitarian law and making almost like a known event when you are targeting civilians or civilian infrastructure, no wonder people are going to leave. If you don't spare the civilians in a war and you allow wars to be waged without limit, well, the human being's gonna flee. It's just, it's, it's, it's, it's, it's, it's basic survival skills. You're gonna flee unless you are prevented of fleeing, which is another business. But just this to say that, that I think that, that if we don't restore some sort of minimal, at least to that particular subset of people fleeing, it's going to be hard. And we all know that over the last few.

Years.

The Middle east has been.

The center of many conflicts. And in countries who don't have, I would say.

The means as much as we have here in the Northern Hemisphere. I've welcomed millions of refugees.

And why? Because it's always the same thing. Refugees always hope they're going to go back home. So the 80% of the refugees are really around.

A country, a neighboring country, of the country they fled because their hope is to go back.

[A]

Which sort of gets us onto the final component of the poly crisis, Les bombes, the bombs, violence. And, you know, I've been one of a number of commentators, and we've been corrected. I fully accept that. Who in recent years have made the comment that it's something new, that health is now being targeted and being used as a weapon of war from, you know, we saw it in Ukraine with the targeting of health facilities.

We've obviously seen it in the Middle east, in Gaza, Palestine and the Lebanon.

[B]

In Syria.

[A]

And Syria. Absolutely in Syria.

And yet people like you have actually been pointing to the fact that in a sense, this is not new. And you mentioned Afghanistan and this was something. A few years ago, you got into quite a controversy over the United States destroyed a facility of medicines Sans Frontieres, Doctors Without Borders. And your fury at your righteous indignation went as far as calling it a war crime. And I guess.

You know, we don't need to get into the details of that unless you'd like to. But it's more, I think, the question of.

You know, ladies and gentlemen, civilians, their food, their resources, their infrastructure, their health have always been targets of war. And since the end of the Second World War, we made some success, I suppose, in limiting the impact of that. But not really.

[B]

Well.

Yes, not really. The thing is, it's quite interesting because I do think that when you look at history, I'm not a historian, and I'm saying that in a very, I would say, humble way, but when we look at the Post World War II, we had the feeling that right after that we're entering this era of humanitarian, I would say, spirit and collaboration. And this is where the without border movement started. MSF was created in 1971, and we were there, and there was some sort of a common understanding about different things. But the reality is, yes, civilization, civilians, never been.

Absolutely spared, but we were trying to follow some sort of rule of war.

And we tried to save what we call this humanitarian space where we are trying to spare the civilians, we are trying to spare.

The civilian infrastructure, which means the school, the hospital, the market.

And what we call the civilian neighborhood. But it seems today that in a decomplexified way, it's happening.

In full impunity. And at the very least.

It'S important to talk about it because a lot of people are saying, well, it's free for all. Everything happens. Well, people don't like to be named in shame, regardless who you are. So I still think that we should not let.

Currently people to get away with murder. We should name them and put them in front of what they're doing. And that was part of the exercise.

With the attack on Kunto's hospital trauma center was to to just say it happened, let's go at the bottom of this. And then we end up being one of the artisans with RCRC and with the elected member of the UN Security Council back then to put a resolution called 2286 on the protection of the medical mission in conflict time. And there was nothing much, much new, but it was to reiterate the world rules of war. And then by doing that, and we all know that words don't save always life. And as we said when we received the Peace Nobel Prize, but we know that silence may kill. So we thought that it was worth it to bring into that level of that security platform and make it a topic, a security topic for the rest of the world. And by doing that, it was at least allowing that full impunity when it was happening. So that was a bit the reason that drove us back then.

And as we see now, we can tell that words are not saving lives.

[A]

But silence absolutely kills, to borrow the old Act UP phrase.

There's something in what you've said there, and I don't know if it is a contradiction. Maybe it's just you joining and sewing yourself through the fabric of human existence, but an atrocity that happened on the front lines where all the action happens, where you understand how all of these different pieces fit together. But righteous anger and retribution has to happen at the international level. And so you mentioned the UN Security Council. There we are back in New York as some years later you and I were in September. So there's no escaping the fact that notwithstanding the importance of the front line, you are also looking at the, the role of international institutions, international law to speak truth to power. Do you see that as a sort of a logical flow or do you see, I don't know, are there elements of contradiction for yourself in that?

[B]

That's a very good question. And in the book, and hoping I'm going to find an English publisher eventually for this book, did I talk about that? And I talk about the fact that we were quite internally divided about going or not going to the UN Security Council because a few of our members, and rightly so, said we are speaking the language of the powerful and then we are giving them basically.

I would say a free ride of excuses by doing that, but not operationalizing it and not implementing it. And so I Think there's a contradiction in that for sure.

So this is why as well. And some people in the movement are wondering about those humanitarian principle about neutrality, independence and partiality, using them as a protection shield for humanitarian.

And some. And then I'm paying tribute to Ronnie Brahman with an emblematic character in the United AIDS sector, especially for MSF Doctors Without Borders, but is saying yes, they have a utility, but it's more like an opportunistic utility to a certain extent because if you are using that as your sole protection and you are not thinking through your security and your operation, you might be in for some deception and some security issue. And I, I agree with him most of the time I would not articulate things like him, but I think that he's raising some real contradiction in ourselves.

[A]

What a level of confidence and self awareness that the institution and the leaders of the institution can have, that reflection.

That'S so unlike so many other aspects of, of human existence at the moment. It's my way or the highway. I'm right, you're wrong. Well look, we're coming up to the top of the hour. Joanne and.

I just wonder if there are things that we've missed. I know there's a whole lot of other topics I would love to have covered with you and maybe I can put a request in for us to do a part two at some point in the not too distant future. But is there anything that we've missed? Anything that you think our viewers and listeners would, would really need to know right now.

[B]

Just to, to. To buckle up? The buckle of the first question is, is the book is why did I write this book and why I'm still speaking up nowadays is the fact that.

That book is a call for our common humanity. I think that if we don't recognize the humanity in the other person, the person we call other, I think we are denying our own humanity. And so I profoundly believe that everyone can make a difference. You don't need to be at the front line of crisis to make a difference. But I think that as things are getting more tense and the dynamic is more polarized, I truly believe that we need to ask ourselves individually what can I do at my measure? And I'm profoundly convinced that the transnational challenges we're facing.

A good part of the solution will come from individual who will come together and make a difference. And I think we need to go back you as an activist of the HIV AIDS time to go back and inspire ourselves from that movement because it came from the people who were being affected and it just decided to get together and move on together.

[A]

Well, that's a sobering but rousing call to action that I think all of us need.

Dr. Joanne Louve, thank you so much. We'll have the links to the book.

Le Beau La Bomme Elle Est Miron, which is available in all good bookstores and online, and I do hope an English version.

Can be produced and developed and you can guarantee you have our support in any way we can to advocate for that. I think it's a really, really important message that all of us have to read and hear. Joanne, you are a Shot in the Arm. Thank you so much.

[B]

Thank you so much, Jeremy.

[A]

Well, that's it for this episode. Thank you so much to Dr. Joanne Liu. Again, you can find her book in French, lebola Les Bommes et Les et Les Mi grand on all good book platforms. A big thanks to the Shot in the Arm team for getting this episode done, to our director and producer, Eric Aspera of newsdoc Media, our assistant producer, Waisha Rafael, and a big thanks to you. Don't forget to subscribe and give us five stars wherever you consume your podcast past content. Have a great week and a safe week, everybody.